Bjørnar T Antonsen1, Merete S Johansen2, Frida G Rø3, Elfrida H Kvarstein4, Theresa Wilberg5. 1. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: bjornar.antonsen@medisin.uio.no. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: merete.johansen@medisin.uio.no. 3. Department of Psychology, University of Oslo, Oslo, Norway. Electronic address: f.g.ro@psykologi.uio.no. 4. Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: elfridak@online.no. 5. Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: uxthwi@ous-hf.no.
Abstract
OBJECTIVE: Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). METHODS:Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years. RESULTS: RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. CONCLUSION: These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
RCT Entities:
OBJECTIVE: Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). METHODS: Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years. RESULTS: RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. CONCLUSION: These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
Authors: Alessandro Talia; Madeleine Miller-Bottome; Hannah Katznelson; Signe H Pedersen; Howard Steele; Paul Schröder; Amy Origlieri; Fredrik B Scharff; Guido Giovanardi; Mart Andersson; Vittorio Lingiardi; Jeremy D Safran; Susanne Lunn; Stig Poulsen; Svenja Taubner Journal: Psychother Res Date: 2018-01-03
Authors: Ole Jakob Storebø; Jutta M Stoffers-Winterling; Birgit A Völlm; Mickey T Kongerslev; Jessica T Mattivi; Mie S Jørgensen; Erlend Faltinsen; Adnan Todorovac; Christian P Sales; Henriette E Callesen; Klaus Lieb; Erik Simonsen Journal: Cochrane Database Syst Rev Date: 2020-05-04