Dosage-trial Mentalisation-Based Treatment (MBT): Intensive Outpatient MBT versus Day Hospital MBT.

Objective:

To compare the treatment outcome and costs of Intensive Outpatient Mentalisation-Based (IOP-MBT) and Day Hospital MBT (DH-MBT).



Design:

A randomised controlled trial comparing IOP-MBT with DH-MBT. After the baseline measurement, patients will be followed up every 6 months for a total of 36 months.



Study population and data analysis:

1. Referral to the MBT-program as implemented by De Viersprong;

2. At least one PD as diagnosed according to DSM-IV criteria.

Analysis will be performed according to the intention to treat principle. In both treatment arms (IOP-MBT and DH-MBT) at least 40 patients will be included.



Intervention:

The MBT-program offers 18-month psychotherapy designed specifically for treatment refractory patients with complex personality disorders, often complicated by multi-morbidity, who have typically had a history of unsuccessful treatments. DH-MBT consists of daily group psychotherapy, weekly individual psychotherapy, individual crisisplanning from a mentalizing perspective, art therapy twice a week, and writing therapy. IOP-MBT consists of group psychotherapy twice a week, weekly individual psychotherapy, and individual crisisplanning from a mentalizing perspective.



Outcome measures:

The primary outcome measures refer to the frequency and severity of manifestions of (borderline) personality disorder, symptomatic functioning, quality of life, and care consumption. The secondary outcome measures include axis I diagnoses, interpersonal and personality functioning, mentalisation, and treatment adherence.

1. Intensive Outpatient Mentalisation-Based Treatment (IOP-MBT) and Day Hospital Mentalisation-Based Treatment (DH-MBT) will both result in clinical improvement for patients with severe Personality Disorders (PDs);

2. Matching-hypothesis: the highest level of improvement is expected in DH-MBT, for patients with the highest level(s) of severity.

Baseline measurements will be taken after randomisation and follow-up measurements will be conducted every 6 months after the baseline measurement (i.e. after 6, 12, 18, 24, 30, and 36 months).

The MBT-program consists of a maximum of 18 months MBT, conducted conform the treatment manual (Bateman & Fonagy 2004, 2006), and continued by a maximum of 18 months of maintenance mentalizing (group) therapy. MBT aims to strenghten patients' capacity to understand their own and others' mental states in attachment contexts in order to address their difficulties with affect, impulse regulation, and interpersonal functioning, which act as triggers for acts of suicide and self-harm (Bateman & Fonagy, 2009).



MBT-DH: The day hospital program includes daily group psychotherapy, weekly individual psychotherapy, individual crisisplanning from a mentalizing perspective, art therapy twice a week, mentalizing cognitive therapy and writing therapy.



MBT-IOP: The outpatient MBT program consists of group psychotherapy twice a week, weekly individual psychotherapy, and individual crisisplanning from a mentalizing perspective.