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

Abstract

Background: 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.

Aims: 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.

Method: 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.

Results: 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).

Conclusions: 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.

Keywords: Personality disorders; borderline personality disorder; brief intervention; group psychotherapy; mentalisation-based treatment.

Fig. 1

Association between mentalisation change and change in emotional reactivity and social functioning. Scatterplots show partial correlations between mentalisation change and (a) emotional reactivity and (b) social functioning, controlling for gender and age. Positive score-change on the MZQ horizontal axis indicates improved mentalising capacity. Negative score-change on outcome vertical axes indicates improvements in emotional reactivity (ERS) and social functioning (SFQ). ERS, Emotional Reactivity Scale; MBT, mentalisation-based treatment; MZQ, Mentalization Questionnaire; SFQ, Social Functioning Questionnaire.