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Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder:Multicentre randomised clinical trial

Authors :
Matthijs Blankers
Elisabeth M. P. Laurenssen
Zwaan Lucas
Jack Dekker
Dawn Bales
Dine J. Feenstra
Patrick Luyten
Maaike L. Smits
Roel Verheul
Mirjam Soons
Hester V Eeren
APH - Mental Health
Clinical Psychology
Source :
Smits, M L, Feenstra, DI J, Eeren, H V, Bales, D L, Laurenssen, E M P, Blankers, M, Soons, M B J, Dekker, J J M, Lucas, Z, Verheul, R & Luyten, P 2020, ' Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder : Multicentre randomised clinical trial ', British Journal of Psychiatry, vol. 216, no. 2, pp. 79-84 . https://doi.org/10.1192/bjp.2019.9, British Journal of Psychiatry, 216(2), 79-84. Royal College of Psychiatrists
Publication Year :
2020

Abstract

BackgroundTwo 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.AimsTo 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.MethodIn 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.ResultsSignificant 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.ConclusionsAlthough 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.

Details

Language :
English
ISSN :
00071250
Database :
OpenAIRE
Journal :
Smits, M L, Feenstra, DI J, Eeren, H V, Bales, D L, Laurenssen, E M P, Blankers, M, Soons, M B J, Dekker, J J M, Lucas, Z, Verheul, R & Luyten, P 2020, ' Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder : Multicentre randomised clinical trial ', British Journal of Psychiatry, vol. 216, no. 2, pp. 79-84 . https://doi.org/10.1192/bjp.2019.9, British Journal of Psychiatry, 216(2), 79-84. Royal College of Psychiatrists
Accession number :
edsair.doi.dedup.....9a0de71b998cb2b278e08d6c0479721e