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

Niall M McGowan; Nandana Syam; Debra McKenna; Steve Pearce; Kate E A Saunders

doi:10.1192/bjo.2021.974

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

BJPsych Open. 2021 Aug 2;7(5):e140. doi: 10.1192/bjo.2021.974.

Authors

Niall M McGowan¹, Nandana Syam², Debra McKenna³, Steve Pearce³, Kate E A Saunders⁴

Affiliations

¹ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
² Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, UK.
³ Oxfordshire Complex Needs Service, Oxford Health NHS Foundation Trust, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
⁴ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; and NIHR Oxford Health Biomedical Research Centre, Oxford, UK.

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.