Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial

Emma Beck; Sune Bo; Mie Sedoc Jørgensen; Matthias Gondan; Stig Poulsen; Ole Jakob Storebø; Christian Fjellerad Andersen; Espen Folmo; Carla Sharp; Jesper Pedersen; Erik Simonsen

doi:10.1111/jcpp.13152

Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial

Emma Beck^*, Sune Bo, Mie Sedoc Jørgensen, Matthias Gondan, Stig Poulsen, Ole Jakob Storebø, Christian Fjellerad Andersen, Espen Folmo, Carla Sharp, Jesper Pedersen, Erik Simonsen

^*Corresponding author for this work

Department of Clinical Medicine

19 Citations (Scopus)

Abstract

Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. Method: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. Results: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval −6.3 to 7.1, p =.91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. Conclusions: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.

Original language	English
Journal	Journal of Child Psychology and Psychiatry and Allied Disciplines
ISSN	0021-9630
DOIs	https://doi.org/10.1111/jcpp.13152
Publication status	Published - 1 May 2020

Keywords

adolescence
borderline personality disorder
group psychotherapy
Mentalization-based treatment
mentalizing

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10.1111/jcpp.13152

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Beck, E., Bo, S., Jørgensen, M. S., Gondan, M., Poulsen, S., Storebø, O. J., Fjellerad Andersen, C., Folmo, E., Sharp, C., Pedersen, J., & Simonsen, E. (2020). Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial. Journal of Child Psychology and Psychiatry and Allied Disciplines. https://doi.org/10.1111/jcpp.13152

Beck, E, Bo, S, Jørgensen, MS, Gondan, M , Poulsen, S, Storebø, OJ, Fjellerad Andersen, C, Folmo, E, Sharp, C, Pedersen, J & Simonsen, E 2020, 'Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial', Journal of Child Psychology and Psychiatry and Allied Disciplines. https://doi.org/10.1111/jcpp.13152

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title = "Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial",

abstract = "Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. Method: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. Results: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval −6.3 to 7.1, p =.91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. Conclusions: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.",

keywords = "adolescence, borderline personality disorder, group psychotherapy, Mentalization-based treatment, mentalizing",

author = "Emma Beck and Sune Bo and J{\o}rgensen, {Mie Sedoc} and Matthias Gondan and Stig Poulsen and Storeb{\o}, {Ole Jakob} and {Fjellerad Andersen}, Christian and Espen Folmo and Carla Sharp and Jesper Pedersen and Erik Simonsen",

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doi = "10.1111/jcpp.13152",

language = "English",

journal = "Journal of Child Psychology and Psychiatry and Allied Disciplines",

issn = "0021-9630",

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T1 - Mentalization-based treatment in groups for adolescents with borderline personality disorder

T2 - a randomized controlled trial

AU - Beck, Emma

AU - Bo, Sune

AU - Jørgensen, Mie Sedoc

AU - Gondan, Matthias

AU - Poulsen, Stig

AU - Storebø, Ole Jakob

AU - Fjellerad Andersen, Christian

AU - Folmo, Espen

AU - Sharp, Carla

AU - Pedersen, Jesper

AU - Simonsen, Erik

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. Method: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. Results: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval −6.3 to 7.1, p =.91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. Conclusions: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.

AB - Background: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. Method: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. Results: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval −6.3 to 7.1, p =.91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. Conclusions: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.

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KW - borderline personality disorder

KW - group psychotherapy

KW - Mentalization-based treatment

KW - mentalizing

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DO - 10.1111/jcpp.13152

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SN - 0021-9630

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JF - Journal of Child Psychology and Psychiatry and Allied Disciplines

ER -

Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial

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