Manual Assisted Cognitive Treatment for Deliberate Self-Harm in Borderline Personality Disorder Patients

Harvard University, Cambridge, Massachusetts, United States
Journal of Personality Disorders (Impact Factor: 2.31). 11/2006; 20(5):482-92. DOI: 10.1521/pedi.2006.20.5.482
Source: PubMed


This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.

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    • "It has been used successfully in those with personality disturbance and has been shown to significantly reduce the number of repeated self-harm episodes.5 When specifically adapted for a personality disorder population, MACT resulted in a significant decrease in the frequency and severity of self-harm.6 "
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    ABSTRACT: Aims and method To assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months’ follow-up. Results Twenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation. Clinical implications It is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.
    06/2014; 38(3):108-11. DOI:10.1192/pb.bp.113.043109
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    • "The current research sought to extend previous evidence regarding MACT in a number of ways. First, the study sought to explore the utility of MACT as a stand-alone outpatient treatment for BPD and BPD-related suicidality, in contrast to previous studies where MACT was often part of an inpatient treatment or a more extensive outpatient treatment regimen (e.g., Weinberg et al., 2006), or in which multiple diagnoses were sampled (e.g., Tyrer et al., 2003). Although this is not a controlled clinical trial in that we do not compare MACT to a control condition here, we are able to compare the effects of MACT without concurrent treatments in this study to the effects of MACT with concurrent treatments from previous research. "
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    ABSTRACT: This study examined the efficacy of Manual Assisted Cognitive Therapy (MACT) as a stand-alone treatment for Borderline Personality Disorder (BPD) with suicidal ideation, and piloted a Therapeutic Assessment (TA) intervention among 16 patients randomly assigned to MACT or MACT+TA. Although MACT was associated with significant reductions in BPD features and suicidal ideation, less than half of the sample completed the treatment. The TA augmentation did not improve treatment retention but it was associated with somewhat greater clinical improvement. Although findings associate MACT with symptom reduction among persisting patients, attrition rate was problematically high in the overall sample.
    Psychiatry Research 08/2010; 178(3):531-5. DOI:10.1016/j.psychres.2010.04.055 · 2.47 Impact Factor
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    • "A wave of effective new therapies has been developed for the treatment of borderline personality disorder that is distinct from those that would be used to treat bipolar disorder. These include long and short versions of dialectal behavior therapy (Linehan et al., 2006; Lynch et al., 2006; Stanley et al., 2007), short and long term cognitive behavioral therapy tailored for borderline personality disorder (Davidson et al., 2006; Weinberg et al., 2006), mentalization-based and transference-focused therapy (Bateman & Fonagy, 2008; Clarkin et al., 2007), schema-focused therapy (Giesen-Bloo et al., 2006; Young, 1999) and adjunctive group psychoeducation (Blum et al., 2008). Misdiagnosis would presumably delay the use of these more appropriate psychotherapies. "
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    ABSTRACT: Recent reports suggest bipolar disorder is not only under-diagnosed but may at times be over-diagnosed. Little is known about factors that increase the odds of such mistakes. The present work explores whether symptoms of borderline personality disorder increase the odds of a bipolar misdiagnosis. Psychiatric outpatients (n=610) presenting for treatment were administered the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for DSM-IV Personality for DSM-IV axis II disorders (SIDP-IV), as well as a questionnaire asking if they had ever been diagnosed with bipolar disorder by a mental health care professional. Eighty-two patients who reported having been previously diagnosed with bipolar disorder but who did not have it according to the SCID were compared to 528 patients who had never been diagnosed with bipolar disorder. Patients with borderline personality disorder had significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was unique in predicting this outcome. Patients with borderline personality disorder, regardless of how they meet criteria, may be at increased risk of being misdiagnosed with bipolar disorder.
    Journal of Psychiatric Research 11/2009; 44(6):405-8. DOI:10.1016/j.jpsychires.2009.09.011 · 3.96 Impact Factor
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