Smiits, ML;
Luyten, P;
Feenstra, DJ;
Bales, DL;
Kamphuis, JH;
Dekker, JJM;
Verheul, R;
(2022)
Trauma and outcome in mentalization-based therapy for borderline personality disorder.
American Journal of Psychotherapy
, 75
(1)
pp. 12-20.
10.1176/appi.psychotherapy.20210027.
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Abstract
Background: Recent meta-analyses suggest that many patients with borderline personality disorder (BPD) have a history of (complex) trauma. Although trauma is central in mentalization-based approaches to the understanding of BPD, surprisingly little is known about the effects of trauma on treatment outcomes in Mentalization-based treatment (MBT). This paper investigates the prevalence and impact of childhood trauma in BPD patients in MBT in the context of a randomized controlled trial comparing MBT day hospital (MBT-DH) and intensive outpatient MBT (MBT-IOP). Methods. All 114 patients from the original multicenter RCT were included. Childhood trauma was assessed at baseline by the Childhood Trauma Questionnaire and its impact on symptom severity, interpersonal functioning and borderline pathology was investigated over a time horizon of 36 months after start of treatment using multilevel modeling. Results. Childhood trauma was very common in BPD patients referred to MBT, with more than 85% of patients meeting cut-off criteria for substantial childhood trauma. However, childhood trauma had little impact on outcome in both MBT-DH and MBT-IOP in terms of improvements in BPD features and interpersonal functioning, although patients with high levels of childhood trauma seemed to improve more rapidly in MBT-DH compared with MBT-IOP in terms of symptom severity. Patients with a history of emotional neglect also showed more rapid changes in BPD symptoms in MBT-DH compared with MBT-IOP. Conclusions. Findings are discussed in the context of a social communicative approach to BPD, with a focus on the need to address trauma in (MBT) treatment for BPD.
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