Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial

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.

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

“…A recent, randomized-controlled trial found MBT-p led to significant improvements in social functioning at post-treatment and at 6-month follow up. Results further revealed a trend toward better performance on measures of mentalizing ability in the MBT-p group and an increased effectiveness of MBT-p in early psychosis versus prolonged psychosis [ 110 ].…”

Promoting an integrating recovery style: A mentalization‐informed approach

“…MBT‐p is an emerging treatment that has led to multiple case studies and initial research studies. However, in the first RCT conducted using MBT‐p, Weijers et al (2020a) found that while treatment as usual (TAU) and MBT‐p plus TAU both showed large, significant improvements in social functioning at the end of treatment, improvements in the MBT‐p group were superior, more robust, and remained significant at a 6‐month follow‐up.…”

“…Formal MBT‐p includes a treatment package that is 18‐month long and includes a combination of weekly group therapy and half‐hour individual session once per 2 weeks (Weijers et al, 2020a) offered on an outpatient basis. The dose of individual and group therapy is minimized in the formal MBT‐p approach to avoid overwhelming patients with mentalization interventions.…”

Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders

“…Studies reporting impairments in the affective rather than cognitive components of mentalizing such as empathy ( Derntl et al, 2009 ; Montag et al, 2020 ) are less common and there is only a limited spectrum of performance-based approaches to measure them ( Bonfils et al, 2016 ). Yet, the improvement of affective mentalizing abilities is receiving increasing attention in psychotherapies for patients with schizophrenia ( Liotti and Gilbert, 2011 ; Lempa et al, 2013 ; Montag, 2015 ; Weijers et al, 2020 ), and valid and reliable instruments are needed in order to investigate their effectiveness.…”