Antonsen Bjørnar T, Johansen Merete S, Rø Frida G, Kvarstein Elfrida H, Wilberg Theresa
Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Department of Psychology, University of Oslo, Oslo, Norway.
Compr Psychiatry. 2016 Jan;64:46-58. doi: 10.1016/j.comppsych.2015.05.016. Epub 2015 Jun 3.
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).
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.
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.
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.
心理化是一种将行为理解为各种心理状态表达的能力，被认为在一系列精神病理学中，尤其是人格障碍（PDs）中很重要。本研究的首要目的是调查以反思功能（RF）衡量的心理化能力与进入研究治疗前的临床表现之间的关系。第二个目的是调查基线RF与长期临床结果之间的关系，既包括独立于治疗的情况（预测分析），也包括依赖于治疗的情况（调节分析）。
来自一项随机临床试验（乌勒瓦尔人格项目）的79名患有边缘型和/或回避型PD的患者被随机分配到一个逐步递减治疗方案组，该方案包括短期日间医院治疗，随后是门诊联合小组治疗和个体心理治疗，或者门诊个体心理治疗组。在基线、8个月、18个月、3年和6年时，对患者的症状困扰、心理社会功能、人格功能和自尊等变量进行评估。
在基线时，RF与广泛的变量显著相关。在纵向分析中，未发现RF是长期临床结果的预测因素。然而，在考虑治疗类型时，RF有显著的调节作用。与逐步递减治疗方案相比，RF低的患者在门诊个体治疗中预后更好。相反，中等RF组的患者在逐步递减治疗方案中取得了更好疗效。
这些发现表明，RF与人格病理学的核心方面相关，并捕捉了成年PD患者临床上的相关现象。此外，具有不同心理化能力的患者可能需要不同类型的治疗方法。
