Borderline personality disorder and mentalization-based treatment

Studies of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD).

Background

Mentalization-based treatment is one of the evidence-based treatments developed for borderline personality disorder (BPD). MBT was first introduced in Norway, at the Outpatient Clinic for Specialized Personality Disorder Treatment, Oslo University Hospital in 2008, thereafter in 2009, at the Bergen Addiction Clinic, currently Department of addiction medicine, Haukeland University Hospital, Bergen.

Since then MBT has been widely implemented within the Norwegian Network of Personality Disorder alongside other treatment approaches for personality disorder, manualized treatments and non-manualized, group-based treatments. This project is concerned with the implementation, outcomes, and utility of MBT as provided within specialist mental health and addiction services.

The implementation of MBT facilitated development of Norwegian treatment manuals with systems for evaluation of therapists fidelity to MBT. Norwegian MBT manuals and fidelity scoring systems were fully available from 2012.

Completed clinical MBT studies from the research group, based on data collections (period 2009-2016) among patients with BPD at Oslo University Hospital and a pilot study of patients with substance use disorder (Bergen Addiction Clinic), have supported positive effects, and also indicated that MBT seems well suited for patients with characteristic BPD social cognition problems of hypermentalizing.

When compared to group-based psychodynamic treatment programmes, MBT benefits were particularly found for BPD patients with severe personality disorder. Treatment processes with increasing experience of therapeutic alliance and mutual understanding of therapeutic work (tasks in therapy) have been associated with positive outcomes. Qualitative studies further emphasize positive experiences of group cohesion, the focus on mentalizing, that basic psychoeducation may boost the therapy process and outline a focused therapist strategy as an important aspect of therapeutic alliance. Studies also indicate that the strategic quality of treatment sessions varies, that group-based processes may be difficult for patients feeling too different from others, and particularly challenging for poorly mentalizing patients with inadequate social cognition.

Publications on MBT within the research group

  1. Folmo EJ, Langjord T, Myhrvold NCS, Stänicke E, Majse Lind M, & Kvarstein EH (2022). Pedagogical stance in mentalization‐based treatment. Journal of Clinical Psychology, 1-21. DOI: 10.1002/jclp.23335
  2. Folmo E.J., Stänicke E., Johansen M.S., Pedersen G. & Kvarstein E.H. (2020): Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder, Psychotherapy Research, DOI: 10.1080/10503307.2020.1831097
  3. Ditlefsen, I. T., Nissen-Lie, H. A., Andenæs, A., Normann-Eide, E., Johansen, M. S., & Kvarstein, E. H. (2020). “Yes, There Is Actually Hope!”—A Qualitative Investigation of How Patients Experience Mentalization-Based Psychoeducation Tailored for Borderline Personality Disorder. Journal of Psychotherapy Integration. Advance online publication. http://dx.doi.org/10.1037/int0000243
  4. Kvarstein EH, Folmo E, Antonsen BT, Normann-Eide E, Pedersen G and Wilberg T (2020). Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT). Frontiers in Psychiatry, 11:691. doi: 10.3389/fpsyt.2020.00691
  5. Morken, K. T. E., Binder, P.-E., Arefjord, N. M., & Karterud, S. W. (2019). Mentalization based treatment from the patients’ perspective–What ingredients do they emphasize? Frontiers in Psychology, 10, 1327. doi: 10.3389/fpsyg.2019.01327
  6. Morken, K. T., & Karterud, S. W. (2019). Mentalization-Based Group Therapy (MBT-G) in a Pilot Study of Female Personality Disordered and Substance-Abusing Patients. Gruppenpsychotherapie Und Gruppendynamik, 55(3), 183-205.
  7. Folmo EJ, Karterud SW, Kongerslev M, Kvarstein EH & Stänicke E (2019). Battles of the comfort zone: Modelling therapeutic strategy, alliance, and epistemic trust. A qualitative study of mentalization-based therapy for borderline personality disorder. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-018-09414-3
  8. Kvarstein EH, Pedersen G, Folmo E, Urnes Ø, Johansen M, Hummelen B, Wilberg T & Karterud S (2018). Mentalization-based treatment or psychodynamic treatment programs for patients with borderline personality disorder - the impact of clinical severity. Psychology and Psychotherapy: Theory, Research and Practice. DOI:10.1111/papt.12179
  9. Folmo EJ, Karterud SW, Bremer K, Walther KL, Kvarstein EH & Pedersen GAF (2017). The design of the MBT-G adherence and quality scale. Scandinavian Journal of Psychology, 58, 341–349. DOI: 10.1111/sjop.12375
  10. Karterud S, Pedersen G, Engen M, Johansen MS, Johansson P, Urnes Ø, Wilberg T & Bateman A (2012). The MBT adherence and Competence Scale (MBT-ACS): Development, structure and reliability. Psychotherapy Research, 23(6), 705-717. DOI: 10.1080/10503307.2012.708795.

Further scheduled MBT research and research collaborations

  • Is MBT sustainable? A comparison of MBT effects in two different treatment periods 2009-2012 and 2013-2016 (N=155) (PI: Elfrida Kvarstein).
  • TREATPD: Multicentre large sample study investigating several utility aspects of MBT versus non-manualized treatments as implemented within mental health services. Data collection completed in 2022. (See separate project TREATPD, (PI Elfrida Kvarstein). TREATPD data will also contribute to separate studies of patients with comorbid substance abuse disorder (PI Katharina Morken)
  • «Stick to the plot» - a study investigating the use of case-formulations in MBT, integration of case formulations in the MBT group component and impacts on group cohesion. The project was unfortunately stopped after half-completed data collection, due to the Covid-19 pandemic in March 2020. The collected data will contribute to research on group cohesion in MBT (PI: was Elfrida Kvarstein).

Other current MBT projects for patients with BPD

See project: Minding Mentalizing

Collaborations

  • Network for Personality Pisorders, including the Outpatient Clinic for Specialized Personality Disorder Treatment / Oslo University Hospital and MBT Team at Outpatient Addiction Clinic / Haukeland University Hospital
  • Researchers from the Research Group for Personality Psychiatry
  • Psychotherapy Quality Laboratorium, Oslo University Hospital
  • International collaborator and clinical supervisor: Anthony Bateman (UK).
  • Central in early MBT implementation and early MBT research in Norway, MBT supervision, and MBT education: Sigmund Karterud
  • Nordic MBT research Network collaborated in translation of MBT manuals

Contact

Principle Investigator (Oslo project and main TREATPD)

Principle Investigator (Bergen addiction projects)

Published Feb. 22, 2022 2:48 PM - Last modified Jan. 8, 2024 5:36 PM
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