1
|
Juul S, Jakobsen JC, Hestbaek E, Kamp CB, Olsen MH, Rishede M, Frandsen FW, Bo S, Poulsen S, Sørensen P, Bateman A, Simonsen S. Response to Philips et al.: Several Fundamental Misconceptions about Evidence-Based Practice. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024:1-2. [PMID: 39236700 DOI: 10.1159/000540903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Emilie Hestbaek
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Barkholt Kamp
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marie Rishede
- Department of Psychiatry Mental Health Services East, Region Zealand, Roskilde, Denmark
| | - Frederik Weischer Frandsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Anthony Bateman
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Choi-Kain LW, Murray GE, Jurist J, Ren B, Germine L. Online psychoeducation and digital assessments as a first step of treatment for borderline personality disorder: A protocol for a pilot randomized controlled trial. PLoS One 2023; 18:e0294331. [PMID: 38060545 PMCID: PMC10703320 DOI: 10.1371/journal.pone.0294331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Treatment trials for borderline personality disorder (BPD) have consistently demonstrated that approaches that are diagnostically tailored are superior to those which are not. Currently, gold standard treatments for BPD are highly intensive, lengthy, and specialized, leading to a critical gap between the supply and demand of effective, evidence-based treatment for patients who receive a diagnosis of BPD. Psychoeducation, which is a common component of most treatments known to be effective, is a low-cost, low-burden intervention proven to relieve symptoms. The present study builds on psychoeducation research, assessing online video prescriptions as a means of disseminating information patients need to know about their diagnosis and care. METHODS This article presents the study protocol for a safety, feasibility, and preliminary efficacy trial of psychoeducational video prescriptions and online assessment with feedback for newly diagnosed individuals with BPD. We aim to recruit 100 adults recently diagnosed with BPD to be randomly assigned to receive videos about BPD or videos about non-BPD mental health topics that are matched in length in the first step of the study. All participants will complete daily surveys about their emotions, interpersonal interactions, and behaviors, as well as self-report assessments and cognitive tests at 4 different time points. Half of the participants in the intervention group will receive feedback on their symptom ratings and cognitive test performance to assess whether there is incremental value in tailoring this online set of interventions with individualized feedback unique to each participant. This study aims to assess the effects of BPD-focused psychoeducational videos with and without personalized feedback, on BPD and depressive symptom severity as well as core mechanisms of the disorder such as loneliness, rejection sensitivity, cognitive control difficulties, and self-clarity. Results will inform efforts to progress to a larger, more definitive trial. TRIAL REGISTRATION Clinical trials registration: The protocol is registered with ClinicalTrials.gov NCT05358925.
Collapse
Affiliation(s)
- Lois W. Choi-Kain
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Grace E. Murray
- Boston University, Boston, Massachusetts, United States of America
| | - Julia Jurist
- McLean Hospital, Belmont, Massachusetts, United States of America
| | - Boyu Ren
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Laura Germine
- McLean Hospital, Belmont, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
3
|
Juul S, Jakobsen JC, Hestbaek E, Jørgensen CK, Olsen MH, Rishede M, Frandsen FW, Bo S, Lunn S, Poulsen S, Sørensen P, Bateman A, Simonsen S. Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT). PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:329-339. [PMID: 37935133 PMCID: PMC10716869 DOI: 10.1159/000534289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/21/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT. OBJECTIVE The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD. METHODS Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037. RESULTS Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056). CONCLUSION Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.
Collapse
Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Emilie Hestbaek
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Rishede
- Department of Psychiatry Mental Health Services East, Region Zealand, Roskilde, Denmark
| | - Frederik Weischer Frandsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychiatry Mental Health Services East, Region Zealand, Roskilde, Denmark
| | - Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Anthony Bateman
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Riedl D, Rothmund MS, Grote V, Fischer MJ, Kampling H, Kruse J, Nolte T, Labek K, Lampe A. Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study. Front Psychiatry 2023; 14:1150422. [PMID: 37252135 PMCID: PMC10213326 DOI: 10.3389/fpsyt.2023.1150422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Inpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation. Methods In this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress. Results A total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from β = 0.69 to β = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (β = 0.42, 0.18-0.28; p < 0.001) and epistemic credulity (β = 0.19, 0.29-0.38; p < 0.001) and increases in epistemic trust (β = 0.42, 0.18-0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000). Conclusion Mentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.
Collapse
Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Sophie Rothmund
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Tobias Nolte
- Anna Freud National Center for Children and Families, London, United Kingdom
- Research Department for Clinical, Educational and Heath Psychology, University College London, London, United Kingdom
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center, Schruns, Austria
| |
Collapse
|
5
|
Riedl D, Kampling H, Nolte T, Lampe A, Beutel ME, Brähler E, Kruse J. Measuring Impairments of Mentalization with the 15-Item Mentalization Questionnaire (MZQ) and Introducing the MZQ-6 Short Scale: Reliability, Validity and Norm Values Based on a Representative Sample of the German Population. Diagnostics (Basel) 2022; 13:135. [PMID: 36611427 PMCID: PMC9818984 DOI: 10.3390/diagnostics13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
Deficits in mentalization are indicated by impaired emotional awareness and self-reflectiveness, and are associated with various mental disorders. However, there is a lack of validated research instruments. In this study, the psychometric properties of the Mentalization Questionnaire (MZQ) were evaluated in a representative German population sample with n = 2487 participants. Analyses included evaluation of the MZQs acceptance, reliability, and validity. Factorial validity was established with exploratory (EFA) and confirmatory factor analyses (CFA) after the dataset was randomly split. Dimensionality was evaluated with a bi-factor model. For convergent validity, correlations with the OPD SQS, PHQ-4, and POMS were calculated. While acceptance was good, internal consistencies (ω = 0.65-0.79) and factor structure of the original four subscales were not acceptable (TLI = 0.87, CFI = 0.91, RMSEA = 0.071). EFA indicated a 3-factor solution, which was not confirmed by CFA (TLI = 0.89, CFI = 0.91, RMSEA = 0.073). Correlations between subscales and bi-factor analyses indicated an underlying general factor (TLI = 0.94, CFI = 0.96, RMSEA = 0.053). A shortened 6-item version was comparable to the original scale. Age and sex-specific representative norm-values are presented. The MZQ is a feasible, reliable and valid self-report instrument to measure representations of inner mental states. However, when applied to non-clinical samples, the total score of the MZQ should be used.
Collapse
Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Tobias Nolte
- Wellcome Department of Imaging Neuroscience, University College London, London WC1N 3AR, UK
- Anna Freud National Centre for Children and Families, London N1 9JH, UK
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
- VAMED Rehabilitation Center, 6780 Schruns, Austria
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, 35390 Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, 35037 Marburg, Germany
| |
Collapse
|
6
|
Hestbæk E, Hasselby-Andersen M, Juul S, Beier N, Simonsen S. Mentalizing the patient-Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study. Front Psychiatry 2022; 13:1088872. [PMID: 36620679 PMCID: PMC9815536 DOI: 10.3389/fpsyt.2022.1088872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Mentalization-based therapy (MBT) is an evidence-supported psychotherapy approach for borderline personality disorder (BPD) that has been implemented in mental health services worldwide. Originally, MBT was developed as an 18-months program for BPD. However, a short-term (5 months) MBT program has been developed. Research into patient experiences with long-term MBT for BPD is scarce, and no studies have investigated patient experience with short-term MBT for BPD. Objective The objective of this study was to explore patient experience with short-term MBT for BPD in the Danish mental health services. Methods Semi-structured qualitative interviews were conducted with 12 outpatients diagnosed with BPD, who attended short-term MBT for 5 months. The interviews were verbatim transcribed and analyzed using thematic analysis with double coding. Results The analysis resulted in four subordinate themes: (1) Treatment duration - too short or appropriately short?, (2) The group as a "safe space," (3) Bad experiences impacted treatment negatively, and (4) My life has changed for the better. Conclusion The results suggest that most of the patients were overall satisfied with short-term MBT, which they experienced as having a positive impact on their lives. However, a subgroup of patients wanted more therapy. This study highlighted the strengths and limitations of short-term MBT for BPD as experienced by the patients, and points to barriers in developing service-user informed short-term treatment options for BPD.
Collapse
Affiliation(s)
- Emilie Hestbæk
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
| | - Mathilde Hasselby-Andersen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Nynne Beier
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Gentofte, Denmark
| |
Collapse
|
7
|
Juul S. Improving the methodological quality of randomized clinical trials assessing psychotherapy for borderline personality disorder: Recommendations for the future. Front Psychiatry 2022; 13:1053844. [PMID: 36590623 PMCID: PMC9794985 DOI: 10.3389/fpsyt.2022.1053844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sophie Juul
- Copenhagen Trial Unit – Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| |
Collapse
|