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Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial

Published online by Cambridge University Press:  26 February 2018

Elisabeth M. P. Laurenssen ,
Patrick Luyten ,
Martijn J. Kikkert ,
Dieuwertje Westra ,
Jaap Peen ,
Mirjam B. J. Soons ,
Anne-Marie van Dam ,
Anna J. van Broekhuyzen ,
Matthijs Blankers  and
Jan J. V. Busschbach
...Show all authors
Elisabeth M. P. Laurenssen*
Affiliation:
Dutch Knowledge Centre for Child and Adolescent Psychiatry, Utrecht, The Netherlands
Patrick Luyten
Affiliation:
Faculty of Psychology and Educational Sciences, University of Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, UK
Martijn J. Kikkert
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
Dieuwertje Westra
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
Jaap Peen
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
Mirjam B. J. Soons
Affiliation:
NPI Specialist in Personality Problems, Amsterdam, The Netherlands
Anne-Marie van Dam
Affiliation:
Mentrum, Amsterdam, The Netherlands
Anna J. van Broekhuyzen
Affiliation:
De Viersprong, Amsterdam, The Netherlands
Matthijs Blankers
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Trimbos Institute, Utrecht, The Netherlands
Jan J. V. Busschbach
Affiliation:
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
Jack J. M. Dekker
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Department of Clinical Psychology, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
*
Author for correspondence: Elisabeth Laurenssen, E-mail: [email protected]
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Abstract

Background

Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service.

Methods

Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles.

Results

Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%).

Conclusions

MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.

Keywords

Mentalization-Based Treatmentborderline personality disorderrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2522 - 2529
Copyright
Copyright © Cambridge University Press 2018 

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References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ed., text revision. Washington, DC: American Psychiatric Association.Google Scholar
Arntz, A, van den Hoorn, MA, Cornelis, J, Verheul, R, van den Bosch, WMC and de Bie, AJHT (2003) Reliability and validity of the borderline personality disorder severity index. Journal of Personality Disorders 17, 45–59.Google Scholar
Bales, D, van Beek, N, Smits, M, Willemsen, S, Busschbach, JJV, Verheul, R et al. (2012) Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands. Journal of Personality Disorders 26, 568–582.Google Scholar
Bales, DL, Timman, R, Andrea, H, Busschbach, JJ, Verheul, R and Kamphuis, JH (2015) Effectiveness of day hospital mentalization-based treatment for patients with severe borderline personality disorder: a matched control study. Clinical Psychology and Psychotherapy 22, 409–417.Google Scholar
Bales, DL, Timman, R, Luyten, P, Busschbach, JJV, Verheul, R and Hutsebaut, J (2017) Implementation of evidence based treatment programs in routine clinical practice: the impact of organizational changes on treatment outcome of day-hospital mentalization-based treatment (MBT-DH). Personality and Mental Health 11, 266–277.Google Scholar
Bateman, A, Bales, D and Hutsebaut, J (2012) A Quality Manual for MBT. London: Anna Freud National Centre for Children and Families. http://www.annafreud.org/media/1217/a-quality-manual-for-mbt-edited-april-23rd-2014-2.pdf.Google Scholar
Bateman, A and Fonagy, P (1999) Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. American Journal of Psychiatry 156, 1563–1569.Google Scholar
Bateman, A and Fonagy, P (2001) Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. American Journal of Psychiatry 158, 36–42.Google Scholar
Bateman, A and Fonagy, P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford: Oxford University Press.Google Scholar
Bateman, A and Fonagy, P (2008) 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry 165, 631–638.Google Scholar
Bateman, A and Fonagy, P (2009) Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry 166, 1355–1364.Google Scholar
Bateman, A and Krawitz, R (2013) Borderline Personality Disorder: An Evidence-Based Guide for Generalist Mental Health Professionals. Oxford: Oxford University Press.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J and Erbaugh, J (1961) An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Blankers, M, Koeter, MWJ and Schippers, GM (2010) Missing data approaches in eHealth research: simulation study and a tutorial for nonmathematically inclined researchers. Journal of Medical Internet Research 12, e54.Google Scholar
Blum, N, St John, D, Pfohl, B, Stuart, S, McCormick, B, Allen, J et al. (2008) Systems training for emotional predictability and problem solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. American Journal of Psychiatry 165, 468–478.Google Scholar
Busschbach, JJV, McDonnell, J, Essink-Bot, ML and van Hout, BA (1999) Estimating parametric relationships between health description and health valuation with an application to the EuroQol EQ-5D. Journal of Health Economics 18, 551–571.Google Scholar
Chanen, AM, Jackson, HJ, McCutcheon, LK, Jovev, M, Dudgeon, P, Yuen, HP et al. (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. British Journal of Psychiatry 193, 477–484.Google Scholar
Clarkin, JF, Levy, KN, Lenzenweger, MF and Kernberg, OF (2007) Evaluating three treatments for borderline personality disorder: a multiwave study. American Journal of Psychiatry 164, 922–928.Google Scholar
Committee on Comparative Effectiveness Research Prioritization (2009) Initial National Priorities for Comparative Effectiveness Research. Washington, DC: National Academies Press.Google Scholar
Cristea, IA, Gentili, C, Cotet, CD, Palomba, D, Barbui, C and Cuijpers, P (2017) Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry 74, 319–328.Google Scholar
De Beurs, E (2006) Brief Symptom Inventory (BSI): Handleiding. Leiden, The Netherlands: Pits BV.Google Scholar
Distel, MA, De Moor, MHM and Boomsma, DI (2009) Nederlandse vertaling van de personality assessment inventory-borderline schaal (PAI-BOR): normgegevens, factorstructuur en betrouwbaarheid. Psychologie en Gezondheid 37, 38–46.Google Scholar
Fonagy, P, Luyten, P and Allison, E (2015) Epistemic petrification and the restoration of epistemic trust: a new conceptualization of borderline personality disorder and its psychosocial treatment. Journal of Personality Disorders 29, 575–609.Google Scholar
Fonagy, P, Luyten, P, Allison, E and Campbell, C (2017a) What we have changed our minds about: part 1. Borderline personality disorder as a limitation of resilience. Borderline Personality Disorder and Emotion Dysregulation 4, 11.Google Scholar
Fonagy, P, Luyten, P, Allison, E and Campbell, C (2017b) What we have changed our minds about: part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation 4, 9.Google Scholar
Fonagy, P, Luyten, P and Bateman, A (2017c) Treating borderline personality disorder with psychotherapy: where do we go from here? JAMA Psychiatry 74, 316–317.Google Scholar
Giesen-Bloo, J, van Dyck, R, Spinhoven, P, van Tilburg, W, Dirksen, C, van Asselt, T et al. (2006) Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry 63, 649–658.Google Scholar
Honaker, J, King, G and Blackwell, M (2011) Amelia II: a program for missing data. Journal of Statistical Software 45, 1–47.Google Scholar
Horowitz, LM, Alden, LE, Wiggins, JS and Pincus, AL (2000) Inventory of Interpersonal Problems: Manual. San Antonio: Psychological Corporation.Google Scholar
Karterud, S, Pedersen, G, Engen, M, Johansen, MS, Johansson, PN, Schluter, C et al. (2013) The MBT adherence and competence scale (MBT-ACS): development, structure and reliability. Psychotherapy Research 23, 705–717.Google Scholar
Laurenssen, EMP, Eeren, HV, Kikkert, MJ, Peen, J, Westra, D, Dekker, JJM et al. (2016) The burden of disease in patients eligible for mentalization-based treatment (MBT): quality of life and costs. Health and Quality of Life Outcomes 14, 145.Google Scholar
Laurenssen, EMP, Smits, ML, Bales, DL, Feenstra, DJ, Eeren, HV, Noom, MJ et al. (2014a) Day hospital mentalization-based treatment versus intensive outpatient mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial. BMC Psychiatry 14, 301.Google Scholar
Laurenssen, EMP, Westra, D, Kikkert, MJ, Noom, MJ, Eeren, HV, van Broekhuyzen, AJ et al. (2014b) Day hospital mentalization-based treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial. BMC Psychiatry 14, 149.Google Scholar
Leichsenring, F, Leibing, E, Kruse, J, New, AS and Leweke, F (2011) Borderline personality disorder. Lancet 377, 74–84.Google Scholar
Livesley, WJ (2012) Integrated treatment: a conceptual framework for an evidence-based approach to the treatment of personality disorder. Journal of Personality Disorders 26, 17–42.Google Scholar
McMain, SF, Guimond, T, Streiner, DL, Cardish, RJ and Links, PS (2012) Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry 169, 650–661.Google Scholar
National Institute for Health and Clinical Excellence (2009) Borderline Personality Disorder: Treatment and Management. London: National Institute for Health and Clinical Excellence.Google Scholar
Rubin, DB (1987) Multiple Imputation for Survey Nonresponse. New York: Wiley.Google Scholar
StataCorp (2011) Stata Statistical Software: Release 12. College Station: StataCorp..Google Scholar
Stoffers, JM, Vollm, BA, Rucker, G, Timmer, A, Huband, N and Lieb, K (2012) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews 8, CD005652.Google Scholar
Van Groenestijn, MAC, Akkerhuis, GW, Kupka, RW, Schneider, N and Nolen, WA (1999) Gestructureerd Klinisch Interview Voor de Vaststelling van DSM-IV As I Stoornissen. Amsterdam, The Netherlands: Harcourt Test Publishers.Google Scholar
Van Oenen, FJ, Bernardt, C and Van der Post, L (2007) Praktijkboek Crisisinterventie. Utrecht, The Netherlands: De Tijdstroom.Google Scholar
Weertman, A, Arntz, A and Kerkhofs, MLM (2000) SCID II; Gestructureerd Klinisch Interview voor DSM-IV As-II Persoonlijkheidsstoornissen. Amsterdam, The Netherlands: Harcourt Test Publishers.Google Scholar
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A et al. (1998) Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry 155, 1733–1739.Google Scholar
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