Kvarstein E H, Bremer K, Baltzersen Å L, Ekberg A, Normann-Eide E, Ulvestad D A, Pedersen G, Wilberg T
Section for Treatment Research, Dpt for Research and Innovation, Division for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Personal Ment Health. 2025 Nov;19(4):e70036. doi: 10.1002/pmh.70036.
Though positive effects of mentalization-based treatment (MBT) for patients with severe borderline personality disorder (BPD) are increasingly documented, less is known about the sustainability of specialized treatment standards and the maintenance of positive outcomes over time. This study aimed to investigate the organizational and clinical sustainability of an outpatient MBT program across two successive treatment periods. The study compares outpatients referred to MBT in a tertiary-level, specialist mental health service in 2009-2011 (Period I: n = 96) versus 2011-2015 (Period II: n = 89). Organizational quality was based on the MBT quality manual (2019). By structured clinical interviews and repeated self-reports, comparisons included baseline characteristics of eligible patients, clinical outcomes during treatment, therapeutic alliance, therapist countertransferences, and treatment adherence. The MBT team, organization, and systems for quality assurance held satisfactory standards and stability across the two time periods largely compatible with manual recommendations. Patient selection to MBT was in accordance with the targeted patient group, admitting poorly functioning young adults with BPD in both periods. Period II included patients with more severe BPD and self-harming behaviors. Clinical improvement rendered effect sizes in the large range irrespective of time period, and overall 70% remission rates of self-harming. Patient-reported alliance to therapists and therapist-reported countertransference responses were stable with satisfactory levels in both periods. Both periods had low rates of drop-out, though higher in Period II. Results support positive effects and sustainability of MBT for poorly functioning BPD patients treated in a tertiary outpatient MBT-unit within a supportive and stable organizational environment.
尽管基于心理化的治疗（MBT）对重度边缘型人格障碍（BPD）患者的积极效果越来越多地得到记录，但对于专门治疗标准的可持续性以及随着时间推移积极结果的维持情况却知之甚少。本研究旨在调查门诊MBT项目在两个连续治疗阶段的组织和临床可持续性。该研究比较了2009 - 2011年（第一阶段：n = 96）与2011 - 2015年（第二阶段：n = 89）在三级专科心理健康服务机构中接受MBT治疗的门诊患者。组织质量基于MBT质量手册（2019年）。通过结构化临床访谈和重复的自我报告，比较内容包括符合条件患者的基线特征、治疗期间的临床结果、治疗联盟、治疗师的反移情以及治疗依从性。MBT团队、组织和质量保证系统在两个时间段内都保持了令人满意的标准和稳定性，在很大程度上与手册建议相符。入选MBT的患者符合目标患者群体，两个阶段均收治功能较差的患有BPD的年轻成年人。第二阶段纳入了病情更严重且有自我伤害行为的患者。无论时间段如何，临床改善的效应量都处于较大范围，总体自我伤害缓解率为70%。患者报告的与治疗师的联盟以及治疗师报告的反移情反应在两个阶段都很稳定且水平令人满意。两个阶段的退出率都很低，尽管第二阶段略高。结果支持了在支持性和稳定的组织环境中，在三级门诊MBT单元中接受治疗的功能较差的BPD患者接受MBT治疗具有积极效果和可持续性。
