Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial
Open accessAbstract
Objective We examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm.Method A total of 80 adolescents (85% female) consecutively presenting to mental health services with self-harm and comorbid depression were randomly allocated to either MBT-A or TAU. Adolescents were assessed for self-harm, risk-taking and mood at baseline and at 3-monthly intervals until 12 months. Their attachment style, mentalization ability and borderline personality disorder (BPD) features were also assessed at baseline and at the end of the 12-month treatment.Results MBT-A was more effective than TAU in reducing self-harm and depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent BPD symptoms and traits.Conclusions MBT-A may be an effective intervention to reduce self-harm in adolescents.
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Only mentalization-based treatment (MBT-A) has so far demonstrated comparable results.
“Only mentalization-based treatment (MBT-A) 13 has so far demonstrated comparable results.”
From Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial (2014) · cites this paper as [13]
The Discussion reports that MBT-A reduced adolescent self-harm more than routine care and says it was, to the authors’ knowledge, the first specialist adolescent self-harm program shown to outperform routine care. That supports a claim of unusual effectiveness in this setting, but the citing sentence does not identify the results to which MBT-A is supposedly comparable; this paper cannot establish that comparison. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAn important difference between MBT-A and DBT-A is the 3-times-longer duration of MBT-A (1 year) compared to DBT-A (4 months).
“From a pragmatic and economic perspective, an important difference between these treatments is the 3-times-longer duration of MBT-A (1 year) compared to DBT-A (4 months).”
From Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial (2014) · cites this paper as [13]
The MBT-A section describes MBT-A as a year-long program. The paper’s comparison treatment was treatment as usual, not DBT-A; the passages do not establish a four-month DBT-A duration or the claimed threefold difference. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.
“The results indicate that the majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.”
The evidence base for these adaptations is rather scarce; a recent review identified only ten randomized clinical trials.
“The evidence base for these adaptations is rather scarce. A recent review identified only ten randomized clinical trials [22–31].”
In a recent RCT reported by Rossouw and Fonagy, mentalization-based treatment for adolescents was superior to TAU in reducing self-harm and depression.
“In a recent RCT reported by Rossouw and Fonagy, 13 mentalization-based treatment for adolescents was superior to TAU in reducing selfharm and depression.”
From Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial (2014) · cites this paper as [13]
The paucity of randomized controlled trials offers scarce evidence for effective treatments for self-harming adolescents.
“The paucity of randomized controlled trials (RCTs) offers scarce evidence for effective treatments for self-harming adolescents.”
From Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial (2014) · cites this paper as [13]
Interventions aiming to strengthen mentalising ability have been seen to decrease self-injury alongside borderline symptomatology.
“Accordingly, interventions aiming to strengthen mentalising ability have been seen to decrease self-injury alongside borderline symptomatology [36, 37], with further trials ongoing [38].”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [36]
Dropout rates varied widely, ranging from 15 to 75%.
“Dropout rates varied widely, ranging from 15 to 75%.”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [27]
The Treatment Received section reports that 50% of MBT-A participants and 43% of TAU participants completed 12 months of treatment. The Participant Adherence and Statistical Analysis sections do not report dropout rates ranging from 15% to 75%; searches for dropout, attrition, and discontinuation did not locate that range in our copy. (LLM, conf=0.75)
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References 48 · Cited by 746
Research works printed but not linked: 5
- [28]28. Vrouva I, Fonagy P, Fearon PR, Roussow T. The risk-taking and self-harm inventory for adolescents: development and psycho- metric evaluation. Psychol Assess. 2010;22:852-865.
- [39]39. Bateman A, Fonagy P. Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford, UK: Oxford University Press; 2004.
- [48]48. Angold A, Costello EJ, Messer SC, Pickles A, Winder F, Silver D. Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res. 1995;5:237-249.
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- Authors
- Rossouw, T. I., & Fonagy, P.
- Affiliations
- National Health Service (GB)
- Anna Freud Centre (GB)
- ORCID
- Fonagy, Peter
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 51
- Issue
- 12
- Pages
- 1304-1313.e3
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2123106705
- Cited by
- 746
- References
- 48
- Citations by year
- 2026: 38 · 2025: 47 · 2024: 58 · 2023: 51 · 2022: 48 · 2021: 113 · 2020: 71 · 2019: 59 · 2018: 55 · 2017: 45 · 2016: 38 · 2015: 51 · 2014: 40 · 2013: 25 · 2012: 4
- FWCI
- 43.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0510-10228)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- self-harm, adolescents, depression, attachment avoidance, borderline personality traits, risk-taking, usual care, early intervention
- MeSH terms
- Adolescent, Adolescent Behavior, Borderline Personality Disorder, Depression, Female, Humans, Male, Psychiatric Status Rating Scales, Risk-Taking, Comorbidity, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders, Theory of Mind
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