Efficacy of mentalization‐based therapy in treating self‐harm: A systematic review and meta‐analysis
Open accessAbstract
Introduction: Mentalization‐based therapy (MBT) and its adapted version for adolescents (MBT‐A) are repeatedly highlighted as promising treatments for reducing self‐harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self‐harm, recent meta‐analyses have yielded mixed results. To inform best‐practice clinical decision‐making, we conducted a systematic review and meta‐analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(‐A) in reducing self‐harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). Methods: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre–post, three RCTs) and five MBT‐A studies (two pre–post, three RCTs). Aggregated effect sizes were estimated using random‐effects models. Meta‐regressions were conducted to assess the effect of moderator variables (treatment duration, drop‐out rates, and age) on effect sizes. Results: Overall, both MBT and MBT‐A demonstrated promising effects in reducing self‐harm ( g = −0.82, 95% CI −1.15 to −0.50), borderline personality disorder ( g = −1.08, 95% CI −1.38 to −0.77), and depression ( g = −1.1, 95% CI −1.52 to −0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(‐A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults ( g = −0.56, 95% CI −0.88 to −0.24). Conclusion: Although the pre–post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(‐A) to control conditions, so that prioritizing the application of MBT (‐A) for the treatment of self‐harm is not supported. Possible explanations and further implications are discussed.
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Several types of MBT for BPD are empirically supported.
“Several types of MBT for BPD are empirically supported [40–42].”
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“However, a recent systematic review and meta-analysis on the efficacy of MBT in treating self-harm showed no superiority of MBT to control conditions (e.g., treatment as usual, structured clinical management) [11].”
BackgroundRemeeus, M. G. A., Clarke, S. L., Feenstra, D. J., Van Eeren, H., Smits, M. L., Debruyne, S., Kouijzer, M. E. J., Luyten, P., Scholte, R. H. J., & Hutsebaut, J. (2024) · Trials · doi:10.1186/s13063-024-08095-9 · Cited by 3 · see citing works
- Authors
- Hajek Gross, C., Oehlke, S., Prillinger, K., Goreis, A., Plener, P. L., & Kothgassner, O. D.
- Affiliations
- Department of Child and Adolescent Psychiatry Medical University Vienna Vienna Austria
- Medical University of Vienna (AT)
- Universität Ulm (DE)
- Corresponding author
- Kothgassner, Oswald D.
- ORCID
- Venue
- Suicide and Life-Threatening Behavior
- Publisher
- Wiley
- Published
- 2024-01-27
- Volume
- 54
- Issue
- 2
- Pages
- 317-337
- ISSN
- 0363-0234 (ISSN-L)
- 1943-278X
- OpenAlex
- W4391280662
- Cited by
- 31
- References
- 19
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 4 · 2021: 1
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Suicide and Life-Threatening Behavior (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Austrian Science Fund (KLI963‐B)
- Medizinische Universität Wien
- 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 › Psychotherapy Techniques and Applications
- Keywords
- mentalization-based treatment, self-harm, borderline personality disorder, depression, treatment efficacy, adolescents, adults, psychotherapy
- MeSH terms
- Mentalization, Mentalization-Based Therapy, Adolescent, Adult, Borderline Personality Disorder, Depression, Humans, Psychotherapy, Self-Injurious Behavior, Treatment Outcome
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