Abstract
BackgroundMentalisation-based treatment (MBT) in borderline personality disorder (BPD) has a growing evidence base, but there is a lack of effectiveness and moderator studies. The present study examined the effectiveness of MBT in a naturalistic setting and explored psychiatric and psychological moderators of outcome.MethodBorderline and general psychiatric symptoms, suicidality, self-harm, alexithymia and self-image were measured in a group of BPD patients (n = 75) receiving MBT; assessments were made at baseline, and subsequently after 6, 12 and 18 months (when treatment ended). Borderline symptoms were the primary outcome variable.ResultsBorderline symptoms improved significantly (d = 0.79, p < .001), as did general psychiatric symptoms, suicidality, self-harm, self-rated alexithymia and self-image. BPD severity or psychological moderators had no effect on outcome. Younger patients improved more on self-harm, although this could be explained by the fact that older patients had considerably lower baseline self-harm.ConclusionsMBT seems to be an effective treatment in a naturalistic setting for BPD patients. This study is one of the first studies of MBT showing that outcomes related to mentalisation, self-image and self-rated alexithymia improved. Initial symptom severity did not influence results indicating that MBT treatment is well adapted to patients with severe BPD symptoms.Trial registrationThe study was retrospectively registered 25 September 2017 in the ClinicalTrials.gov PRS registry, no. NCT03295838.
Highlights
Mentalisation-based treatment (MBT) in borderline personality disorder (BPD) has a growing evidence base, but there is a lack of effectiveness and moderator studies
MBT seems to be an effective treatment in a naturalistic setting for BPD patients
This study is one of the first studies of MBT showing that outcomes related to mentalisation, self-image and self-rated alexithymia improved
Summary
Mentalisation-based treatment (MBT) in borderline personality disorder (BPD) has a growing evidence base, but there is a lack of effectiveness and moderator studies. What’s more, efficacy studies have for the most part been carried out by the researchers who designed and developed MBT, which leaves these studies open to criticisms of bias and allegiance effects. A randomised controlled trial in Denmark carried out by an independent group of researchers [9] compared MBT with supportive psychodynamic group psychotherapy at the end of treatment 2 years after intake. Both treatment arms showed significant improvements, but MBT was superior to the control treatment only in regard to patients’ general assessment of functioning (GAF). There was a skewed allocation to treatment conditions in the Danish study and a general lack of adherence to the MBT treatment manual, along with a lack of expert supervision in MBT
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