Bateman Anthony, Fonagy Peter
Consultant Psychiatrist in Psychotherapy, Barnet Enfield and Haringey Mental Health NHS Trust, Halliwick Psychological Therapies Service, St Ann's Hospital, St Ann's Road, London.
Am J Psychiatry. 2009 Dec;166(12):1355-64. doi: 10.1176/appi.ajp.2009.09040539. Epub 2009 Oct 15.
This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder.
Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables.
Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization.
Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.
本随机对照试验在门诊环境中测试了一种为期18个月的基于心智化的治疗（MBT）方法相对于结构化临床管理（SCM）门诊方法治疗边缘型人格障碍的有效性。
连续转诊至专业人格障碍治疗中心且符合入选标准的患者（N = 134）被随机分配至MBT或SCM组。11名经验和培训年限相同的心理健康专业人员担任治疗师。对治疗分配不知情的独立评估人员每6个月进行一次评估。主要结局是危机事件的发生，包括自杀和严重自伤行为以及住院治疗的综合情况。次要结局包括社交和人际功能以及自我报告的症状。每隔6个月评估一次的结局指标，对于二元数据使用混合效应逻辑回归进行分析，对于计数数据使用泊松回归模型进行分析，对于自我报告变量使用混合效应线性增长曲线模型进行分析。
在所有结局变量上，两种治疗条件下均观察到显著改善。随机分配至MBT组的患者在自我报告和具有临床意义的问题（包括自杀未遂和住院治疗）方面下降幅度更大。
结构化治疗可改善边缘型人格障碍患者的结局。关注特定心理过程可为结构化临床支持带来额外益处。基于心智化的治疗在培训方面要求相对较低，因此可能有助于在一般心理健康服务中实施。现在需要独立研究小组进行进一步评估。
