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Hajek Gross C, Oehlke SM, Prillinger K, Goreis A, Plener PL, Kothgassner OD. Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis. Suicide Life Threat Behav 2024; 54:317-337. [PMID: 38279664 DOI: 10.1111/sltb.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.
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Affiliation(s)
- Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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). Psychother Psychosom 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Gilbey D, Brealey G, Mateo-Arriero I, Waters Z, Ansell M, Janse van Rensburg E, De Gouveia Belinelo P, Milroy H, Pace G, Runions K, Salmin I, Woolard A. The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service. Clin Psychol Psychother 2023; 30:1303-1312. [PMID: 37078825 DOI: 10.1002/cpp.2854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. METHOD Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6 months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. RESULTS Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. CONCLUSIONS The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.
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Affiliation(s)
- Dylan Gilbey
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Georgia Brealey
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Irene Mateo-Arriero
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Megan Ansell
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Giulia Pace
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Kevin Runions
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Ivan Salmin
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
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Midgley N, Mortimer R, Carter M, Casey P, Coffman L, Edbrooke-Childs J, Edridge C, Fonagy P, Gomes M, Kapoor A, Marks S, Martin P, Moltrecht B, Morris E, Pokorna N, McFarquhar T. Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties. PLoS One 2023; 18:e0289503. [PMID: 37590277 PMCID: PMC10434917 DOI: 10.1371/journal.pone.0289503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION Clinical trial registration: ISRCTN 11620914.
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Affiliation(s)
- Nick Midgley
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Rose Mortimer
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Mark Carter
- Barnet, Enfield and Haringey NHS Trust, United Kingdom
| | - Polly Casey
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Chloe Edridge
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Peter Fonagy
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | - Anoushka Kapoor
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Bettina Moltrecht
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Emma Morris
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Nikola Pokorna
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Tara McFarquhar
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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Blankers M, Smits ML, Feenstra DJ, Horn EK, Kamphuis JH, Bales DL, Lucas Z, Remeeus MGA, Dekker JJM, Verheul R, Busschbach JJV, Luyten P. Economic evaluation of day hospital versus intensive outpatient mentalization-based treatment alongside a randomized controlled trial with 36-month follow-up. Personal Disord 2023; 14:207-215. [PMID: 35771495 DOI: 10.1037/per0000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mentalization-based treatment (MBT) has demonstrated robust effectiveness in the treatment of borderline personality disorder (BPD) in both day-hospital (MBT-DH) and intensive outpatient MBT (MBT-IOP) programs. Given the large differences in intensity and associated treatment costs, there is a need for studies comparing their cost-effectiveness. A health economic evaluation of MBT-DH versus MBT-IOP was performed alongside a multicenter randomized controlled trial with a 36-month follow-up. In three mental health-care institutions in the Netherlands, 114 patients were randomly allocated to MBT-DH (n = 70) or MBT-IOP (n = 44) and assessed every 6 months. Societal costs were compared with quality-adjusted life years (QALYs) gained and the number of months in remission over 36 months. The QALY gains over 36 months were 1.96 (SD = .58) for MBT-DH and 1.83 (SD = .56) for MBT-IOP; the respective number of months in remission were 16.0 (SD = 11.5) and 11.1 (SD = 10.7). Societal costs were €106,038 for MBT-DH and €91,368 for MBT-IOP. The incremental cost for one additional QALY with MBT-DH compared with MBT-IOP was €107,000. The incremental cost for 1 month in remission was almost €3000. Assuming a willingness-to-pay threshold of €50,000 for a QALY, there was a 33% likelihood that MBT-DH is more cost-effective than MBT-IOP in terms of costs per QALY. Although MBT-DH leads to slightly more QALYs and remission months, it is probably not cost-effective when compared with MBT-IOP for BPD patients, as the small additional health benefits in MBT-DH did not outweigh the substantially higher societal costs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Maaike L Smits
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
| | - Dine J Feenstra
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
| | | | - Jan Henk Kamphuis
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
| | - Dawn L Bales
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
| | | | | | | | | | - Jan J V Busschbach
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
| | - Patrick Luyten
- De Viersprong, Viersprong Institute for Studies on Personality Disorders
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Feldmann-Sinnige M, Pielage S, van Eck van der Sluijs JF. [Body-oriented mentalization based therapy in severe somatic symptom disorder]. Tijdschr Psychiatr 2023; 65:542-548. [PMID: 37947464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Body-oriented mentalization based therapy (L-MBT) is used in specialist mental health care for the treatment of patients with somatic symptom disorder or functional neurological disorder. L-MBT focuses on increasing awareness of bodily sensations and integrating them with psychological functions such as thinking, feeling or remembering. The goal of L-MBT is that patients with somatic symptom disorders learn to mentalize their body signals and the associated inner experiences. There are favorable experiences in clinical practice, but to date the mechanism of change and the effectiveness of treatment with L-MBT has not yet been sufficiently scientifically demonstrated. AIM To investigate whether patients with severe somatic symptom disorders improve their body awareness and mentalizing capacity during an intensive treatment program based on L-MBT. METHOD Body awareness and mentalizing capacity were assessed in patients following intensive treatment at Altrecht Psychosomatics Eikenboom, a highly specialized treatment center for adults with a severe somatic symptom disorder or functional neurological disorder Patients’ body awareness was assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), mentalizing capacity with the Mentalization Questionnaire (MZQ). Questionnaires were filled in at the start, halfway and at the end of treatment. RESULTS Both body awareness and mentalizing ability improved significantly during the intensive L-MBT-based treatment with generally a large effect size. CONCLUSION During an intensive treatment program based on L-MBT, there is an increase in body awareness and mentalizing capacity in patients diagnosed with a severe somatic symptom disorder.
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Weijers J, Ten Kate C, Viechtbauer W, Rampaart LJA, Eurelings EHM, Selten JP. Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial. Psychol Med 2021; 51:2846-2855. [PMID: 32466811 PMCID: PMC8640364 DOI: 10.1017/s0033291720001506] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired mentalizing ability - an impaired ability to understand one's own and other people's behavior in terms of mental states - is associated with social dysfunction in non-affective psychotic disorder (NAPD). We tested whether adding mentalization-based treatment for psychotic disorder (MBTp) to treatment as usual (TAU) results in greater improvement in social functioning. METHODS Multicenter, rater-blinded, randomized controlled trial. Eighty-four patients with NAPD were assigned to TAU or MBTp plus TAU. Patients in the MBTp group received 18 months of MBTp, consisting of weekly group sessions and one individual session per 2 weeks. Social functioning was measured using the Social Functioning Scale. We conducted ANCOVAs to examine the difference between treatment conditions directly after treatment and at 6-month follow-up and performed moderation and mediation analyses. RESULTS Intention-to-treat analyses showed no significant differences between groups post-treatment (p = 0.31) but revealed the MBTp group to be superior to TAU at follow-up (p = 0.03). Patients in the MBTp group also seemed to perform better on measures of mentalizing ability, although evidence of a mediation effect was limited (p = 0.06). Lastly, MBTp treatment was less effective in chronic patients than in recent-onset patients (p = 0.049) and overall symptoms at baseline were mild, which may have reduced the overall effectiveness of the intervention. CONCLUSION The results suggest that MBTp plus TAU may lead to more robust improvements in social functioning compared to TAU, especially for patients with a recent onset of psychosis.
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Affiliation(s)
- J. Weijers
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - C. Ten Kate
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - W. Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - L. J. A. Rampaart
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - E. H. M. Eurelings
- Department of Clinical Psychology, Health, and Neuropsychology, Leiden University, Wassenaarseweg 52, 2333 AKLeiden, The Netherlands
| | - J. P. Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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