Metacognition as a predictor of change in the treatment for borderline personality disorder: A preliminary pilot study.

Abstract

There is evidence that a key feature in borderline personality disorder (BPD) is the difficulty to reflect on one's own as well as on other people's state of mind. So far, no study has examined the link between metacognition and symptom change presented by BPD patients across treatment. This preliminary pilot study represents a first step in describing impairments in different dimensions of metacognition and their connection with the symptoms presented by a N ϭ 10 BPD sample. The transcripts from the first and the penultimate session of a 10-session version of Good Psychiatric Management were analyzed. The global score and the 3 subscales of the Metacognition Assessment Scale-Revised were used to assess metacognitive abilities: Understanding of one's own mind, Understanding of other's mind, and Mastery. Symptoms were assessed with the Outcome Questionnaire-45.2. Results show a general low level of metacognition. Therapy sessions with BPD patients seem to be characterized by impairments in metacognition, notably in the reflection on other's states of mind and in the use of this information to solve conflicts and problems. Moreover, sessions highlighting a higher level of the Understanding of other's mind at the onset of treatment were linked with better outcome compared to sessions showing poorer metacognitive abilities in this area. Implications for an integrated treatment for BPD and future research are discussed.

Metacognitive improvement and symptom change in a 3‐month treatment for borderline personality disorder

“…Cronbach's alpha was α = .94 for the present study and .91 for the pilot study (Maillard et al ., ).…”

“…In a pilot study, pre–post therapy session transcripts of 10 BPD patients were analysed with the MAS‐R (Maillard et al ., ). The findings, to be taken cautiously, showed significant improvement in the metacognition's mastery function and a link between the level of understanding of others’ mind at the treatment onset and better outcomes after a short‐term treatment.…”

Metacognitively oriented psychotherapy for schizotypal personality disorder: A two‐case series

“…This is proposed to lead to therapeutic change when it promotes an awareness of maladaptive schemas, allows access to healthy aspects of the self and increases the ability to plan behaviours consistent with one's wishes in everyday life. Evidence supporting MIT includes several case series that indicated a reliable clinical change in symptoms and interpersonal functioning, 41,42 including a pilot RCT reporting encouraging results for a group intervention on PD. 43 Findings for the group-based approach to MIT have been reported in an open trial 44 and in a pilot study including clients with borderline personality disorder.…”

Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial

“…Levy and colleagues (2006) examined change in three forms of psychotherapy for BPD --TFP, DBT and supportive therapy -and found that only TFP was associated with an increase in mentalizing functions, along with development of more secure attachment patterns in some patients in this group [29]. Consistent results were presented by Fischer-Kern and colleagues [61] (see also de Meulemeester et al [62]; Maillard et al, [63]). Other research has underlined the moderating factor of mentalizing capacities for outcome for different categories of PD [64,65].…”