Changing from a traditional psychodynamic treatment programme to mentalization‐based treatment for patients with borderline personality disorder – Does it make a difference?

Abstract

ObjectivesFew studies outside United Kingdom have documented effects of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). This study aimed to investigate outcomes for BPD patients treated in an MBT programme in a Norwegian specialist treatment unit and compare benefits of the implemented MBT with the unit's former psychodynamic treatment programme.DesignA naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after transition to MBT.MethodsThe sample consisted of 345 BPD patients treated in the period 1993–2013. Before 2008, patients were admitted to a psychodynamic treatment programme (n = 281), after 2008 patients received MBT (n = 64). Symptom distress, interpersonal problems, and global functioning were assessed repeatedly throughout the treatment. Suicidal/self-harming acts, hospital admissions, medication, and occupational status were assessed at the start and end of treatment. Therapists' competence and adherence to MBT was rated and found satisfactory. The statistical method for longitudinal analyses was mixed models.ResultsBPD patients in MBT and in the former psychodynamic treatment programme had comparable baseline severity and impairments of functioning. BPD patients in MBT had a remarkably low drop-out rate (2%), significantly lower than the former treatment. Improvements of symptom distress, interpersonal, global and occupational functioning were significantly greater for MBT patients. Large reductions in suicidal/self-harming acts, hospital admissions, and use of medication were evident in the course of both treatments.ConclusionsThe study confirms the effectiveness of MBT for BPD patients and indicates greater clinical benefits than in traditional psychodynamic treatment programmes.Practitioner pointsMBT is an effective treatment for patients with BPD.MBT can successfully be implemented in therapeutic settings outside United Kingdom and may be more beneficial than psychodynamic treatment programmes for BPD patients.

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

“…Treatment (MBT/PDT) was added as a categorical predictor to each model. The effect of treatment was the main result in the former study (Kvarstein et al ., ), rendered significantly larger benefits for patients in MBT than PDT on all the outcome measures, and explained 16% residual slope variation in the different models. Estimates for step 2 are given in Tables 2–4.…”

“…This study compares longitudinal effects of clinical severity in a sample of patients with BPD who received MBT or a traditional, psychodynamic, group-based treatment programme (PDT). This sample is described in a former study comparing outcomes in the two treatment approaches (Kvarstein et al, 2014). It compared outcomes for patients treated within the same department, but before and after a change in treatment approach, from PDT (period 1993PDT (period -2008 to MBT (period 2008MBT (period -2013.…”