1
|
Flaaten E, Langfeldt M, Morken KTE. Antisocial personality disorder and therapeutic pessimism - how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals? Front Psychol 2024; 15:1320405. [PMID: 38449745 PMCID: PMC10915228 DOI: 10.3389/fpsyg.2024.1320405] [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: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism.
Collapse
Affiliation(s)
- Emilie Flaaten
- Drammen Hospital, Outpatient Team for Addiction and Mental Health, Vestre Viken Hospital Trust, Drammen, Norway
| | - Maria Langfeldt
- Blakstad Hospital, Section of Security Psychiatry, Vestre Viken Hospital Trust, Drammen, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
2
|
Kasper LA, Hauschild S, Schrauf LM, Taubner S. Enhancing mentalization by specific interventions within mentalization-based treatment of adolescents with conduct disorder. Front Psychol 2024; 14:1223040. [PMID: 38259532 PMCID: PMC10800920 DOI: 10.3389/fpsyg.2023.1223040] [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: 05/15/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Objective Mentalization is discussed as a mechanism of change in psychotherapy due to its positive effects on psychological functioning. In order to specifically apply mentalization-based interventions, a better understanding of the relationship between interventions and in-session mentalization is needed. The study aimed to explore the association between interventions and effective mentalizing. Method Fifteen therapy sessions of three therapies with male adolescents with conduct disorder were transcribed and rated with the Reflective Functioning (RF) Scale and a newly developed Mentalization-based Treatment (MBT) intervention coding manual. The coded interventions were categorized into intervention levels according to the MBT manual. Fisher's exact tests were performed to test differences in frequencies of interventions in high-RF sequences (RF score ≥ 4) compared with remaining therapy sequences (RF score ≤ 3). Results Specific MBT interventions such as demand questions, affectelaboration, empathic validation, change of subject, challenge, patienttherapist relation and mentalizing for the patient were related to effective mentalizing. Moreover, intervention levels such as supportive & empathic, basic- mentalizing & affect mode and relational mentalizing were positively associated with effective mentalizing. Conclusion MBT interventions seem to promote effective mentalizing at various intervention levels. Interventions that enhance effective mentalizing seem to be patient specific. In line with MBT theory, their effect on effective mentalizing might depend on various variables, such as the patients' arousal and pre-mentalizing mode.
Collapse
Affiliation(s)
- Lea A. Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Lisa M. Schrauf
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
3
|
Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S. Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study. Eur Child Adolesc Psychiatry 2023; 32:2611-2622. [PMID: 36434148 PMCID: PMC9702655 DOI: 10.1007/s00787-022-02113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.
Collapse
Affiliation(s)
- Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany.
- Psychological Institute, University of Heidelberg, Heidelberg, Germany.
| | - Lea Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Jana Volkert
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Youth Psychiatry, Lucerne Psychiatry, Lucerne, Switzerland
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
4
|
Lodewyk K, Bagnell A, Courtney DB, Newton AS. Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. Child Adolesc Ment Health 2023. [PMID: 37463769 DOI: 10.1111/camh.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders. METHOD Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines. RESULTS In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause. CONCLUSIONS To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.
Collapse
Affiliation(s)
| | | | - Darren B Courtney
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
5
|
Morken KT, Øvrebø M, Klippenberg C, Morvik T, Gikling EL. Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:649. [PMID: 36373390 PMCID: PMC9893041 DOI: 10.4081/ripppo.2022.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.
Collapse
Affiliation(s)
- Katharina T.E. Morken
- Department of Clinical Psychology, University of Bergen, Bergen, Norway,Department of Addiction Medicine, Research Section, Haukeland University Hospital, Bergen, Norway,Department of Clinical Psychology, University of Bergen, Bergen; Department of Addiction Medicine, Research Section, Haukeland University Hospital, Bergen, Norway.
| | - Morten Øvrebø
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Therese Morvik
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | |
Collapse
|
6
|
Taubner S, Bertsch K, Protić S, Fehr T. Editorial: Unlearning of Aggressive Behavior and Mechanisms of Change. Front Psychiatry 2022; 13:919122. [PMID: 35757217 PMCID: PMC9214206 DOI: 10.3389/fpsyt.2022.919122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital of the University Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany.,NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
| | - Sonja Protić
- Institute of Criminological and Sociological Research, University of Belgrade, Belgrade, Serbia
| | - Thorsten Fehr
- Department of Neuropsychology, Center for Cognitive Sciences, University of Bremen, Bremen, Germany.,Center for Advanced Imaging, Universities of Bremen and Magdeburg, Bremen, Germany
| |
Collapse
|
7
|
Volkert J, Taubner S, Byrne G, Rossouw T, Midgley N. Introduction to Mentalization-Based Approaches for Parents, Children, Youths, and Families. Am J Psychother 2021; 75:4-11. [PMID: 34724808 DOI: 10.1176/appi.psychotherapy.20210020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Family members mentalize when they try to understand each other's behavior on the basis of intentional mental states. This article aims to introduce and briefly describe how the concept of mentalization can provide a useful framework for clinicians to understand psychopathology of children, youths, and families. The authors further outline how mentalization-based techniques and interventions can be applied to build epistemic trust and to reestablish mentalizing in families by presenting clinical vignettes of initial sessions from various clinical settings in the United Kingdom and Germany. The article concludes with a brief summary about the current evidence for mentalization-based interventions with children, adolescents, and families and provides an outlook for future clinical and research work.
Collapse
Affiliation(s)
- Jana Volkert
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Svenja Taubner
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Gerry Byrne
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Trudie Rossouw
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| | - Nick Midgley
- Department of Psychology, MSB Medical School Berlin, Berlin (Volkert); Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany (Volkert, Taubner); Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom (Byrne); North East London National Health Service Foundation Trust, London (Rossouw); Anna Freud Centre and University College London, London (Midgley)
| |
Collapse
|