Mentalization‐based treatment or psychodynamic treatment programmes for patients with borderline personality disorder – the impact of clinical severity

Abstract

Objectives. Mentalization-based treatment (MBT), originally designed for patients with borderline personality disorder (BPD), may be particularly indicated for severe conditions. However, there is limited documentation of how increasing severity of personality disorder (PD) effect outcomes of highly specialized treatments. This study aimed to investigate associations between clinical severity and outcomes for patients in MBT as compared to a psychodynamic group-based treatment programme (PDT).Design. A naturalistic, longitudinal, comparison study.Methods. The sample included 345 patients with BPD (PDT n = 281, MBT n = 64). The number of diagnosed PDs, PD criteria, and symptom disorders were chosen as baseline indicators of clinical severity. Clinical outcomes (global functioning, symptom distress, interpersonal problems) were repeatedly assessed over three years. Therapists' fidelity to MBT was satisfactory. Linear mixed models were the applied statistics.Results. In PDT, greater clinical severity was associated with poorer improvement rates. Clinical severity was not associated with significant differences in outcomes for patients in MBT. Differences in outcomes for patients in MBT and PDT increased significantly with higher severity of disorder.Conclusions. Supporting previous research, this study indicates that clinical benefits associated with MBT also apply for BPD patients with severe conditions. The results also suggest that increasing severity was a challenge in PDT. Practitioner pointsMBT may be particularly beneficial for severely disordered BPD patients Differences between MBT and PDT were less pronounced in moderately disordered BPD patients.

Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder

“…In 2013-2015, five raters evaluated 19 individual sessions (eight therapists) and 9 group sessions in the programme. For individual therapists, the mean adherence level was 4.7 (SD = 1.2) and the mean MBT competence level was 4.4 (SD = 1.2) (Kvarstein et al, 2019). For group therapists, the mean adherence level was 5.1 (SD = 1.37) and competence level 4.9 (SD = 1.30) (Kvarstein et al, 2020).…”

“…However, the clinical severity of PD in terms of comorbidity has been investigated. Studies of social cognition among patients with BPD have indicated that more impaired mentalizing is associated with more severe, comorbid PD (Normann-Eide et al, 2019), and MBT studies differentiating between patients with only BPD and patients with PD comorbidity recommend MBT for the more complex conditions (Kvarstein et al, 2019). BPD with comorbid paranoid PD represents a common form of severe personality pathology and can be conceptualized within the frame of epistemic trust.…”

Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

“…In addition, the GSI was 1.54 (SD = 0.66) and IIP was 1.65 (SD = 0.52). With respect to GSI this score is in the "Moderate" to "Sever" range [37,42,43], and a score of 1.65 on CIP is associated with severe interpersonal distress [42,44]. Thus, all these measures reflect a poorly functioning patient group with a high level of symptom and interpersonal distress.…”

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

“…Keeping a therapeutic focus on mental states, interpersonal interpretation, and interaction, it provides an explicit challenge of mentalizing others, both therapists and group members. MBT studies have indicated that this specialized approach is particularly justified for BPD patients with severe disorder ( 20 – 22 ). For patients, the treatment, interventions, and formats, represent complex social situations and will activate all aspects of social cognition.…”