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Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial

Smits, ML; Feenstra, DJ; Eeren, HV; Bales, DL; Laurenssen, EMP; Blankers, M; Soons, MBJ; ... Luyten, PJ; + view all (2019) Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial. The British Journal of Psychiatry 10.1192/bjp.2019.9. (In press).

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Abstract

BACKGROUND: Two types of Mentalization-Based Treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): Day Hospital MBT (MBT-DH) and Intensive Outpatient MBT (MBT-IOP). No trial has yet compared their efficacy. AIMS: To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesized to be superior to MBT-IOP because of its higher treatment intensity. METHOD: In a multicentre randomized controlled trial conducted at three sites in the Netherlands, BPD patients were randomly assigned to MBT-DH (n=70) or MBT-IOP (n=44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every six months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles. RESULTS: Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes. CONCLUSIONS: Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients in MBT-DH and MBT-IOP thus seem to follow different trajectories of change, which may have important implications for clinical decisionmaking. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialized treatments such as MBT for BPD patients. DECLARATION OF INTEREST: P.L. and D.B. have been involved in the training and dissemination of MBT.

Type: Article
Title: Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial
DOI: 10.1192/bjp.2019.9
Publisher version: https://doi.org/10.1192/bjp.2019.9
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Mentalization-based treatment, Borderline personality disorder, Randomized controlled trial, Treament intensity
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: http://discovery.ucl.ac.uk/id/eprint/10065923
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