New mentalization-based therapy for borderline personality disorder

Introduction: Borderline Personality Disorder (BPD) is characterised by deficits in affect and impulse regulation, along with interpersonal difficulties (Lieb et al., 2004). It is thought to develop through a complex relationship between adverse childhood events, such as childhood abuse and genetics. A recent developmental model of BPD and one that is gaining popularity focuses on mentalization. Following their exposition of the mentalizing model of BPD, Bateman and Fonagy developed the Mentalization Based Treatment (MBT) intervention for BPD (Bateman & Fonagy 2006). This intervention includes both group and individual therapy with the focus on the patient’s relationship with the therapist and other members of the group. Promising evidence that MBT interventions are effective for treating symptoms of BPD is beginning to emerge. Methods: First a systematic review examining the prevalence of childhood abuse in BPD patients was conducted. Second, an empirical study of the efficacy of a group-only adaptation of the MBT intervention for BPD, delivered in a routine health service setting. Finally, planned exploratory analyses were conducted in order to ascertain what factors might predict group completion. Results: The results of the systematic review suggested that that emotional abuse (mean prevalence 63%) and emotional neglect (mean prevalence 63.1%) are the most common forms of abuse reported by this population followed by physical neglect (mean prevalence 40.89%) , sexual abuse (mean prevalence 36.9%) and physical abuse (mean prevalence 32.49%). The results of the second study revealed that the HUB is an acceptable treatment to participants, with indicators of treatment efficacy in relation to reducing overall psychiatric symptoms along with specific symptoms including interpersonal sensitivities, depression, phobic anxiety and paranoid ideation. Finally, exploratory analyses suggested that patients who were older and with less histrionic symptoms (as defined by the Personality Disorder Questionnaire-4) were more likely to complete the HUB. Conclusions: These findings demonstrate that a group-only MBT intervention displays promising effectiveness in treating core symptoms of BPD and is acceptable to patients. Further it suggests that group-only MBT interventions are worth continued investigation both into their efficacies and the potential efficiencies associated a group-based intervention