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Mentalization Based Treatment For Personality D... |LINK|



Mentalization-based therapy shares common elements and techniques with psychodynamic, cognitive-behavioral, systemic, dialectical behavior, and social-ecological therapies. MBT practitioners work to create a safe environment in which patients can begin a deep exploration of their own feelings and those of others, ultimately developing their capacity for mentalization. The health professional is very much focused on the client's present and not so much on the past




Mentalization Based Treatment for Personality D...



Dialectical behavior therapy (DBT) is based in behaviorism, mindfulness, and the investigation of self, and mentalization-based therapy is based in psychoanalysis, attachment theory, and acceptance, among others. Both can be useful modalities.


There have been studies conducted on mentalization for borderline personality disorder, with participants showing improvement in depressive symptoms, a decrease in suicidality and self-mutilation, and better social and interpersonal functioning, among other outcomes. Session frequency can differ but some therapists recommend two sessions a week both one-on-one with a mental health professional as well as group treatment; these sessions can last for 12 to 18 months or more.


Look for a licensed, experienced mental health professional with an understanding of borderline personality disorder, and some training and experience in mentalization-based interventions. In addition to finding someone with the appropriate educational background and relevant experience, look for a therapist with whom you feel comfortable working on personal, family, and relationship matters.


While MBT and Dialectical Behavior Therapy (DBT) are both effective at treating borderline personality disorder and have similar roots in CBT and goals of emotional regulation, there are some key differences between the two treatments.


Antisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD.


This paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components.


This study tests the hypothesis that patients with comorbid BPD and ASPD receiving outpatient MBT would be more likely to show improvements in symptoms related to aggression than those offered an outpatient structured protocol of similar intensity but excluding MBT components. This comorbid population was selected for pragmatic reasons, as a subsample of a trial originally designed to compare MBT to Structured Clinical Management (SCM) in a sample of consecutive referrals to a personality disorder unit that specialises in BPD [49]. At the time of the original trial, MBT had not yet been indicated for ASPD and the trial was not designed with this diagnosis in mind. Nevertheless, our original design allows us to measure change in important psychological features directly related to characteristics of ASPD such as anger, hostility, impulsivity (as reflected in self-harm and suicide) and difficulty in relaxing interpersonal control related to loss of dignity, self-worth and self-respect [54]. Mood disorders, particularly anxiety and depression, are known to co-occur with ASPD [9, 55, 56] and to be frequent triggers for aggression [57, 58]. The trial design also enabled us to test whether MBT may be effective in reducing negative affect states, particularly depression and anxiety. Finally, the study design enabled us to measure change due to treatment in common consequences of aggression, such as psychiatric symptoms including quality of familial and social relationships, and subjective wellbeing.


An outpatient SCM protocol was developed through the Barnet, Enfield and Haringey Mental Health NHS Trust to reflect best generic practice for personality disorder offered by non-specialist practitioners within UK psychiatric services. Weekly individual and group sessions were offered, with appointments every 3 months for psychiatric review. Therapy was based on a counselling model closest to a supportive approach with case management, advocacy support, and problem-oriented psychotherapeutic interventions; the treatment model has been manualised [59].


People with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment.


Psychotherapy for borderline personality disorder is often lengthy and resource-intensive. However, the current length of outpatient treatments is arbitrary and based on trials that never tested if the treatment intensity could be reduced. As a result, there is insufficient evidence to inform the decision between short-term and long-term psychotherapy for borderline personality disorder. Mentalization-based therapy is one treatment option for borderline personality disorder and consists traditionally of an 18-month treatment program.


This trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder.


Borderline personality disorder is a psychiatric condition characterized by a pervasive pattern of symptoms such as interpersonal conflicts, identity diffusion, impulsivity, and emotional dysregulation [1]. According to epidemiological studies, 1.6% of the general population suffer from borderline personality disorder [2]. In clinical populations, it is the most common personality disorder [2], with a prevalence of between 9% and 22% of all psychiatric outpatients [3,4,5]. Borderline personality disorder is associated with high levels of psychiatric comorbidity, particularly depression, anxiety disorders, eating disorders, substance abuse [6,7,8], and other personality disorders [9]. Together, these findings emphasize the need for the development of efficacious and cost-effective treatments for this severe and highly prevalent disorder.


However, while intensive outpatient MBT currently has empirical support as an 18-month program for borderline personality disorder, evidence that this is the optimal length of the intervention is not available. Consequently, MBT is now offered for different lengths of time (both shorter and longer) in outpatient settings around the world [14]. Various other short-term psychotherapies for borderline personality disorder have already been developed and tested in randomized clinical trials, e.g., emotion regulation group therapy [24], systems training for emotional predictability and problem-solving [25, 26], and brief dialectical behavior therapy skills training [27]. However, all the trials have either compared a short-term experimental group to a short-term control group or tested the short-term treatment as an adjunctive to treatment as usual. Thus, these trials do not provide guidance on evidence-based decisions regarding the optimal length of treatment for borderline patients. In addition, no empirical evidence is available to identify which subtypes of patients would benefit from short-term treatment and which would require more intensive treatment [28].


Participants who are receiving psychotropic treatment will be allowed to continue their medical treatment while participating in the trial. The medical protocol will follow national as well as international medical recommendations for the treatment of borderline personality disorder and comorbid disorders [39, 41]. Psychiatrists or attending physicians at the clinic will assess the need for additional psychotropic treatment and are asked to adhere to the guidelines. All participants, regardless of treatment condition, will be asked about their current medication by trial personnel during trial interviews to allow us to measure any potential differences in the use of psychotropic medication between the groups.


The primary outcome is the severity of borderline symptomatology assessed with the ZAN-BPD [38], which is a clinician-administered scale for the assessment of change in borderline psychopathology over time. Each of the nine borderline personality disorder criteria are rated on a 0 to 4 anchored scale reflecting the severity of symptoms. The rating is intended to reflect both the frequency and the severity of borderline psychopathology. The interview provides a total score of borderline psychopathology ranging from 0 to 36. ZAN-BPD will be assessed by investigators blind to treatment allocation at baseline, and at the 8-, 16-, and 24-month follow-ups. We will video-record interviews to allow an assessment of inter-rater reliability based on the intraclass correlation coefficient. The results will be evaluated using the guidelines provided by Cicchetti [45].


This trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term MBT for outpatients with subthreshold or diagnosed borderline personality disorder. To the best of our knowledge, short-term MBT has never been tested before. Gaining more information on how different lengths of treatment work for specific subtypes of patients may help to minimize the potential burden from long-term psychotherapy for some, while at the same time it may identify subtypes of patients for whom short-term psychotherapy is contraindicated. This knowledge may enhance the cost-effectiveness of treatment options for borderline personality disorder. Further, this trial may provide information on the potential predictors and mediators of treatment response. 041b061a72


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