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

Abstract

Objectives: Few 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.

Design: A naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after transition to MBT.

Methods: The 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.

Results: BPD 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.

Conclusions: The study confirms the effectiveness of MBT for BPD patients and indicates greater clinical benefits than in traditional psychodynamic treatment programmes.

Practitioner points: MBT 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.

Keywords: MBT; borderline personality disorder; group psychotherapy; mentalization-based treatment; psychodynamic psychotherapy; step-down programme.