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Two-year follow-up and changes in reflective functioning in specialist and nonspecialist treatment models for personality disorder

Chiesa, M; Luyten, P; Fonagy, P; (2021) Two-year follow-up and changes in reflective functioning in specialist and nonspecialist treatment models for personality disorder. Personality Disorders: Theory, Research, and Treatment 10.1037/per0000464. (In press). Green open access

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Abstract

There is a growing body of studies linking impairments in mentalizing or reflective functioning (RF) with childhood adversity, the development of personality disorder (PD), and psychiatric morbidity. Fewer studies have investigated the purported role of changes in RF in relation to clinical outcome in treatments focusing on this capacity. Moreover, it is as yet unclear whether specialist and nonspecialist treatment models are equally effective in bringing about change in RF in conjunction with symptomatic improvement. This study aimed to investigate the association between changes in RF in three samples of individuals with PD treated in two specialist psychosocial programs (a step-down model; RT-CBP, and a long-term residential model; RT) and in an outpatient general psychiatric service (GP) over a 2-year period after intake into treatment. RF was assessed using the Reflective Functioning Scale scored on the Adult Attachment Interview and clinical outcome was assessed in terms of psychiatric distress, social adjustment, and global functioning. Changes in RF were most marked in RT-CBP compared with RT and GP. Changes in RF explained differences between treatment models for social and global adjustment outcomes, but not for disparities in psychiatric distress. A medium-intensity treatment approach to PD such as RT-CBP was more effective in improving RF and provided a balance between psychotherapy input and efforts at social integration, by bringing patients into closer contact with their social world.

Type: Article
Title: Two-year follow-up and changes in reflective functioning in specialist and nonspecialist treatment models for personality disorder
Open access status: An open access version is available from UCL Discovery
DOI: 10.1037/per0000464
Publisher version: https://doi.org/10.1037/per0000464
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: personality disorder, reflective functioning, psychotherapy, psychotherapy research, mechanisms of change
UCL classification: UCL
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: https://discovery.ucl.ac.uk/id/eprint/10107656
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