Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration
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Developmental clinical research in recent years has highlighted the value treating psychotic disorders at the earliest stage to reduce long-term morbidity. It is now suggested that treatment during the clinical high risk states (CHR), preceding by 1–4 years the onset of psychotic disorders, may delay or prevent the onset of psychosis, and contribute to a more positive prognosis. In this article, we wish to provide a rationale and clinical illustration of mentalization-based treatment (MBT) as an indicated preventive treatment for CHR. We will first review the notion of high-risk for psychosis, providing a trans-theoretical developmental framework for conceptualizing the clinical progression from sub-clinical towards clinical psychotic states. Second, we address the commonalities and differences between the constructs of mentalization and metacognition, and discuss their relevance in preventive psychotherapeutic treatment for CHR. Thirdly, we provide a clinical illustration of MBT to emerging psychosis. Finally, we conclude by discussing the specific contributions of MBT approach in youths at CHR, and the necessary research for evaluating its relevance in the context of risk for developing psychosis.
KeywordsMentalizing Schizophrenia Schizotypy Psychodynamic Prevention
We would like to thank Deborah Badoud, Yasmina Lakeshaft Lachat, and Larisa Morosan for their help on the manuscript.
This work was funded by a Swiss National Science Foundation Grant (100019-159440) awarded to M.D.
Compliance with Ethical standards
Conflict of interest
None of the authors declare any conflict of interest.
The patient described in this manuscript gave her full consent after reading the excerpts of text relating to her treatment.
- Arnedo, J., Svrakic, D. M., Del Val, C., Romero-Zaliz, R., Hernandez-Cuervo, H., Genetics, Molecular, et al. (2015). Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. Am J Psychiatry, 172(2), 139–153.CrossRefPubMedGoogle Scholar
- Bateman, A. W., & Fonagy, P. (2012). Handbook of mentalizing in mental health practice. Arlington: Am Psychiatr Publ.Google Scholar
- Clemmensen, L., van Os, J., Drukker, M., Munkholm, A., Rimvall, M. K., Vaever, M., et al. (2015). Psychotic experiences and hyper-theory-of-mind in preadolescence—a birth cohort study. Psychol Med, 46, 1–15.Google Scholar
- Debbané, M. (2015). Schizotypy: A developmental perspective. In O. Mason & G. Claridge (Eds.), Schizotypy: New dimensions. London: Routledge.Google Scholar
- Debbané, M. (2016). Mentaliser. Louvain-la-Neuve: De Boeck Supérieur.Google Scholar
- Debbané, M., Salaminios, G., Badoud, D., Luyten, P., Solida-Tozzi, A., Fonagy, P., et al. (under review). Attachment, neurobiology, and mentalization along the psychosis continuum.Google Scholar
- Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. London: Routledge.Google Scholar
- McGlashan, T. H., Walsh, B. C., & Woods, S. W. (2010). The psychosis-risk prodrome: handbook for diagnosis and follow-up. New York: Oxford University Press.Google Scholar
- Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., et al. (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: The PACE 400 study. [Evaluation studies research support, non-US Gov’t]. JAMA Psychiatry, 70(8), 793–802.CrossRefPubMedGoogle Scholar
- Schimmelmann, B. G., Michel, C., Martz-Irngartinger, A., Linder, C., & Schultze-Lutter, F. (2015). Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies. World Psychiatry, 14(2), 189–197.CrossRefPubMedPubMedCentralGoogle Scholar
- Solms, M. (2013). The conscious id. Psyche-Zeitschrift Fur Psychoanalyse Und Ihre Anwendungen, 67(9–10), 991.Google Scholar