Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

“The BPD patients in this study are likely to be representative for BPD patients assigned to MBT or OPT in the Netherlands.”

“This possibility is supported by previous research indicating that day treatment has powerful, beneficial effects for patients with a variety of Axis II disorders (Ogrodniczuk and Piper, 2001), including those typically associated with a high degree of pathology (Bateman and Fonagy, 1999).”

“A mentalisationbased format for psychotherapy for borderline personality disorder, MBT, was developed and manualised, and has been shown to be effective in a randomised controlled clinical trial (Bateman & Fonagy, 1999).”

“These scores were comparable to those of other BPD treatment trials that employed these measures (Bateman & Fonagy, 1999; Koons et al., 2001).”

“Subgroup analysis provided moderate quality positive effects of MBT on suicidal behavior, self-injury and dysfunctional interpersonal patterns in comparison with SCM.”

“Together with the results of other studies (27), the data from our study contrast with previous reports that psychodynamic psychotherapy has little efficacy among psychiatric patients (28).”

“Fortunately, the results of major outcome-studies of the past decade indicate that today’s treatments for BPD are effective in reducing depression (Bateman & Fonagy, 1999; Bohus et al., 2004, 2000; Brown, Newman, Charlesworth, Crits-Christoph, & Beck, 2004; Koons et al., 2001; Kröger et al., 2006;…”

“DBT places an emphasis on reducing self-harming and on emotion regulation [15], whereas MBT focuses on understanding and developing relationship skills [17].”

“…therapies aimed, in part, at ameliorating maladaptive attachment in borderline personality disorder showed efficacy in preventing suicidal behavior (Bateman and Fonagy, 1999) or “suicidality” (Clarkin et al., 2007), with the latter showing evidence of improving attachment patterns (Levy et al.,…”

“effective than general psychiatric services in reducing suicidal and self-mutilatory acts.(10) Similarly, relative to TAU alone, PST plus usual care resulted in a decrease in repeat hospitalizations for self-harm in individuals with a history of previous selfharm.”

“Research in which this mentalization-based psychotherapeutic approach was used in conjunction with medication in a day hospital program indicated that it is highly efficacious but requires at least 12 months (62).”

“…includes both long-term psychotherapies delivered in a day hospital setting and a group format (e.g., Mentalization Based Treatment as described by Bateman & Fonagy, 1999, 2001), and short-term psychotherapies delivered in an out-patient setting and an individual format (e.g., cognitive therapy…”

“Whether the results of the study would have been different if a substantial percentage of those with borderline personality disorder had participated in one of the psychotherapeutic approaches specifically developed for the treatment of borderline personality disorder (dialectical behavioral treatment or DBT [11], men…”

“…psychotherapy, ranging from milder adjustment disorders or stress reactions to severe personality disorders, such as borderline personality disorder or psychotic conditions (Bateman & Fonagy, 1999, 2001; Clarkin, Yeomans, & Kernberg, 1999; Gill, 1951; Luborsky, 1984; Schlesinger, 1969).”

“Although there is debate about whether and to what extent hospitalization is effective for people with a BPD diagnosis (Clarke et al. 2013; Bateman & Fonagy 1999; Paris, 2004; Verhaeghe & Bracke 2008), there is evidence that hospital admission can be helpful (Helleman et al. 2013).”

“…recent support for a psychoanalytically based approach has come from a randomised study examining the effectiveness of a psychoanalytically oriented partial hospitalisation programme with standard psychiatric care for patients with border-line personality disorder (Bateman & Fonagy, 1999, 2001).”

“” Similar to Bateman and Fonagy’s effectiveness study (7), our study was conducted in a naturalistic setting, we excluded few severe cases with complicated comorbidity, and we included consecutive patients with low socioeconomic levels and health status.”

“Although these therapies are relatively new with children and families, there are positive data regarding effectiveness in adults with personality disorders and impaired mentalising abilities ( Bateman and Fonagy, 1999 , 2001 , 2004 ).”

“…in reducing repetition of self-harm: one after 6 months’ follow-up (Guthrie et al, 2001), three at the completion of the intervention duration of 12 months (Linehan et al, 1991; Brown et al, 2005; Carter et al, 2005); and one at treatment completion after 18 months (Bateman & Fonagy, 1999).”

“Further, psychoanalytic research is increasingly published in prestigious mainstream journals in psychology and psychiatry (e.g., Bateman and Fonagy 1999, 2001; Blatt et al. 1998; Leichsenring, Rabung, and Leibing 2004; Lenzenweger et al. 2001; Levy, Clarkin, and Kernberg in press; Shedler and…”

“This manualized treatment was first implemented in a partial hospital setting, which served a relatively poor catchment area of London and which was part of England s National Health Service (15).”

“Although mentalization-based treatment (MBT) (Bateman & Fonagy, 2004), a modified psychodynamic psychotherapy, yMembers of the Board of The International Association for Forensic Psychotherapy (IAFP). was designed for people with BPD, recently there has been increasing interest in whether MBT is effective in treating…”

“2 Psychoanalytic approaches have been the most commonly used treatment for some time, and have demonstrated effectiveness over 18 months.(47) It seems likely that for many people, a stable therapeutic relationship might be helpful in allowing a more functional psychological development.”

“Despite the demonstrated overall cost savings across the majority of the 30 evaluations included, the cost-offset calculations for six economic evaluations included in this review did not result in cost-savings [26,41,42,45,47,50].”

“A preliminary study ~Bateman & Fonagy, 1999! examined the effects of an 18-month MBT-based approach to partial hospitalization on patients with BPD. Results were included decreased self-mutilation and suicide attempts; reduced length of inpatient hospitalizations; and reduced anxiety, depression,…”

“(2) MBT Trial Bateman & Fonagy, 1999, 2001, 2008 [20,42,43] UK Moderate DSM-III-R (SCID/DIB) 8y (93) CT/ Specialised therapy 22 (22) 30.”

“These include Dialectical Behavior Therapy (DBT; Linehan, 1993), Mentalization Based Therapy (Bateman & Fonagy, 1999), TransferenceFocused Psychotherapy (Clarkin, Kernberg, & Yeomans, 1999), and Schema Therapy (Giesen-Bloo et al., 2006).”

“Alternative possibilities include 1) partial hospitalization, for which empiric data exist supporting efficacy in mentalization-based programming [28, 43]; however, accessibility to this type of specialized approach is limited; and 2) crisis intervention unit (CIU) [44].”

“MBT ( Bateman and Fonagy 1999 ), SFT (Giesen-Bloo et al. 2006) and TFP (Clarkin et al. 2007) each have had one, well-controlled randomized clinical trial indicating the superiority of these treatments when compared to various control therapies (largely including active treatments themselves).”

“Mentalisation-Based Treatment (MBT) ToM Bateman and Fonagy (1999) 11 BPD, self-harm, other PD Length: 18 months, 1 per week Format: individual psychotherapy, supplemented with group sessions Content: sessions focus on the process of mentalising within a close attachment relationship, encourage…”

“There have been a number of promising developments in the psychological treatment of borderline problems (Bateman & Fonagy, 1999; Benjamin, 2003; Davidson, 2002; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Ryle, 1997; Yeomans, Selzer, & Clarkin, 1992; Young, Klosko, & Weishaar, 2003).”

“Dialectical behavior therapy (DBT; Linehan, 1993, Verheul et al., 2003), mentalization-based treatment (Bateman and Fonagy, 1999, 2004), and schema-focused therapy (Giesen-Bloo et al., 2006b; Young, 1999) have received the most empirical support.”

“Mentalization Based Therapy One randomized controlled trial of 44 patients with BPD assessed the efficacy of psychoanalytically informed partial hospitalization treatment, of which Mentalization based treatment (MBT) was the primary modality in comparison with routine psychiatric care [ 47 ].”

“Results of randomized controlled outcome studies suggest that only psychodynamic and dialectical behavior therapies have demonstrated efficacy in treating BPD (Bateman & Fonagy, 1999; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991).”

“MBT was first tested with a small RCT (n=41) in a day program lasting 18 months [ 22 ] and was found to be superior to TAU.”

“…(Bateman & Fonagy, 2014) was found to be more effective in randomized controlled trials than usual treatment (e.g. Bales, Timman, Andrea, Busschenbach, Verheul, & Kamphuis, 2015; Bateman & Fonagy, 1999, 2008, 2009; Jørgensen, Freund, Boye, Jordet, Andersen, & Kjolbye, 2013; Rossouw & Fonagy, 2012).”

“,posttraumatic stress disorder, eating disorders, antisocial PD, and depression) in a number of contexts (inpatient, partial hospitalization [38, 147–149] and outpatient [152]), and in different groups of patients (adolescents, families [153], and substance abusers [136]) (65).”

“Psychodynamic approaches, including interpersonal psychodynamic psychotherapy [55], mentalizationbased therapy [56], object-relations psychodynamic psychotherapy [57], and transference-focused psychotherapy [58] have also been studied for adults with DSH.”

“Other studies have found that more structured group therapy (eg, MBT) had good effects on poorly functioning patients with PDs (cf, Bateman & Fonagy, 1999 , 2001 , 2008 , 2009 ).”

“In developing the concept further it is necessary to distinguish those elements which may overlap with other psychological approaches to the treatment of personality disorder, including cognitive therapy (9), cognitive analytic and dynamic psychotherapies (4, 10, 11).”

“…in the interpersonal realm, whereas treatments such as Transference Focused Psychotherapy (Clarkin et al., 2007) and Mentalization Based Treatment (Bateman & Fonagy, 1999) which focus on facilitating a capacity for plausible and complex mental representations of self and other in relationship,…”

“…therapy is specifically designed to improve mentalization by focusing on the relationship between the therapist and the person with BPD and leads to a reduction in BPD symptoms and subjective distress at the end of the intervention and at longterm follow-ups (Bateman & Fonagy, 1999, 2001, 2008).”

“However, this review failed to take into account the impressive results of the 18-month follow-up study of Bateman & Fonagy’s day treatment trial (2), which made a strong impact on the American treatment guidelines for borderline personality disorder (PD) (3).”

“Studies that have specifically examined the efficacy of intervening in BPD have focused on treating adults rather than mother–infant dyads (Bateman & Fonagy, 1999; Linehan, Armstrong, Suarez, Allmari, & Heard, 1991; Stevenson & Meares, 1992).”

“Moreover, medicationeffects were not found in other treatment types (Bateman & Fonagy,1999; Black et al., 2009; Ryle & Golynkina, 2000), though samples sizes were considerably smaller in fi rst and last studies, and Black et al. investigatedashort-termprogramtobeaddedtoregulartreatment.”

“As a consequence, methodologically sound research on psychotherapeutic treatments for cluster B PD has increased during the last 10 years. However, no study has directly compared outpatient, day hospital, and inpatient treatment within one patient sample. The available published studies have focused either on the deve…”

“5 mg DEX in mostly outpatient BPD samples with comorbid PTSD, no significant differences were found between BPD and healthy comparison subjects, but hypersuppression was reported in those BPD subjects with comorbid PTSD compared to BPD subjects without PTSD, suggesting that enhanced negative feedback of the HPA axis i…”

“PD (e.g., Bateman & Fonagy, 1999, 2000, 2001; Chiesa & Fonagy, 2003; Clarkin et al., 2001; Clarkin & Levy, 2003).”