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Region Hovedstaden - en del af Københavns Universitetshospital

Mechanisms of change in mentalization-based therapy for borderline personality disorder: Patient attachment and therapist attunement

Projekt: Typer af projekterProjekt

  • Simonsen, Sebastian (Projektleder, organisatorisk)
  • Juul , Sophie (Projektdeltager)
  • Hestbæk , Emilie (Projektdeltager)
  • Sørensen, Per (Projektdeltager)
  • Poulsen, Stig, Institut for psykologi, Københavns Universitet, Danmark (Projektleder, faglig)
  • Talia, Alessandro, Department of Public Health and Primary Care, University of Cambridge, Storbritannien (Samarbejdspartner)
  • Falkenström, Fredrik, Linnaeus University, Sverige (Samarbejdspartner)
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- Background and rationale:
A recent Cochrane systematic review with meta-analysis assessing the effects of psychotherapy for borderline personality disorder (BPD), concluded that some specialized psychotherapy approaches are more effective than treatment as usual (TAU) in reducing BPD symptom severity, self-harm, suicide-related outcomes and depression. However, only changes in BPD symptom severity reached a clinically important level, and the quality of studies is generally considered low, with small effects and a risk of inflated effects due to risk of bias and unstable results at follow-up (Storebø et al.,2020). While evidence for efficacy of treatment for a group of severely disturbed patients is very encouraging, an important next step for the field is to better understand the processes behind these effects. Specifically, within process research, it is important to investigate the actual therapeutic situation and to take the perspective of both the patient (asking, “how do patients change within the psychotherapeutic process?”) and the therapist (asking, “what are the most helpful interventions?”). Knowing answers to these questions is essential for both successful training and implementation.

Mentalization-based therapy (MBT) is an evidence-based manualized treatment for BPD and is recommended inclinical guidelines. While the theoretical model, as presented by Bateman and Fonagy has a solid empirical foundation in research on PDs and their relationship with attachment and social cognition, research that specifically tests mentalization as a mechanism of change in psychotherapy trials is still needed. So far, research has demonstrated that mentalizing correlates with symptom change, while only one study has directly tested and supported mentalizing as the mechanism of change in MBT.Thus, more research is needed to replicate and extend results, particularly concerning the temporal association between improved mentalization and general symptom distress. Such research should preferably use an observer-rated measure of mentalization, measured in-session. This avoids the limited validity of self-reported measures of mentalization and embeds the result within an understanding of psychotherapy change occurring within an interpersonal encounter. The current project meets both these standards and, in addition, is embedded in an ongoing,well-conducted RCT in the Capital Region of Denmark investigating the beneficial and harmful effects of short-term compared with long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder.

- Objectives:
The aim of the current study is to research the in-session processes of MBT for people suffering from BPD by analysing attachment-related behaviour in the psychotherapeutic dialogue with the use of the Patient Attachment Coding System (PACS) and the Therapist Attunement Scales (TASc). The study aims to promote the understanding of change processes in therapy with regard to both patient change (do attachment and mentalization change within therapy, and do these changes explain symptom change?) and therapist attunement (how does therapist attunement facilitate better patient mentalizing?).

- Methods
In an ongoing RCT, MBT therapy sessions are videotaped for ratings of adherence to ensure that the interventions delivered are MBT as prescribed by the treatment manual. The present project will generate new data by analysing the videotaped individual sessions using the PACS and TASc measures.

ID: 79720114