Comparing Short- and Long-Term Group Therapy: Seven-Year Follow-Up of a Randomized Clinical Trial

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

Objective

Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.

Method

An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.

Results

Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.

Conclusion

Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

Mentalization as Mediator between Adult Attachment and Interpersonal Distress

BACKGROUND

The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems.

METHODS

The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model.

RESULTS

The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects.

CONCLUSION

We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.

Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders

Objectives

Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow‐up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress.

Method

 We analyzed time‐series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital.

Results

Patterns of correlations were stable from admission to the hospital until follow‐up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time.

Conclusion

Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.