Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder
Abstract
OBJECTIVE: This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder. METHOD: Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables. RESULTS: Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization. CONCLUSIONS: Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.
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Bateman 2009 reported a statistically significant difference between the two treatment conditions in favour of MBT outpatient treatment (SMD 0.55, N = 134, 95% CI 0.20 to 0.89).
“Bateman 2009 report data indicating a statistically significant difference between the two treatment conditions in favour of MBToutpatient treatment (SMD 0.55, N = 134, 95% CI 0.20 to 0.89; Analysis 1.17).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 found a moderate to large statistically significant difference between the two treatment conditions in favour of MBT-outpatient treatment for general psychopathology.
“Bateman 2009 report data indicating a moderate to large statistically significant difference between the two treatment conditions in favour of MBT-outpatient treatment (SMD -0.67, N = 134, 95% CI -1.02 to -0.33; Analysis 1.16).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
There is a clear trend towards new kinds of control conditions such as CTBE or guideline-oriented treatments.
“There is a clear trend towards new kinds of control conditions such as CTBE (Linehan 2006; Doering 2010) or guideline-oriented treatments (Bateman 2009;McMain 2009).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 used randomization using a stochastic minimization program (MINIM) balancing for age (blocked as 18-25, 26-30, >30 years), gender, and presence of antisocial personality disorder.
“randomization using a stochastic minimization program (MINIM) balancing for age (blocked as 18-25, 26-30, >30 years), gender, and presence of antisocial personality disorder.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 treatment allocation was made offsite, and a study psychiatrist informed patients of their assignment.
“Treatment allocation was made offsite [...] A study psychiatrist informed patients of their assignment.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 assessors were blind to treatment group.
“Assessors were blind to treatment group.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 had a study protocol available (ISRCTN27660668) and no indication for selective reporting.
“Study protocol available (ISRCTN27660668).No indication for selective reporting.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 reported a large, statistically significant difference favouring MBT-outpatient treatment in interpersonal pathology (SMD -0.95; N = 134, 95% CI -1.30 to -0.59; Analysis 1.10).
“Bateman 2009 report data indicating a large, statistically significant difference in favour or MBT-outpatient treatment in terms of interpersonal pathology (SMD -0.95; N = 134, 95% CI -1.30 to -0.59; Analysis 1.10).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 reported data indicating a large, significant effect of smaller proportions of participants with parasuicidality in the experimental group (RR 0.56; N = 134, 95% CI 0.34 to 0.92; Analysis 1.9).
“Bateman 2009 report data indicating large, significant effects of smaller proportions of participants with both suicidality (RR 0.11; N = 134, 95% CI 0.03 to 0.46; Analysis 1.7) and parasuicidality (RR 0.56; N = 134, 95% CI 0.34 to 0.92; Analysis 1.9) in the experimental group.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
MBT has been compared with control groups in two trials, one testing MBT in a partial hospitalisation (MBT-PH; Bateman 1999) and one testing MBT in an outpatient setting (MBT-out; Bateman 2009).
“It has been compared with control groups in two trials, one testing MBT in a partial hospitalisation (MBT-PH; Bateman 1999) and one testing MBT in an outpatient setting (MBT-out; Bateman 2009).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
Bateman 2009 reported data indicating a large, significant effect of smaller proportions of participants with suicidality in the experimental group (RR 0.11; N = 134, 95% CI 0.03 to 0.46; Analysis 1.7).
“Bateman 2009 report data indicating large, significant effects of smaller proportions of participants with both suicidality (RR 0.11; N = 134, 95% CI 0.03 to 0.46; Analysis 1.7) and parasuicidality (RR 0.56; N = 134, 95% CI 0.34 to 0.92; Analysis 1.9) in the experimental group.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 2009
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 [37]
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- Authors
- Bateman, A., & Fonagy, P.
- Affiliations
- Barnet Enfield and Haringey Mental Health Trust (GB)
- St Ann’s Hospital (GB)
- Venue
- American Journal of Psychiatry
- Published
- 2009-12
- Volume
- 166
- Issue
- 12
- Pages
- 1355-1364
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2127089902
- Cited by
- 961
- References
- 29
- Citations by year
- 2026: 34 · 2025: 30 · 2024: 41 · 2023: 29 · 2022: 50 · 2021: 78 · 2020: 56 · 2019: 73 · 2018: 71 · 2017: 63 · 2016: 69 · 2015: 59 · 2014: 70 · 2013: 86 · 2012: 71
- FWCI
- 54.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- borderline personality disorder, mentalization-based treatment, outpatient care, crisis events, suicide attempts, self-harm, hospitalization, therapist training, treatment effectiveness
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care, Mental Disorders, Borderline Personality Disorder, Double-Blind Method, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotherapy, Psychotherapy, Group, Suicide, Attempted, Comorbidity, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome
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