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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: a.laurenssen@kenniscentrum-kjp.nl
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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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