Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments
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Purpose of the Review
This review aims to outline the most recent evidence on the efficacy and effectiveness of mentalization-based treatment (MBT) for personality disorders (PD) from 2015 to 2018 and to describe new treatment developments.
Since 2015, 14 new—primarily effectiveness—MBT trials have been published. The main body of studies investigated adult populations (n = 11), patients with a borderline personality disorder (BPD) diagnosis (n = 8), and compared MBT with another psychotherapeutic treatment (n = 6). The majority of studies suggest that MBT has the potential to improve the clinical outcomes for adolescents and adults with a PD diagnosis, particularly BPD, and also with comorbid diagnoses and there are indications for changes in mentalizing being a specific mechanism of change promoted by MBT.
Despite promising findings, there is an urgent need for methodological sound and sufficiently powered studies to investigate both the efficacy and effectiveness of MBT, especially beyond BPD.
KeywordsMentalizing Personality disorders Clinical trials Review
Compliance with Ethical Standards
Conflict of Interest
Jana Volkert, Sophie Hauschild, and Svenja Taubner declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.Juanmartí FB, Lizeretti NP. The efficacy of psychotherapy for borderline personality disorder: A review. Papeles del Psicólogo. 2017;38(2):148–56.Google Scholar
- 5.Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet [Internet]. (2011 Jan 1) [cited 2018 Nov 1];377(9759):74–84. Available from: https://www.sciencedirect.com/science/article/pii/S0140673610614225
- 6.Stoffers J, Völlm B, Lieb K. AS14–02 - Common and distinct treatment elements in psychotherapies for borderline personality disorder. Eur Psychiatry [Internet]. (2012 Jan 1) [cited 2018 Nov 1];27:1. Available from: https://www.sciencedirect.com/science/article/pii/S0924933812739937
- 8.American Psychiatric Association. APA DSM-5 [Internet]. Diagnostic and statistical manual of mental disorders. 2013. (DSM-5®). American Psychiatric Pub.Google Scholar
- 9.Volkert J, Gablonski T-C, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. Br J Psychiatry [Internet]. (2018 Sep 28) [cited 2018 Nov 1];1–7. Available from: https://www.cambridge.org/core/product/identifier/S0007125018002027/type/journal_article.
- 10.Torgersen S. Epidemiology. In: Oldham J M, Skodol A E, Bender D S. (eds.) The American Psychiatric Publishing textbook of personality disorders. Arlington: American Psychiatric Publishing, Inc. 2005. p. 129–42.Google Scholar
- 15.Gunderson J, Weinberg I, Choi-Kain L. Borderline Personality Disorder. Vol. 11. FOCUS: The Journal of Lifelong Learning in Psychiatry; 2013. 249–260 pGoogle Scholar
- 16.Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet. 2015;385:717–26.Google Scholar
- 18.Bateman A, Fonagy P. Mentalization-based treatment for personality disorders: a practical guide. New York: Oxford University Press. 2016.Google Scholar
- 19.Fonagy P, Gergely G, Jurist E, Target M. Affect regulation, Mentalization, and the development of self. New York: Other Press; 2002.Google Scholar
- 20.Katznelson H. Reflective functioning: A review. Clin Psychol Rev. 2014;34:107–17.Google Scholar
- 21.Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol [Internet]. (2009 Nov 14) [cited 2018 Nov 2];21(04):1355. Available from: http://www.journals.cambridge.org/abstract_S0954579409990198.
- 22.Rossouw TI, Fonagy P. mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry [Internet]. (2012);51(12):1304–13. Available from: firstname.lastname@example.org.Google Scholar
- 23.Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156(10):1563–9.Google Scholar
- 24.Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1355–64.Google Scholar
- 25.Bales D, van Beek N, Smits M, Willemsen S, Busschbach JJV, Verheul R, et al. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands. J Pers Disord. 2012;26(4):568–82.Google Scholar
- 28.Bateman A, Fonagy P. Personality Disorders : Theory , Research , and Treatment A Randomized Controlled Trial of a Mentalization-Based Borderline Personality Disorder A Randomized Controlled Trial of a Mentalization-Based Intervention (MBT-FACTS) for Families of People With. 2019;10(1):70.Google Scholar
- 29.•• Bateman A, O’Connell J, Lorenzini N, Gardner T, Fonagy P. A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry. (2016);16:304. This RCT found a reduction of suicide attempts, self-harming behaviour, and depressive symptoms with medium to moderate effect sizes in the MBT group compared to structured clinical management for patients with both Antisocial and Borderline PD. Google Scholar
- 30.• Falconer CJ, Cutting P, Davies EB, Hollis C, Stallard P, Moran P. Adjunctive avatar therapy for mentalization-based treatment of borderline personality disorder: A mixed-methods feasibility study. Evid Based Ment Health. 2017;20(4):123–7 This feasibility study reports promising results on the usefulness of avatar-MBT as an add-on to standard MBT with regard to facilitating perspective taking, emotional distancing and group participation in a sample of patients with BPD. CrossRefGoogle Scholar
- 31.• Laurenssen EMP, Luyten P, Kikkert MJ, Westra D, Peen J, Soons MBJ, et al. Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial. Psychol Med. 2018;27:1–8 This study reports significantly fewer drop-outs in the intensive day hospital MBT compared to TAU, but no significant differences between the groups in any of the outcome variables in patients with a BPD diagnosis. Google Scholar
- 32.Möller C, Kalgren L, Sandell A, Falkenström F, Philips B. Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence. Trials. 2016/07/14 ed. 2017;27(6):749–65.Google Scholar
- 34.Robinson P, Hellier J, Barrett B, Barzdaitiene D, Bateman A, Bogaardt A, et al. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials. 2016/11/20 ed. 2016;17(1):549.CrossRefGoogle Scholar
- 35.Bales DL, Timman R, Andrea H, Busschbach JJV, Verheul R, Kamphuis JH. Effectiveness of day hospital Mentalization-based treatment for patients with severe borderline personality disorder: a matched control study. Clin Psychol Psychother. 2015;22(5):409–17.Google Scholar
- 36.Bales DL, Timman R, Luyten P, Busschbach J, Verheul R, Hutsebaut J. Implementation of evidence-based treatments for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment. Personal Ment Health. 2017;11(4):266–77.CrossRefGoogle Scholar
- 38.•• Edel MA, Raaff V, Dimaggio G, Buchheim A, Brüne M. Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder – A pilot study. Br J Clin Psychol. 2017;56(1):1–15 This study found that DBT+MBT was superior to DBT in reducing fearful attachment, improving affective mentalizing and reducing self-harm in a female sample of patients with BPD. CrossRefGoogle Scholar
- 40.Hauber K, Boon AE, Vermeiren R. Examining changes in personality disorder and symptomology in an adolescent sample receiving intensive mentalization based treatment: a pilot study. Child Adolesc Psychiatry Ment Health. 2017;1–7. Available from: https://doi.org/10.1186/s13034-017-0197-9.
- 41.Kvarstein EH, Pedersen G, Folmo E, Urnes Ø, Johansen MS, Hummelen B, et al. Mentalization-based treatment or psychodynamic treatment programmes for patients with borderline personality disorder - the impact of clinical severity. Psychol Psychother Theory Res Pract. 2018. 1-21.Google Scholar
- 42.Kvarstein EH, Pedersen G, Urnes Ø, Hummelen B, Wilberg T, Karterud S. Changing from a traditional psychodynamic treatment programme to mentalization-based treatment for patients with borderline personality disorder – does it make a difference? Psychol Psychother Theory, Res Pract. 2015;88(1):71–86.Google Scholar
- 43.Thomsen MS, Ruocco AC, Uliaszek AA, Mathiesen BB, Simonsen E. Changes in neurocognitive functioning after 6 months of Mentalization-based treatment for borderline personality disorder. J Pers Disord. 2017;31(3):306–24.Google Scholar
- 44.Byrne G, Lees G. When the bough breaks the lighthouse programme. In: Celebi M, editor. Weaving the cradle: facilitating groups to promote attunement and bonding between parents, their babies and toddlers. London: Singing Dragon; 2017. p. 144–54.Google Scholar
- 45.Taubner S, Gablonski T-C, Hauschild S, Schroeder-Pfeifer P, Kaess M, Wladika W, et al. Mentalization-based Treatment for adolescents with conduct disorder: feasibility and pilot study. (submitted).Google Scholar
- 46.Bevington D, Fuggle P, Cracknell L, Fonagy P. Adaptive Mentalization-based integrative Treatment: A guide for teams to develop Systems of Care [internet]. New York, NY; [cited 15 November 2018]. Available from: http://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780198718673.001.0001/med-9780198718673
- 47.Bateman AW, Fonagy P, editors. Handbook of mentalizing in mental health practice. Handbook of mentalizing in mental health practice. Arlington, VA, US: American Psychiatric Publishing, Inc.; 2012. xxiii, 593-xxiii, 593.Google Scholar
- 48.•• Malda-Castillo J, Browne C, Perez-Algorta G. Mentalization-based treatment and its evidence-base status: A systematic literature review. Psychol Psychother Theory Res Pract [Internet]. 2018. [cited 10 November 2018]. Available from: email@example.com, This systematic literature review on the evidence-base status of MBT found that MBT is a potentially effictive method across a range of mental disorders, but concludes that future studies need to increase their methodological quality. Google Scholar
- 49.De Meulemeester C, Vansteelandt K, Luyten P, Lowyck B. Mentalizing as a Mechanism of Change in the Treatment of Patients With Borderline Personality Disorder: A Parallel Process Growth Modeling Approach. Personal Disord Theory Res Treat. 2017;9(1):22–9.Google Scholar