Mentalization-based Treatment For Adolescents Research Articles

Co-Constructing Mentalizing Contexts in Therapeutic Work with Adolescents-Exploring Resilience in Social Support Networks

ABSTRACT Adolescence, a transformative phase of human development, is marked by a growing need for social support. During this pivotal period, young individuals grapple with the challenges of identity formation, emotional regulation, and forging meaningful relationships. Research has underscored the significance of a robust social network in fostering resilience and promoting mental well-being. In this exploration, we consider the evolving landscape of adolescent support, drawing insights from the concept of Mentalization-Based Therapy (MBT), especially from the specialized treatment model explicitly designed for adolescents, known as Mentalization-Based Treatment for Adolescents (MBT-A). MBT-A is an approach that emphasizes establishing a therapeutic alliance, epistemic trust, and mentalizing within an adolescents’ therapy and social context. This approach includes forming a dynamic external support network to help the young person remain connected with their social environment. Through two case examples, we illuminate how this approach aims to strengthen mentalizing within peer groups and the wider social contexts adolescents live within. This paper will consider the various ways in which therapists might step outside the activity of individual therapeutic sessions to address mentalizing barriers preventing the adolescent from accessing everyday social support. In this process, we encourage creativity and multiple participant involvement, challenging the boundaries of perceived therapeutic practice.

청소년 자녀를 둔 부모를 위한 정신화 훈련 프로그램 개발 및 효과

This study is intended to develop a mentalization training program for parents with adolescents. Based on mentalization development theory and the mentalization-based treatment for adolescents and families by Fonagy and his colleagues, a program with four stages of understanding the mentalization attitude, practicing explicit mentalization, exploring mentalization inhibitory factors, and reinforcing effective mentalization was developed. 18 parents in G and P cities were recruited; the program was conducted on the experiment group and no treatment was given on the control group. According to analysis, the program had a significant effect on reducing parental non-mentalization and improving emotional regulation and relationships with adolescents, whereas there was no significant effect on certainty, interest and curiosity, which are sub-factors of mentalization. A supplementary analysis of the sessions and comments indicated that the program led parents to perceive their children as separate individuals from themselves.
 And through the process of sensitively recognizing and validating each other's emotional signals, the level of arousal can be appropriately adjusted, so that they can interact without being easily immersed in their own and children's emotions. It leads to a positive virtuous cycle of gaining empathy from children as well as restoring confidence in maintaining close relationships with children.

청소년 자녀를 둔 부모를 위한 정신화 훈련 프로그램 개발 및 효과

This study is intended to develop a mentalization training program for parents with adolescents. Based on mentalization development theory and the mentalization-based treatment for adolescents and families by Fonagy and his colleagues, a program with four stages of understanding the mentalization attitude, practicing explicit mentalization, exploring mentalization inhibitory factors, and reinforcing effective mentalization was developed. 18 parents in G and P cities were recruited; the program was conducted on the experiment group and no treatment was given on the control group. According to analysis, the program had a significant effect on reducing parental non-mentalization and improving emotional regulation and relationships with adolescents, whereas there was no significant effect on certainty, interest and curiosity, which are sub-factors of mentalization. A supplementary analysis of the sessions and comments indicated that the program led parents to perceive their children as separate individuals from themselves.
 And through the process of sensitively recognizing and validating each other's emotional signals, the level of arousal can be appropriately adjusted, so that they can interact without being easily immersed in their own and children's emotions. It leads to a positive virtuous cycle of gaining empathy from children as well as restoring confidence in maintaining close relationships with children.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): protocol of a feasibility and pilot study

BackgroundConduct disorder (CD) is a complex mental disorder characterized by severe rule-breaking and aggressive behavior. While studies have shown that several therapeutic interventions are effective in treating CD symptoms, researchers call for treatments based on etiological knowledge and potential patho-mechanisms. Mentalization-based treatment (MBT) may represent such a treatment approach: Studies have shown that individuals with CD show mentalizing deficits and that mentalizing might represent a protective factor against the development of the disorder. As MBT focuses on the understanding of social behavior in terms of mental states, fostering mentalizing might help CD individuals to (re)gain an adaptive way of coping with negative emotions especially in social interactions and thus reduce aggressive behavior. For this purpose, MBT was adapted for adolescents with CD (MBT-CD). This is a protocol of a feasibility and pilot study to inform the planning of a prospective RCT. The primary aim is to estimate the feasibility of an RCT based on the acceptability of the intervention and the scientific assessments by CD individuals and their families indicated by quantitative and qualitative data, as well as based on necessary organizational resources to conduct an RCT. The secondary aim is to investigate the course of symptom severity and mentalizing skills.MethodsThe bi-center study is carried out in two outpatient settings associated with university hospitals (Heidelberg and Mainz) in Germany. Adolescents aged between 11 and 18 years with a CD or oppositional defiant disorder (ODD) diagnosis are included. Participants receive MBT-CD for 6 to 12 months. The primary outcome of the feasibility study (e.g., recruitment and adherence rates) will be descriptively analyzed. Multilevel modeling will be used to investigate secondary outcome data.DiscussionFostering the capacity to mentalize social interactions triggering non-mentalized, aggressive behavior might help CD individuals to behave more adaptively. The feasibility trial is essential for gathering information on how to properly conduct MBT-CD including appropriate scientific assessments in this patient group, in order to subsequently investigate the effectiveness of MBT-CD in an RCT.Trial registrationClinicalTrials.gov, NCT02988453. November 30, 2016Sources of monetary supportDietmar Hopp Stiftung, Heidehof StiftungRecruitment statusRecruitment complete and intervention complete, follow-up assessments ongoing (Heidelberg). Recruitment and assessments ongoing (Mainz).Primary sponsor, principal investigator, and lead investigator in HeidelbergSvenja Taubner is responsible for the design and conduct of MBT-CD intervention and feasibility and pilot study, preparation of protocol and revisions, and publication of study results.Secondary sponsor and lead investigator in MainzEsther Sobanski is responsible for the recruitment and data collection in the collaborating center MainzRecruitment countryGermanyHealth condition studiedConduct disorder, oppositional defiant disorderInterventionMentalization-based treatment for conduct disorder (MBT-CD): MBT-CD is an adaptation of MBT for Borderline Personality Disorder. This manualized psychodynamic psychotherapy focuses on increasing mentalizing, i.e., the ability to understand behavior in terms of mental states, in patients. MBT-CD includes weekly individual sessions with the patient and monthly family sessions.Key inclusion and exclusion criteriaIncluded are adolescent individuals with a diagnosis of conduct disorder or oppositional defiant disorder aged between 11 and 18 years.Study typeFeasibility and pilot study (single-group)Date of first enrollment19.01.2017Study statusThe trial is currently in the follow-up assessment phase in Heidelberg and in the recruitment and treatment phase in Mainz.Primary outcomesAcceptability of MBT-CD intervention (as indicated by recruitment rates, completion rates, drop-out rates, treatment duration, oral evaluation), acceptability of scientific assessments (as indicated by adherence, missing data, oral evaluation), and necessary organizational resources (scientific personnel, recruitment networks, MBT-CD training and supervision) to estimate feasibility of an RCTSecondary outcomesAdolescents’ symptom severity and mentalizing abilityProtocol version20.08.2020, version 1.0

Mentalization-Based Treatment in Adolescent Inpatients: A Naturalistic Multi-Informant Study of Outcomes.

The present era of major cutbacks in intensive treatment programs throughout Europe stresses the importance of evaluating the outcomes of such programs for adolescents with severe personality pathology and comorbidity. Personality pathology has proven to be a valid concept in adolescents, with relatively high prevalence, that needs to be targeted by evidence-based interventions. The present study focused on the evaluation of outcomes of a 12-month mentalization-based treatment for adolescents (MBT-A) program in 118 inpatient adolescents with personality pathology symptoms, using a multi-informant multidomain design. The results showed that during treatment, adolescents improved on general psychiatric symptoms, personality pathology dimensions, and health-related and generic quality of life. Improvement was not only statistically significant, but also clinically important, especially for internalizing domains. Implications for clinical practice and research are discussed.

Enhancing Treatment Engagement in “Treatment Resistant” Incarcerated Youth

ABSTRACT Incarcerated juvenile offenders mandated into treatment in correctional settings are often characterized as “treatment resistant.” Despite the extensive literature and increasingly widespread adoption of evidence-based practices that address the treatment needs of this population (e.g., MST, DBT, T-CBT), there is little writing on the actual process of engaging juvenile justice-involved youth in productive therapeutic work. Yet, the stakes of low engagement and failed treatments are high – including chronification of delinquent behavior and risk of becoming further embroiled in the criminal justice system. Drawing on the writer’s training in Mentalization-Based Treatment for Adolescents (MBT-A) and Developmental-Relational Therapy (DRT), this paper will discuss population and setting-specific barriers to engagement and use composite case material to outline the “nuts and bolts” of setting up productive treatments with juvenile offenders with histories of developmental trauma including setting the frame, formulating goals, practical tools of engagement, and navigating inevitable ruptures in the therapeutic relationship.

24.2 Understanding Mentalization-Based Treatment for Adolescents

24.2 Understanding Mentalization-Based Treatment for Adolescents

Mentalization-Based Treatment for Adolescents with Borderline Personality Disorder - Concept and Efficacy

Mentalization-Based Treatment for Adolescents with Borderline Personality Disorder - Concept and Efficacy In recent years, the concept of mentalization has become increasingly important in practice and research. It describes the imaginative ability to understand human behavior in terms of mental states. Mentalization is a central component to understand the etiology and to treat patients with borderline personality disorder (BPD). Both adult and adolescent patients with BPD have limited mentalization abilities, which can be reliably assessed using the Reflective Functioning Scale. Mentalization-Based Treatment (MBT) was originally developed as an integrative approach for the treatment of adult patients with BPD. It is a manualized psychotherapy with psychodynamic roots with the aim to increase mentalizing abilities of patients. Since then, MBT has been further developed for other mental disorders as well as for the treatment of different age groups. One of these developments is MBT for Adolescents (MBT-A). MBT-A includes both individual as well as family sessions and the average duration of therapy is about twelve months. MBT-A can be applied in inpatient and outpatient settings and aims to improve mentalizing abilities in emotionally important relationships and the whole family system. First studies have found evidence for the efficacy of MBT-A. A randomized controlled trial (RCT) is currently being carried out to evaluate the efficacy of MBT-A for adolescents with conduct disorder. However, further evidence for efficacy and further conceptual development is needed.

11.1 UNDERSTANDING MENTALIZATION-BASED TREATMENT FOR ADOLESCENTS

Mentalization-based treatment for adolescents (MBT-A), as studied in randomized controlled trials of self-harming adolescents, includes the established MBT approach developed initially for adults with BD and for families as well (mentalization-based treatment for families). This approach has been used in both inpatient and outpatient settings. This presentation will provide an understanding of the MBT-A model and its application as implemented in a children’s state hospital setting.

Confidently Approaching Borderline Personality Disorder in Young People: A Primer for the General Child and Adolescent Psychiatrist

Young people exhibiting traits of borderline personality disorder (BPD), including self-injury, chronic suicidality, and emotional dysregulation, present at all levels of care. Many practitioners, however, feel ill-equipped to work with this population without specialized training. This presentation will provide attendees with a knowledge base so that they feel confident working with young people with BPD traits. Attendees will gain practical tools derived from evidence-based treatments, including mentalization-based treatment for adolescents (MBT-A) and dialectical behavior therapy (DBT). They will learn how rational prescribing practices can fit into a comprehensive treatment plan and how they can help families to promote recovery.

The use of mentalization-based treatment for adolescents (MBT-A) with a young woman with mixed personality disorder and tendencies to self-harm.

This article explores the psychological profile and treatment of young people who present clinically with features of borderline and avoidant personality disorder, along with vulnerable narcissistic traits. Self-harm in these youngsters is often used to regulate internal storms. It is argued that the adolescent phase of development is a trigger point for collapse in these vulnerable young people. In therapy, these patients are difficult to connect with emotionally and treatment can be fraught with strong countertransference reactions. A case study is used to illustrate the use of mentalization-based treatment for adolescents for such individuals.

The Treatment of Pediatric Suicidal Behavior

Psychotherapies have stronger empirical support of efficacy and do not have safety concerns associated with many medications; thus, at present, psychotherapy is an appropriate first-line treatment for suicidal ideation and behavior in youth. Integrated Cognitive-Behavioral Therapy (I-CBT) and Multisystemic Therapy (MST) have the strongest preliminary evidence for psychotherapeutic treatment of suicidal behavior in preadolescents and adolescents with a history of suicidal behavior. Mentalization-Based Treatment for Adolescents (MBT-A), Developmental Group Psychotherapy (DGP), and Dialectical Behavior Therapy for Adolescents (DBT-A) have received some support for youth engaging in non-suicidal and/or suicidal self-injurious behaviors. Resourceful Adolescent Parent Program (RAP-P) may be effective in reducing suicidal thoughts and/or self-injurious behaviors (Table 1). In children with a history of recurrent suicidal behavior and for whom psychotherapy alone is ineffective, psychopharmacological treatment may be necessary. Responsible pharmacological treatment of pediatric suicidal behavior requires understanding of the current dearth of efficacy evidence and the limitations of safety evidence within pediatric populations, the range of possible serious side effects, and the potential use of medications, including less toxic SSRIs (Barbey and Roose J Clin Psychiatry 59:42–8, 1998) [IV], as a suicide method. Time to effect of antidepressants may coincide with heightened suicide risk (Simon et al. Am J Psychiatr 163(1):41–7, 2006) [I], and, thus, patients should be monitored particularly closely during this time period. Psychotropic medications for pediatric patients should be part of a comprehensive and integrated treatment and monitoring strategy, including therapeutic drug monitoring and coordinated communication among providers, caregivers, and patients. Although suicide attempts in children younger than five are extremely rare, they do occur (Rosenthal and Rosenthal Am J Psychiatr 141(4):520–25, 1984) [IV]; treatment will focus on family factors and will typically employ dyadic models of psychotherapy to develop or reestablish co-regulation between the child and the caregiver.

"Feasibility of mentalization-based treatment for adolescents with borderline symptoms: A pilot study": Correction to Laurenssen et al. (2013).

"Feasibility of mentalization-based treatment for adolescents with borderline symptoms: A pilot study": Correction to Laurenssen et al. (2013).

Mentalization-Based Treatment for Self-Harm in Adolescents: A Randomized ControlledTrial

ObjectiveWe examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm. MethodA total of 80 adolescents (85% female) consecutively presenting to mental health services with self-harm and comorbid depression were randomly allocated to either MBT-A or TAU. Adolescents were assessed for self-harm, risk-taking and mood at baseline and at 3-monthly intervals until 12 months. Their attachment style, mentalization ability and borderline personality disorder (BPD) features were also assessed at baseline and at the end of the 12-month treatment. ResultsMBT-A was more effective than TAU in reducing self-harm and depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent BPD symptoms and traits. ConclusionsMBT-A may be an effective intervention to reduce self-harm in adolescents. Clinical trial registration information—The emergence of personality disorder traits in adolescents who deliberately self harm and the potential for using a mentalisation based treatment approach as an early intervention for such individuals: a randomised controlled trial; http://www.controlled-trials.com; ISRCTN95266816.

The implementation of mentalization-based treatment for adolescents: a case study from an organizational, team and therapist perspective.

BackgroundReports on problems encountered in the implementation of complex interventions are scarce in psychotherapy literature. This is remarkable given the inherent difficulties of such enterprises and the associated safety risks for patients involved.Case descriptionA case study of the problematic implementation process of Mentalization- Based Treatment for Adolescents (MBT-A), a new therapy for 14 to 18 year old youngsters with severe personality disorders, is presented. The implementation process is described and analyzed at an organizational, team and therapist level.Discussion and evaluationOur analysis shows that problems at all three levels contributed and interacted to make the implementation cumbersome and hazardous.ConclusionThe implementation of complex psychotherapeutic programs for difficult patients could benefit from a structured attention to processes at multiple levels. We therefore propose a new comprehensive heuristic model of treatment integrity. This new model includes organisational, team and therapist adherence to the treatment model as necessary components of treatment integrity in the implementation of complex interventions. The application of this new model of treatment integrity potentially increases the chance of successful implementations and reduces safety risks for first patients enrolling in a new program.