Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment?

Morken, Katharina Teresa Enehaug; Binder, Per‐Einar; Arefjord, Nina; Karterud, Sigmund

doi:10.1080/10503307.2017.1325021

Cited by 17 publications

(19 citation statements)

References 117 publications

(149 reference statements)

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“…As a specialized BPD treatment, MBT will address the relation self-other by work in therapy dyads, groups and direct exploration of significant interpersonal incidents, emotional reactions, and social interpretations (46). Several qualitative studies describing change processes among BPD patients have indeed highlighted the subjective impact of new relational experience, practice, and competence (47)(48)(49)(50). Positive patient-reported group experiences-learning to gain and lend perspectives are indeed emphasized in a qualitative study of MBT (51).…”

Section: Main Findingsmentioning

confidence: 99%

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

et al. 2020

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Background: Mentalization-based treatment (MBT) is an evidence-based treatment for borderline personality disorder (BPD). Differences in treatment outcomes related to specific capacity of social cognition need further attention. This study aimed to investigate social cognition as a predictor of outcome. Method: The study included 31 BPD patients who completed a test of social cognition (Movie for the Assessment of Social Cognition, MASC) before outpatient MBT. The MASC-scores indicated a person's theory of mind (ToM) and different error-types. During treatment repeated self-reports of alliance and clinical outcomes (symptoms, interpersonal problems, social functioning) were applied. Longitudinal analyses were based on Linear Mixed Models (n = 24). Results: The most frequent error-type was excessive ToM (hypermentalizing). Higher levels of excessive ToM were associated with greater improvement of alliance over time and good clinical outcomes. Insufficient ToM errors and low levels of accurate cognitive ToM responses were both associated with poorer improvement over time. The subgroup with frequent insufficient ToM errors had a larger total number of ToM errors. Insufficient ToM errors were associated with more childhood trauma, comorbid avoidant PD traits and/or PTSD, extensive prior treatment, and/or treatment irregularity. Conclusion: This study demonstrates considerable variation of social cognitive capacity among BPD patients and good outcomes for patients with mainly ToM errors of hypermentalizing. It also indicates that poorly responding patients may represent a cohort with more complex problems of social cognition and insufficient mentalizing.

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Section: Main Findingsmentioning

confidence: 99%

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

et al. 2020

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“…So far, only two clinical trials on MBT with PD\SUD patients have been published (Morken et al, 2017b; Philips et al, 2018). In our pilot trial with 18 female PD\SUD patients, we investigated both feasibility and experiences of the treatment (Morken et al, 2017a,b). In the explorative qualitative study, 13 female patients were interviewed on their experiences of change, with a special reference to mental states and feelings (Morken et al, 2017a).…”

Section: Introductionmentioning

confidence: 99%

“…In our pilot trial with 18 female PD\SUD patients, we investigated both feasibility and experiences of the treatment (Morken et al, 2017a,b). In the explorative qualitative study, 13 female patients were interviewed on their experiences of change, with a special reference to mental states and feelings (Morken et al, 2017a). From the perspective of the patients, the changes were pervasive.…”

Section: Introductionmentioning

confidence: 99%

“…This therapy style facilitated the alliance and created a constructive therapeutic process (Folmo et al, 2019). From our investigation of patients’ experiences of change, we found that they experienced meaningful changes in their ability to cope with mental states in self and gained a more flexible understanding of others (Morken et al, 2017a). The question that remains is how they experienced that MBT assisted them in this change process.…”

Section: Introductionmentioning

confidence: 99%

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Mentalization-Based Treatment From the Patients’ Perspective – What Ingredients Do They Emphasize?

Morken

Binder

Arefjord³

et al. 2019

Front. Psychol.

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Objective: The aim of this study was to explore how patients with personality disorder (PD) and substance use disorder (SUD) experience mentalization-based treatment (MBT), in particular what they consider useful and less useful elements of the therapy. Method: Semi-structured qualitative interviews with 13 participants were conducted. Participants were interviewed on their experience of the different elements of MBT, their experience of working in the transference, and their view on MBT as a whole. Thematic analyses were performed within a hermeneutical-phenomenological epistemology, with an emphasis on researcher reflexivity. Results: The following themes were found in the material: “I am not alone,” “Taking blinders off,” “Just say it,” “The paradox of trust,” and “Follow me closely.” Three of these themes concerned therapist interventions; these involved addressing the relationship with the patients, addressing negative or unspoken feelings in the sessions, and validating and tolerating patients’ affect. Two themes concerned group therapy experiences; these were the experience of sameness with co-patients in group and the experience of discovering different perspectives in group. Conclusions: Patients’ experiences of useful elements in MBT resonate with theoretical tenets of (borderline) personality pathology, in particular attachment disturbances and emotional dysregulation. Patients highlight what we would label working in the therapeutic relationship, addressing transferential and counter-transferential processes explicitly, emotional validation, and enhancing mentalizing in its own right.

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“…The results were promising with substantial decrease of substance dependence, as well as improvements on global functioning, psychiatric symptoms and interpersonal functioning [33]. The project in Bergen also resulted in a qualitative study of the patients' experiences of change in MBT [34]. However, until the present study, MBT for concurrent BPD and SUD had not been tested in an RCT.…”

Section: Introductionmentioning

confidence: 99%

Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study

et al. 2018

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Aims: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. Methods: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. Results: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group – a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. Conclusion: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

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Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment?

Abstract: The findings are in line with theoretical assumptions that increasing mentalizing capacity is a central change process for these patients. Furthermore, the findings demonstrate the complex interaction between different modes of mentalizing.

Cited by 17 publications

References 117 publications

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT)

Mentalization-Based Treatment From the Patients’ Perspective – What Ingredients Do They Emphasize?

Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study

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