A service evaluation of short-term mentalisation based treatment for personality disorder

• Published in: BJPsych open Vol. 7; no. 5; p. e140
• Main Authors: McGowan, Niall M., Syam, Nandana, McKenna, Debra, Pearce, Steve, Saunders, Kate E. A.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.09.2021
• Subjects: Borderline personality disorder; brief intervention; Emotions; group psychotherapy; Intervention; Mental health; Mental Health Services; mentalisation-based treatment; Personality disorders; Psychotherapy; Questionnaires; Therapy; brief intervention; mentalisation-based treatment; Personality disorders; borderline personality disorder; group psychotherapy
• ISSN: 2056-4724; 2056-4724
• DOI: 10.1192/bjo.2021.974

People with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment. We aimed to evaluate mental health, client satisfaction and psychological functioning outcomes before and after a 10-week group MBT programme as part of a stepped-care out-patient personality disorder service. We examined routinely collected pre-post treatment outcomes from 176 individuals (73% female) aged 20-63 years, attending a dedicated out-patient personality disorder service, who completed MBT treatment. Participants completed assessments examining mentalising capacity, client satisfaction, emotional reactivity, psychiatric symptom distress and social functioning. Post-MBT outcomes suggested increased mentalising capacity (mean difference 5.1, 95% CI 3.4-6.8, P < 0.001) and increased client satisfaction with care (mean difference 4.3, 95% CI 3.3-5.2, P < 0.001). Post-MBT emotional reactivity (mean difference -6.3, 95% CI -8.4 to -4.3, P < 0.001), psychiatric symptom distress (mean difference -5.2, 95% CI -6.8 to -3.7, P < 0.001) and impaired social functioning (mean difference -0.7, 95% CI -1.2 to -0.3, P = 0.002) were significantly lower than pre-treatment. Improved mentalising capacity predicted improvements in emotional reactivity (β = -0.56, P < 0.001) and social functioning (β = -0.35, P < 0.001). Short-term MBT as a low-intensity treatment for personality disorder was associated with positive pre-post treatment changes in social and psychological functioning. MBT as deployed in this out-patient service expands access to personality disorder treatment.