Health Care Psychologist and PhD Student, de Viersprong and the Viersprong Institute for Studies on Personality Disorders, the Netherlands.
Clinical Psychologist and Principal Investigator, de Viersprong, the Netherlands.
Br J Psychiatry. 2020 Feb;216(2):79-84. doi: 10.1192/bjp.2019.9.
Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD 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 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
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.
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 receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
已经开发出两种基于心理化的治疗（MBT）来治疗边缘型人格障碍（BPD）：日间医院 MBT（MBT-DH）和强化门诊 MBT（MBT-IOP）。目前还没有研究比较它们的疗效。
比较 MBT-DH 和 MBT-IOP 在治疗开始后 18 个月的疗效。由于 MBT-DH 的治疗强度更高，因此假设其优于 MBT-IOP。
在荷兰三个地点进行的一项多中心随机对照试验（荷兰试验登记处：NTR2292）中，将 BPD 患者随机分配到 MBT-DH（n = 70）或 MBT-IOP（n = 44）组。主要结局是症状严重程度（Brief Symptom Inventory）。次要结局指标包括边缘症状、人格功能、人际功能、生活质量和自伤。从基线到治疗开始后 18 个月，患者每 6 个月评估一次。使用基于意向治疗原则的多层次建模对数据进行分析。
所有结局指标均有显著改善，两组的效应大小均为中度至非常大。MBT-DH 在主要结局指标上并不优于 MBT-IOP，但 MBT-DH 在次要结局上显示出明显的优势。
尽管 MBT-DH 的治疗强度更大，但在主要结局指标上并不优于 MBT-IOP，但 MBT-DH 在次要结局上显示出更强的疗效倾向，特别是在关系功能方面。因此，接受 MBT-DH 和 MBT-IOP 的患者似乎遵循不同的变化轨迹，这可能对临床决策具有重要意义。长期随访和成本效益考虑最终可能决定 MBT 等专门治疗对 BPD 患者的最佳强度。
