Division of Psychiatry, Imperial College London, UK.
Health Services Research & Management, City University of London, UK.
Psychol Psychother. 2022 Mar;95(1):212-233. doi: 10.1111/papt.12362. Epub 2021 Aug 29.
Dialectical behaviour therapy (DBT) and mentalization-based therapy (MBT) are widely used evidence-based psychological treatments for borderline personality disorder (BPD). The study aimed to establish evidence on common and unique, and helpful and unhelpful, treatment processes.
Mixed-methods.
In-depth qualitative interview data on patient experiences during treatment were combined with quantitative outcome measures in 73 patients diagnosed with a personality disorder and receiving DBT or MBT.
Across both DBT and MBT, accounts of learning not to react impulsively, learning to question one's thoughts and assumptions, learning to communicate more effectively, and exposure to painful emotions that may previously have been avoided were each associated with less baseline-adjusted self-harm at the end of treatment. Difficulties in interacting with other group members were more likely to be described by patients receiving MBT than DBT, whilst difficulties in the therapeutic relationship were equally common. Both of these types of difficult experience were associated with higher baseline-adjusted levels of BPD traits and emotional dysregulation, at the end of the 12-month study period.
The findings identify novel evidence of common therapeutic processes across DBT and MBT that may help to reduce self-harm. The findings also highlight the potential iatrogenic effect of difficulties in the alliance with therapists or with other group members. This underscores the importance of listening to patients' voices about what they are finding difficult during therapy and working to address these relational challenges, so that the patient is able to progress and make best use of the treatment.
Regardless of whether dialectical behaviour therapy or mentalization based therapy is used, helping service-users to learn not to react impulsively, to question their thoughts and assumptions, and to communicate more effectively, may be beneficial for reducing self-harm. Across both types of therapy, exposure to painful emotions is a difficult experience for service-users, but may also be beneficial for reducing self-harm, if carefully managed. Whilst service-users' experiences across both types of therapy have much in common, accounts of mentalization based therapy stand out in more often describing both helpful and unhelpful experiences of interactions with therapy group members. Service-users across both types of therapy report the benefits of learning intrapersonal mentalization skills, whilst recipients of mentalization based therapy uniquely extend this to learning interpersonal mentalization. Ruptures in the therapeutic alliance, and distressing interactions with group members, may be iatrogenic and must be carefully managed.
辩证行为疗法（DBT）和心理化基础疗法（MBT）是广泛应用于边缘型人格障碍（BPD）的循证心理治疗方法。本研究旨在确定共同的、独特的、有益的和无益的治疗过程的证据。
混合方法。
对 73 名被诊断患有人格障碍并接受 DBT 或 MBT 的患者在治疗期间的患者体验进行深入的定性访谈数据，并结合定量结果进行测量。
在 DBT 和 MBT 中，学习不冲动反应、学习质疑自己的想法和假设、学习更有效地沟通以及接触以前可能避免的痛苦情绪，这些都与治疗结束时自我伤害的基线调整后水平较低有关。在接受 MBT 的患者中，更有可能描述与其他小组成员互动的困难，而在 DBT 中则较少描述这种情况，而在治疗关系中遇到困难的情况在两者中同样常见。在为期 12 个月的研究期间，这两种类型的困难经历都与 BPD 特征和情绪调节的基线调整后水平较高有关。
这些发现确定了 DBT 和 MBT 之间共同治疗过程的新证据，这些证据可能有助于减少自我伤害。这些发现还强调了与治疗师或其他小组成员的联盟中出现困难的潜在治疗性影响。这强调了倾听患者在治疗中遇到困难的声音并努力解决这些关系挑战的重要性，以便患者能够进步并充分利用治疗。
无论使用辩证行为疗法还是心理化基础疗法，帮助服务使用者学习不冲动反应、质疑自己的想法和假设以及更有效地沟通，可能有助于减少自我伤害。在这两种类型的治疗中，接触痛苦的情绪对服务使用者来说是一种困难的经历，但如果处理得当，也可能有助于减少自我伤害。虽然两种类型的治疗中服务使用者的体验有很多共同点，但心理化基础疗法的描述突出了与治疗小组成员的互动中既有帮助又有帮助的体验。两种类型的治疗都有服务使用者报告学习人际心理化技能的好处，而心理化基础疗法的接受者则独特地将其扩展到学习人际心理化技能。治疗联盟的破裂以及与小组成员的痛苦互动可能具有治疗性影响，必须谨慎处理。
