Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)

Sophie Juul; Janus Christian Jakobsen; Emilie Hestbaek; Caroline Kamp Jørgensen; Markus Harboe Olsen; Marie Rishede; Frederik Weischer Frandsen; Sune Bo; Susanne Lunn; Stig Poulsen; Per Sørensen; Anthony Bateman; Sebastian Simonsen

doi:10.1159/000534289

Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)

Sophie Juul^*, Janus Christian Jakobsen, Emilie Hestbaek, Caroline Kamp Jørgensen, Markus Harboe Olsen, Marie Rishede, Frederik Weischer Frandsen, Sune Bo, Susanne Lunn, Stig Poulsen, Per Sørensen, Anthony Bateman, Sebastian Simonsen

^*Corresponding author for this work

4 Citations (Scopus)

Abstract

INTRODUCTION: Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT.

OBJECTIVE: The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD.

METHODS: Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, NCT03677037.

RESULTS: Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056).

CONCLUSION: Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

Original language	English
Journal	Psychotherapy and Psychosomatics
Volume	92
Issue number	5
Pages (from-to)	329-339
Number of pages	11
ISSN	0033-3190
DOIs	https://doi.org/10.1159/000534289
Publication status	Published - 1 Dec 2023

Keywords

Borderline personality disorder
Mentalization-based therapy
Randomized clinical trial
Short-term psychotherapy

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10.1159/000534289

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Juul, S., Jakobsen, J. C., Hestbaek, E., Jørgensen, C. K., Olsen, M. H., Rishede, M., Frandsen, F. W., Bo, S., Lunn, S., Poulsen, S., Sørensen, P., Bateman, A., & Simonsen, S. (2023). Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT). Psychotherapy and Psychosomatics, 92(5), 329-339. https://doi.org/10.1159/000534289

Juul, S , Jakobsen, JC , Hestbaek, E , Jørgensen, CK , Olsen, MH, Rishede, M, Frandsen, FW, Bo, S, Lunn, S, Poulsen, S, Sørensen, P, Bateman, A & Simonsen, S 2023, 'Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)', Psychotherapy and Psychosomatics, vol. 92, no. 5, pp. 329-339. https://doi.org/10.1159/000534289

@article{07420acbb42d407893951d176742cef3,

title = "Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)",

abstract = "INTRODUCTION: Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT.OBJECTIVE: The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD.METHODS: Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037.RESULTS: Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056).CONCLUSION: Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.",

keywords = "Borderline personality disorder, Mentalization-based therapy, Randomized clinical trial, Short-term psychotherapy",

author = "Sophie Juul and Jakobsen, {Janus Christian} and Emilie Hestbaek and J{\o}rgensen, {Caroline Kamp} and Olsen, {Markus Harboe} and Marie Rishede and Frandsen, {Frederik Weischer} and Sune Bo and Susanne Lunn and Stig Poulsen and Per S{\o}rensen and Anthony Bateman and Sebastian Simonsen",

note = "{\textcopyright} 2023 The Author(s). Published by S. Karger AG, Basel.",

year = "2023",

month = dec,

day = "1",

doi = "10.1159/000534289",

language = "English",

volume = "92",

pages = "329--339",

journal = "Psychotherapy and Psychosomatics",

issn = "0033-3190",

publisher = "S./Karger AG",

number = "5",

}

TY - JOUR

T1 - Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder

T2 - A Randomized Clinical Trial (MBT-RCT)

AU - Juul, Sophie

AU - Jakobsen, Janus Christian

AU - Hestbaek, Emilie

AU - Jørgensen, Caroline Kamp

AU - Olsen, Markus Harboe

AU - Rishede, Marie

AU - Frandsen, Frederik Weischer

AU - Bo, Sune

AU - Lunn, Susanne

AU - Poulsen, Stig

AU - Sørensen, Per

AU - Bateman, Anthony

AU - Simonsen, Sebastian

PY - 2023/12/1

Y1 - 2023/12/1

N2 - INTRODUCTION: Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT.OBJECTIVE: The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD.METHODS: Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037.RESULTS: Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056).CONCLUSION: Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

AB - INTRODUCTION: Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT.OBJECTIVE: The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD.METHODS: Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037.RESULTS: Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056).CONCLUSION: Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

KW - Borderline personality disorder

KW - Mentalization-based therapy

KW - Randomized clinical trial

KW - Short-term psychotherapy

UR - http://www.scopus.com/inward/record.url?scp=85177597084&partnerID=8YFLogxK

U2 - 10.1159/000534289

DO - 10.1159/000534289

M3 - Journal article

C2 - 37935133

SN - 0033-3190

VL - 92

SP - 329

EP - 339

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

IS - 5

ER -

Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)

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