8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual

Halliwick Unit, St. Ann's Hospital, Barnet, Enfield, and Haringey Mental Health Trust, London, UK N15 3TH.
American Journal of Psychiatry (Impact Factor: 12.3). 06/2008; 165(5):631-8. DOI: 10.1176/appi.ajp.2007.07040636
Source: PubMed


This study evaluated the effect of mentalization-based treatment by partial hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete.
Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data.
Five years after discharge from mentalization-based treatment, the mentalization-based treatment by partial hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of medication (0.02 versus 1.90 years taking three or more medications), global function above 60 (45% versus 10%), and vocational status (employed or in education 3.2 years versus 1.2 years).
Patients with 18 months of mentalization-based treatment by partial hospitalization followed by 18 months of maintenance mentalizing group therapy remain better than those receiving treatment as usual, but their general social function remains impaired.

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Available from: Peter Fonagy, Jul 10, 2014
    • "Although investigations into treatments of self-harm are sparse, some methods do show promising results (Crawford & Kumar 2007, Bateman & Fonagy 2008, Mehlum & Holseth 2009), notably dialectical behaviour therapy (DBT). Developed by Marsha Linehan (1993), and originally designed to treat chronically suicidal individuals with borderline personality disorder, DBT is a form of cognitive behavioural therapy that focuses on helping people to learn other coping strategies as alternatives to harming themselves. "
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    ABSTRACT: Accessible summary: This paper adds a phenomenological hermeneutic perspective on meanings of caring for adult people who self-harm as disclosed in narratives of dialectical behaviour therapy (DBT)-trained professionals. This paper shows that providing DBT care for people who self-harm means embarking an unpredictable journey, sometimes lonely, but also often together with the person who self-harm and with the DBT team. This paper emphasizes professionals' benefits of the tools and structure offered by DBT; however, the text points to the importance of the genuine meeting, including confirmation, as a prerequisite to recovery. This paper suggests that further research might focus on the meanings of genuine meetings and their organizational prerequisites. Abstract: In this paper, we aim to explore meanings of caring for adult people who self-harm as described in the narratives of professionals trained in dialectical behaviour therapy (DBT). We conducted narrative interviews with nine professionals working in a DBT team and used a phenomenological hermeneutical method to analyse their narratives. Our comprehensive understanding cast the caring relationship as an unpredictable journey, in which the professionals were guides or companions who aimed to walk side-by-side with the person who self-harms, prove to be trustworthy, and keep on track. They sometimes saw the journey as lonely and sometimes as a joint endeavour. Our analysis was informed by Martin Buber's writings on the 'genuine meeting' and confirmation. The professionals emphasized the importance of the tools and structure offered by DBT; however, the text points to the importance of the genuine meeting, including confirmation, as a prerequisite to recovery. Mental health nurses need opportunities for continuous training and counselling.
    No preview · Article · Feb 2015 · Journal of Psychiatric and Mental Health Nursing
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    • "On one hand she appears competent in some areas, but that competency may at best be a pseudocompetency , and she may need more coping skills and more specific work on cognitive processing that may be more directly addressed through DBT (Linehan et al., 2006) or CBT (Davidson et al., 2006). On the other hand, and this may go back to appreciating in more detail the interpersonal events that occurred in the therapy between sessions 3 and 6, a greater focus on mentalization may be needed (Bateman & Fonagy, 2008), either through adding more emphasis on mentalization in the GPM itself or directing the patient to a more mentalization-specific focused treatment. I would not at this juncture suggest a transference-focused therapy approach because I surmise that it is a lack of coping skills and mentalization that appear to be at the heart of this woman's difficulties that are most likely being experienced quite acutely in the therapy but are probably also experienced more or less intensely in many situations throughout any given day. "

    Preview · Article · Jan 2015 · Personality and Mental Health
    • "Few specific psychotherapeutic treatments have been designed specifically for NSSI. (For a review of exceptions see, e.g., Dialectical Behavior Therapy [Linehan et al., 2006], mentalization-based treatment [Bateman & Fonagy, 2008, 2009], and Muehlenkamp, 2006.) Social support, however, seems to be a key factor both in the prevention and treatment response to NSSI (Wichstrøm, 2009). "
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    ABSTRACT: Teenagers and young adults who had experienced child maltreatment, being bullied in school and other serious life events have an increased risk of Non-Suicidal Self-Injury (NSSI), but some individuals manage to escape serious stressful life events. The research question is: does social support make a difference? A national representative sample of 4,718 persons born in 1984 were selected for an interview about their childhood, maltreatment, serious life events and social support in order to test if social support during childhood is a statistical mediator between childhood disadvantages and NSSI. The survey obtained a 67% response rate (N=2,980). The incidence rate of NSSI among this sample was estimated at 2.7% among young adult respondents. Participants with a history of child maltreatment, being bullied in school or other traumatic life events reported a rate of NSSI 6 times greater than participants without this history (odds ratio: 6.0). The correlation between traumatic life events during adolescence and NSSI is reduced when low social support is accounted for in the statistical model (p<0.01). The results indicate that social support is a partial mediator for NSSI. The reported low self-esteem indicates the importance of treating adolescents who are engaged in NSSI with respect and dignity when they are treated in the health care system. Results further imply that increasing social support may reduce the likelihood of NSSI. Copyright © 2014 Elsevier Ltd. All rights reserved.
    No preview · Article · Nov 2014 · Child Abuse & Neglect
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