Skip to main content
Log in

Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments

  • Personality Disorders (K Bertsch, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

This review aims to outline the most recent evidence on the efficacy and effectiveness of mentalization-based treatment (MBT) for personality disorders (PD) from 2015 to 2018 and to describe new treatment developments.

Recent Findings

Since 2015, 14 new—primarily effectiveness—MBT trials have been published. The main body of studies investigated adult populations (n = 11), patients with a borderline personality disorder (BPD) diagnosis (n = 8), and compared MBT with another psychotherapeutic treatment (n = 6). The majority of studies suggest that MBT has the potential to improve the clinical outcomes for adolescents and adults with a PD diagnosis, particularly BPD, and also with comorbid diagnoses and there are indications for changes in mentalizing being a specific mechanism of change promoted by MBT.

Summary

Despite promising findings, there is an urgent need for methodological sound and sufficiently powered studies to investigate both the efficacy and effectiveness of MBT, especially beyond BPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barnicot K, Katsakou C, Marougka S, Priebe S. Treatment completion in psychotherapy for borderline personality disorder - a systematic review and meta-analysis. Acta Psychiatr Scand. 2011;123(5):327–38. Available from:. https://doi.org/10.1111/j.1600-0447.2010.01652.x.

    Article  CAS  PubMed  Google Scholar 

  2. Brazier J, Tumur I, Holmes M, Ferriter M, Parry G, Dent-Brown K, et al. Psychological therapies including dialectical behaviour therapy for borderline personality disorder: a systematic review and preliminary economic evaluation. Health Technol Assess. 2006;10(35):1–61.

    Article  Google Scholar 

  3. Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319–28.

    Article  Google Scholar 

  4. Juanmartí FB, Lizeretti NP. The efficacy of psychotherapy for borderline personality disorder: A review. Papeles del Psicólogo. 2017;38(2):148–56.

  5. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet [Internet]. (2011 Jan 1) [cited 2018 Nov 1];377(9759):74–84. Available from: https://www.sciencedirect.com/science/article/pii/S0140673610614225

  6. Stoffers J, Völlm B, Lieb K. AS14–02 - Common and distinct treatment elements in psychotherapies for borderline personality disorder. Eur Psychiatry [Internet]. (2012 Jan 1) [cited 2018 Nov 1];27:1. Available from: https://www.sciencedirect.com/science/article/pii/S0924933812739937

  7. Calati R, Courtet P. Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data. J Psychiatr Res. 2016/04/30 ed. 2016;79:8–20.

    Article  Google Scholar 

  8. American Psychiatric Association. APA DSM-5 [Internet]. Diagnostic and statistical manual of mental disorders. 2013. (DSM-5®). American Psychiatric Pub.

  9. Volkert J, Gablonski T-C, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. Br J Psychiatry [Internet]. (2018 Sep 28) [cited 2018 Nov 1];1–7. Available from: https://www.cambridge.org/core/product/identifier/S0007125018002027/type/journal_article.

  10. Torgersen S. Epidemiology. In: Oldham J M, Skodol A E, Bender D S. (eds.) The American Psychiatric Publishing textbook of personality disorders. Arlington: American Psychiatric Publishing, Inc. 2005. p. 129–42.

  11. Frankenburg FR, Zanarini MC. The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization. J Clin Psychiatry. 2004;65(12):1660–5.

    Article  Google Scholar 

  12. Moran P, Romaniuk H, Coffey C, Chanen A, Degenhardt L, Borschmann R, et al. The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study. Lancet Psychiatry. 2016;3(7):636–45.

    Article  Google Scholar 

  13. Hiroeh U, Appleby L, Mortensen PB, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet. 2001;358(9299):2110–2.

    Article  CAS  Google Scholar 

  14. Oldham JM. Treatment in psychiatry borderline personality disorder and suicidality. Am J Psychiatry. 2006;163(1):20–6.

    Article  Google Scholar 

  15. Gunderson J, Weinberg I, Choi-Kain L. Borderline Personality Disorder. Vol. 11. FOCUS: The Journal of Lifelong Learning in Psychiatry; 2013. 249–260 p

    Google Scholar 

  16. Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet. 2015;385:717–26.

  17. Jobst A, Hörz S, Birkhofer A, Martius P, Rentrop M. Einstellung von psychotherapeuten gegenüber der behandlung von patienten mit borderline persönlichkeitsstörung. Psychother Psychosom Medizinische Psychol. 2010;60(3–4):126–31.

    Article  Google Scholar 

  18. Bateman A, Fonagy P. Mentalization-based treatment for personality disorders: a practical guide. New York: Oxford University Press. 2016.

  19. Fonagy P, Gergely G, Jurist E, Target M. Affect regulation, Mentalization, and the development of self. New York: Other Press; 2002.

    Google Scholar 

  20. Katznelson H. Reflective functioning: A review. Clin Psychol Rev. 2014;34:107–17.

  21. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol [Internet]. (2009 Nov 14) [cited 2018 Nov 2];21(04):1355. Available from: http://www.journals.cambridge.org/abstract_S0954579409990198.

  22. Rossouw TI, Fonagy P. mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry [Internet]. (2012);51(12):1304–13. Available from: trudie.rossouw@nelft.nhs.uk.

  23. Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156(10):1563–9.

  24. Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1355–64.

  25. Bales D, van Beek N, Smits M, Willemsen S, Busschbach JJV, Verheul R, et al. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands. J Pers Disord. 2012;26(4):568–82.

  26. Jorgensen CR, Freund C, Boye R, Jordet H, Andersen D, Kjolbye M. Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr Scand. 2013 Apr;127(4):305–17.

    Article  CAS  Google Scholar 

  27. Bateman A, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008;165(5):631–8.

    Article  Google Scholar 

  28. Bateman A, Fonagy P. Personality Disorders : Theory , Research , and Treatment A Randomized Controlled Trial of a Mentalization-Based Borderline Personality Disorder A Randomized Controlled Trial of a Mentalization-Based Intervention (MBT-FACTS) for Families of People With. 2019;10(1):70.

  29. •• Bateman A, O’Connell J, Lorenzini N, Gardner T, Fonagy P. A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry. (2016);16:304. This RCT found a reduction of suicide attempts, self-harming behaviour, and depressive symptoms with medium to moderate effect sizes in the MBT group compared to structured clinical management for patients with both Antisocial and Borderline PD.

  30. • Falconer CJ, Cutting P, Davies EB, Hollis C, Stallard P, Moran P. Adjunctive avatar therapy for mentalization-based treatment of borderline personality disorder: A mixed-methods feasibility study. Evid Based Ment Health. 2017;20(4):123–7 This feasibility study reports promising results on the usefulness of avatar-MBT as an add-on to standard MBT with regard to facilitating perspective taking, emotional distancing and group participation in a sample of patients with BPD.

    Article  Google Scholar 

  31. • Laurenssen EMP, Luyten P, Kikkert MJ, Westra D, Peen J, Soons MBJ, et al. Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial. Psychol Med. 2018;27:1–8 This study reports significantly fewer drop-outs in the intensive day hospital MBT compared to TAU, but no significant differences between the groups in any of the outcome variables in patients with a BPD diagnosis.

    Google Scholar 

  32. Möller C, Kalgren L, Sandell A, Falkenström F, Philips B. Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence. Trials. 2016/07/14 ed. 2017;27(6):749–65.

    Google Scholar 

  33. Philips B, Wennberg P, Konradsson P, Franck J. Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study. Eur Addict Res. 2018/02/07 ed. 2018;24(1):1–8.

    Article  Google Scholar 

  34. Robinson P, Hellier J, Barrett B, Barzdaitiene D, Bateman A, Bogaardt A, et al. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials. 2016/11/20 ed. 2016;17(1):549.

    Article  Google Scholar 

  35. Bales DL, Timman R, Andrea H, Busschbach JJV, Verheul R, Kamphuis JH. Effectiveness of day hospital Mentalization-based treatment for patients with severe borderline personality disorder: a matched control study. Clin Psychol Psychother. 2015;22(5):409–17.

  36. Bales DL, Timman R, Luyten P, Busschbach J, Verheul R, Hutsebaut J. Implementation of evidence-based treatments for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment. Personal Ment Health. 2017;11(4):266–77.

    Article  Google Scholar 

  37. Bo S, Sharp C, Beck E, Pedersen J, Gondan M, Simonsen E. First empirical evaluation of outcomes for Mentalization-based group therapy for adolescents with BPD. Personal Disord Theory Res Treat. 2017;8(4):396–401.

    Article  Google Scholar 

  38. •• Edel MA, Raaff V, Dimaggio G, Buchheim A, Brüne M. Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder – A pilot study. Br J Clin Psychol. 2017;56(1):1–15 This study found that DBT+MBT was superior to DBT in reducing fearful attachment, improving affective mentalizing and reducing self-harm in a female sample of patients with BPD.

    Article  Google Scholar 

  39. Griffiths H, Noble A, Duffy F, Schwannauer M. Innovations in practice: evaluating clinical outcome and service utilization in an AMBIT-trained tier 4 child and adolescent mental health service. Child Adolesc Ment Health. 2017;22(3):170–4.

    Article  Google Scholar 

  40. Hauber K, Boon AE, Vermeiren R. Examining changes in personality disorder and symptomology in an adolescent sample receiving intensive mentalization based treatment: a pilot study. Child Adolesc Psychiatry Ment Health. 2017;1–7. Available from: https://doi.org/10.1186/s13034-017-0197-9.

  41. Kvarstein EH, Pedersen G, Folmo E, Urnes Ø, Johansen MS, Hummelen B, et al. Mentalization-based treatment or psychodynamic treatment programmes for patients with borderline personality disorder - the impact of clinical severity. Psychol Psychother Theory Res Pract. 2018. 1-21.

  42. Kvarstein EH, Pedersen G, Urnes Ø, Hummelen B, Wilberg T, Karterud S. Changing from a traditional psychodynamic treatment programme to mentalization-based treatment for patients with borderline personality disorder – does it make a difference? Psychol Psychother Theory, Res Pract. 2015;88(1):71–86.

  43. Thomsen MS, Ruocco AC, Uliaszek AA, Mathiesen BB, Simonsen E. Changes in neurocognitive functioning after 6 months of Mentalization-based treatment for borderline personality disorder. J Pers Disord. 2017;31(3):306–24.

  44. Byrne G, Lees G. When the bough breaks the lighthouse programme. In: Celebi M, editor. Weaving the cradle: facilitating groups to promote attunement and bonding between parents, their babies and toddlers. London: Singing Dragon; 2017. p. 144–54.

    Google Scholar 

  45. Taubner S, Gablonski T-C, Hauschild S, Schroeder-Pfeifer P, Kaess M, Wladika W, et al. Mentalization-based Treatment for adolescents with conduct disorder: feasibility and pilot study. (submitted).

  46. Bevington D, Fuggle P, Cracknell L, Fonagy P. Adaptive Mentalization-based integrative Treatment: A guide for teams to develop Systems of Care [internet]. New York, NY; [cited 15 November 2018]. Available from: http://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780198718673.001.0001/med-9780198718673

  47. Bateman AW, Fonagy P, editors. Handbook of mentalizing in mental health practice. Handbook of mentalizing in mental health practice. Arlington, VA, US: American Psychiatric Publishing, Inc.; 2012. xxiii, 593-xxiii, 593.

  48. •• Malda-Castillo J, Browne C, Perez-Algorta G. Mentalization-based treatment and its evidence-base status: A systematic literature review. Psychol Psychother Theory Res Pract [Internet]. 2018. [cited 10 November 2018]. Available from: j.maldacastillo@lancaster.ac.uk, This systematic literature review on the evidence-base status of MBT found that MBT is a potentially effictive method across a range of mental disorders, but concludes that future studies need to increase their methodological quality.

  49. De Meulemeester C, Vansteelandt K, Luyten P, Lowyck B. Mentalizing as a Mechanism of Change in the Treatment of Patients With Borderline Personality Disorder: A Parallel Process Growth Modeling Approach. Personal Disord Theory Res Treat. 2017;9(1):22–9.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jana Volkert.

Ethics declarations

Conflict of Interest

Jana Volkert, Sophie Hauschild, and Svenja Taubner declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Personality Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Volkert, J., Hauschild, S. & Taubner, S. Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments. Curr Psychiatry Rep 21, 25 (2019). https://doi.org/10.1007/s11920-019-1012-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-019-1012-5

Keywords

Navigation