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Mentalization-based treatment in groups for adolescents with Borderline Personality Disorder: 3- and 12-month follow-up of a randomized controlled trial

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Abstract

Mentalization-based treatment in groups (MBT-G) has never been tested in adolescents with Borderline Personality Disorder (BPD) in a randomized controlled trial. The current study aimed to test the long-term effectiveness of MBT-G in an adolescent sample with BPD or BPD features (≥ 4 DSM-5 BPD criteria). Hundred and eleven patients with BPD (n = 106) or BPD features (n = 5) were randomized to either (1) a 1-year modified MBT-G program comprising three MBT introductory sessions, five individual case formulation sessions, 37 weekly MBT group sessions, and six MBT-Parent sessions, or (2) treatment as usual (TAU), defined as at least 12 individual monthly treatment sessions with follow-up assessments at 3 and 12 months post treatment. The primary outcome was the score on the Borderline Personality Features Scale for Children (BPFS-C), and secondary outcomes included clinician-rated BPD symptoms and global level of functioning as well as self-reported self-harm, depression, externalizing and internalizing symptoms, and caregiver reports. There were no statistically significant differences between MBT-G and TAU on the primary outcome measure or any of the secondary outcomes. Both groups showed improvement on the majority of clinical and social outcomes at both follow-up points, although remission rates were modest with just 35% in MBT-G and 39% in TAU 2 years after inclusion into the study. MBT-G was not superior to TAU in improving borderline features in adolescents. Although improvement was observed equally in both interventions over time, the patients continued to exhibit prominent BPD features, general psychopathology and decreased functioning in the follow-up period, which points to a need for more research and better understanding of effective components in early intervention programs. The ClinicalTrials.gov identifier is NCT02068326.

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Acknowledgements

The authors wish to thank all the participants and their families for participating in this study. We thank the staff at the child and adolescent psychiatry in Region Zealand, and their managers for their support. We are grateful to the therapists and supervisors. We thank the members of the steering committee and a special acknowledgement of Michael Maagensen for assisting in the development of the medical protocol. Thank you to our research assistants Louise Lejbach and Christian Fjellerad Andersen, and also to Karterud for his supervision of therapists and advice on the design of the MBT group program. Thank you to Trygfonden, Department of Child and Adolescent Psychiatry, Psychiatric Research Unit and the Health Scientific Research Fund of Region Zealand, and Department of Health and Medical Sciences at University of Copenhagen for funding this study.

Funding

TrygFonden (Grant Number 115638), Department of Child and Adolescent Psychiatry Region Zealand, Psychiatric Research Unit Region Zealand, the Health Scientific Research Fund of Region Zealand, and Department of Health and Medical Sciences, University of Copenhagen.

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Authors and Affiliations

  1. Psychiatric Research Unit, Region Zealand, Fælledvej 6, 4200, Slagelse, Denmark

    Mie Sedoc Jørgensen, Ole Jakob Storebø, Sune Bo, Emma Beck & Erik Simonsen

  2. Child and Adolescent Psychiatric Department, Region Zealand, Smedegade 16, 4000, Roskilde, Denmark

    Mie Sedoc Jørgensen, Ole Jakob Storebø, Sune Bo, Emma Beck & Jesper Pedersen

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Mie Sedoc Jørgensen & Erik Simonsen

  4. Department of Psychology, University of Southern Denmark, Odense, Denmark

    Ole Jakob Storebø

  5. Department of Psychology, University of Copenhagen, 2A Øster Farimagsgade, 1353, Copenhagen, Denmark

    Stig Poulsen, Matthias Gondan & Emma Beck

  6. Orygen, Melbourne, Australia, and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Andrew M. Chanen

  7. Research Department of Clinical, Education and Health Psychology, University College London, London, UK

    Anthony Bateman

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  1. Mie Sedoc Jørgensen
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Correspondence to Mie Sedoc Jørgensen.

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Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The trial is also approved by the Regional Ethics Committee of Zealand (No: SJ-371), and is registered at the Danish Data Protection Agency (No: REG-55-2014).

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Jørgensen, M.S., Storebø, O.J., Bo, S. et al. Mentalization-based treatment in groups for adolescents with Borderline Personality Disorder: 3- and 12-month follow-up of a randomized controlled trial. Eur Child Adolesc Psychiatry 30, 699–710 (2021). https://doi.org/10.1007/s00787-020-01551-2

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