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Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial

  • Maaike L. Smits (a1), Dine J. Feenstra (a2), Hester V. Eeren (a3), Dawn L. Bales (a4), Elisabeth M. P. Laurenssen (a3), Matthijs Blankers (a5), Mirjam B. J. Soons (a6), Jack J. M. Dekker (a7), Zwaan Lucas (a8), Roel Verheul (a9) and Patrick Luyten (a10)...

Abstract

Background

Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.

Aims

To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.

Method

In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.

Results

Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.

Conclusions

Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.

Declaration of interest

P.L. and D.L.B. have been involved in the training and dissemination of MBT.

Copyright

Corresponding author

Correspondence: Maaike Lisette Smits, Viersprong Institute for Studies on Personality Disorders, PO Box 7, 4660 AA Halsteren, the Netherlands. Email: maaike.smits@deviersprong.nl

References

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Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial

  • Maaike L. Smits (a1), Dine J. Feenstra (a2), Hester V. Eeren (a3), Dawn L. Bales (a4), Elisabeth M. P. Laurenssen (a3), Matthijs Blankers (a5), Mirjam B. J. Soons (a6), Jack J. M. Dekker (a7), Zwaan Lucas (a8), Roel Verheul (a9) and Patrick Luyten (a10)...
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