Mentalization-Based Treatment
TL;DR: MBT was initially developed for the treatment of borderline personality disorder (BPD) in routine clinical services delivered in group and individual modalities, and is currently being developed for treatment of numerous groups, including people with antisocial personality disorder, substance abuse, eating disorders, and at-risk mothers with infants and children.
Abstract: The concept of mentalizing has captured the interest and imagination of an astonishing range of people—from psychoanalysts to neuroscientists, from child development researchers to geneticists, from existential philosophers to phenomenologists—all of whom seem to have found it useful. According to the Thompson Reuter maintained Web of Science, the use of the term in titles and abstracts of scientific papers increased from 10 to 2,750 between 1991 and 2011. Clinicians in particular have enthusiastically embraced the idea, and have put it to innovative use in their practices. Mentalization-based treatment (MBT)—making mentalizing a core focus of therapy—was initially developed for the treatment of borderline personality disorder (BPD) in routine clinical services delivered in group and individual modalities. Therapy with mentalizing as a central component is currently being developed for treatment of numerous groups, including people with antisocial personality disorder, substance abuse, eating disorders, and at-risk mothers with infants and children (A. Bateman & Fonagy, 2011). It is also being used with families and adolescents, in schools, and in managing social groups (Asen & Fonagy, 2011; Fonagy et al., 2009; Twemlow, Fonagy, & Sacco, 2005a, 2005b). In this article, we focus on MBT in the treatment of BPD.
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TL;DR: It is argued that although mentalization-based treatment may be a specific and particular form of practice, the "mentalizing therapist" is a universal constituent of effective psychotherapeutic interventions.
Abstract: Mentalizing-the capacity to understand others' and one's own behavior in terms of mental states-is a defining human social and psychological achievement. It involves a complex and demanding spectrum of capacities that are susceptible to different strengths, weakness, and failings; personality disorders are often associated with severe and consistent mentalizing difficulties (Fonagy & Bateman, 2008). In this article, we will argue for the role of mentalizing in the therapeutic relationship, suggesting that although mentalization-based treatment may be a specific and particular form of practice, the "mentalizing therapist" is a universal constituent of effective psychotherapeutic interventions.
526 citations
Cites background from "Mentalization-Based Treatment"
...In this article, we attempt to broaden our argument in relation to mentalizing and rather than explaining the particulars of the MBT approach (Bateman & Fonagy, 2006), we postulate that mentalizing might productively be conceptualised as the common factor across different forms of effective psychotherapy....
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...MBT is not the only effective therapy for BPD....
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...The MBT technique was designed to guide therapists to avoid this type of iatrogenesis in the course of treatment (Fonagy & Bateman, 2008)....
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...This has been a key part of our understanding of the mechanisms of change since we devised the MBT model (Fonagy & Bateman, 2006)....
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...In this article, we attempt to broaden our argument in relation to mentalizing and rather than explaining the particulars of the MBT approach (Bateman & Fonagy, 2006), we postulate that mentalizing might productively be conceptualised as the common factor across different forms of effective…...
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TL;DR: The results showed that, although some measured components of mentalization progressed over time, only the TiM Project training group significantly improved in third order false belief understanding and changed - in a greater way compared to the control group – in two of the three components of the Mentalizing Task.
Abstract: Mentalization research focuses on different aspects of this topic, highlighting individual differences in mentalizing and proposing programs of intervention for children and adults to increase this ability. The “Thought in Mind Project” (TiM Project) provides training targeted to adults―teachers or parents―to increase their mentalization and, consequently, to obtain mentalization improvement in children. The present research aimed to explore for the first time ever the potential of training for teachers based on the TiM Project, regarding the enhancement of mentalizing of an adult who would have interacted as a teacher with children. For this reason, two teachers – similar for meta-cognitive and meta-emotional skills - and their classes (N=46) were randomly assigned to the training or control condition. In the first case, the teacher participated in training on the implementation of promotion of mentalizing in everyday school teaching strategies; in the second case the teacher participated in a control activity, similar to training for scheduling and methods, but without promoting the implementation of mentalization (in both conditions two meetings lasting about three hours at the beginning of the school year and two supervisions during the school year were conducted). The children were tested by tasks assessing several aspects of mentalization (2nd and 3rd order false belief understanding, Strange Stories, Reading the mind in the Eyes, Mentalizing Task) both before and after the teacher participate in the TiM or control training (i.e. at the beginning and at the end of the school year). The results showed that, although some measured components of mentalization progressed over time, only the TiM training group significantly improved in 3rd order false belief understanding and changed - in a greater way compared to the control group - in two of the three components of the Mentalizing Task. These evidences are promising about the idea that the creation of a mentalizing community promotes the mentalization abilities of its members.
442 citations
Cites background from "Mentalization-Based Treatment"
...Based on psychoanalytic work with borderline patients, a Mentalization Based Treatment (MBT) was created (Allen and Fonagy, 2006; Bateman and Fonagy, 2006, 2013): it is a clinical treatment designed to improve mentalization processes, which is impaired in these individuals....
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Book Chapter•
23 Jan 2008
TL;DR: It is proposed that mentalization is a common theme inPsychoanalytically oriented partial hospital treatment for BPD and may explain why different treatments "work."
Abstract: In this chapter, we will outline how the concept of mentalizing helps us understand some of the common problems associated with borderline personality disorder and how the theoretical understanding is translated into psychotherapeutic intervention. Mentalizing is the process by which we interpret the actions of ourselves and others in terms of underlying intentional states such as personal desires, needs, feelings, beliefs and reasons. This capacity develops within the context of attachment relationships during infancy and childhood. Borderline personality disorder is conceived of as being a disorder of mentalizing. Vulnerability to a loss in mentalizing particularly in interpersonal or stressful circumstances is a core feature of the disorder. If treatment is to be successful it must either have mentalization as its focus or at the very least stimulate development of mentalizing as an epiphenomenon. Treatment focusing on mentalizing itself is described. © Copyright (c) by The Haworth Press, Inc. All rights reserved.
438 citations
TL;DR: A bifactor model of PD pathology in which a general factor and several specific factors of personality pathology (PD 'g' and 's' factors, respectively) account for the covariance among PD criteria is evaluated.
Abstract: Recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualize personality disorders (PDs) as categorical constructs, but high PD co-occurrence suggests underlying latent dimensions. Moreover, several borderline PD criteria resemble Criterion A of the new DSM-5 Section III general criteria for personality pathology (i.e., self and interpersonal dysfunction). We evaluated a bifactor model of PD pathology in which a general factor and several specific factors of personality pathology (PD 'g' and 's' factors, respectively) account for the covariance among PD criteria. In particular, we examined the extent to which the borderline PD criteria would load exclusively onto the g-factor versus on both the g- and one or more s-factors. A large (N = 966) sample of inpatients were interviewed for six DSM-IV (American Psychiatric Association, 1994) PDs using the (Structured Clinical Interview for Personality Disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1994) with no skip-outs. We ran a series of confirmatory, exploratory, and bifactor exploratory factor analyses on the rated PD criteria. The confirmatory analysis largely replicated the DSM PDs, but with high factor correlations. The "standard" exploratory analysis replicated four of the DSM PDs fairly well, but nearly half the criteria cross-loaded. In the bifactor analysis, borderline PD criteria loaded only on the general factor; the remaining PDs loaded either on both the general and a specific factor or largely only on a specific factor. Results are interpreted in the context of several possibilities to define the nature of the general factor.
334 citations
Cites background from "Mentalization-Based Treatment"
...…vulnerability to PD, which may manifest itself phenomenologically as, for example, difficulty in emotion regulation (Linehan, 1993) or vulnerability in core self and interpersonal impairments (Bateman & Fonagy, 2012; Benjamin, 1996; Gunderson & Lyons-Ruth, 2008; Kernberg, 1984; Linehan, 1993)....
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325 citations
References
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12,729 citations
"Mentalization-Based Treatment" refers background in this paper
...A range of therapies are effective in the treatment of BPD (Davidson et al., 2006; Gieson-Bloo et al., 2006; Linehan et al., 2006; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; A. Bateman & Fonagy, 2009; McMain et al., 2009)....
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TL;DR: The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
Abstract: In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
9,580 citations
"Mentalization-Based Treatment" refers background in this paper
...Moreover, the ability to continue to mentalize even under considerable stress is associated with so-called “broaden and build” (Fredrickson, 2001, pp. 218–226) cycles of attachment security....
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Book•
14 May 2007TL;DR: The attachment behavioral system: basic concepts and principles as discussed by the authors, a model of attachment-system functioning and dynamics in adulthood, Normative attachment processes, Measurement of attachmentrelated constructs in adulthood.
Abstract: The attachment behavioral system: basic concepts and principles -- A model of attachment-system functioning and dynamics in adulthood -- Normative attachment processes -- Measurement of attachment-related constructs in adulthood -- Individual differences in attachment-system functioning: development, stability, and change -- Attachment-related mental representations of self and others -- Attachment processes and emotion regulation -- Attachment orientations, behavioral self-regulation, and personal growth -- An attachment perspective on interpersonal regulation -- Attachment processes and couple functioning -- Relations between the attachment and caregiving systems -- Attachment and sex -- Attachment bases of psychopathology -- Implications of attachment theory and research for counseling and psychotherapy -- Applications of attachment theory and research in group and organizational settings -- Reflections on attachment security.
3,433 citations
"Mentalization-Based Treatment" refers background in this paper
...Attachment hyperactivation strategies (Mikulincer & Shaver, 2007) are displayed by the anxious patient with BPD who attaches to others easily and quickly....
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...These cycles reinforce feelings of secure attachment, personal agency, and affect regulation (build), and lead to development of more adaptive environments (broaden; Mikulincer & Shaver, 2007)....
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TL;DR: In this article, Dialectical behavior therapy (DBT) was shown to be more effective in reducing suicidal behavior and borderline personality disorder compared with non-behavioral psychotherapy experts.
Abstract: Context Dialectical behavior therapy (DBT) is a treatment for suicidal behavior and borderline personality disorder with well-documented efficacy. Objective To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non–behavioral psychotherapy experts. Design One-year randomized controlled trial, plus 1 year of posttreatment follow-up. Setting University outpatient clinic and community practice. Participants One hundred one clinically referred women with recent suicidal and self-injurious behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. Intervention One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). Main Outcome Measures Trimester assessments of suicidal behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. Results Dialectical behavior therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F 1,92 =7.3; P = .004), and had lower medical risk (F 1,50 =3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P 1,92 =6.0; P = .007) and psychiatric emergency department visits (F 1,92 =2.9; P = .04). Conclusions Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychotherapy. Dialectical behavior therapy appears to be uniquely effective in reducing suicide attempts.
1,760 citations
"Mentalization-Based Treatment" refers background in this paper
...A range of therapies are effective in the treatment of BPD (Davidson et al., 2006; Gieson-Bloo et al., 2006; Linehan et al., 2006; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; A. Bateman & Fonagy, 2009; McMain et al., 2009)....
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TL;DR: Results suggest that partial hospitalization may offer an alternative to inpatient treatment for patients with borderline personality disorder and that replication is needed with larger groups.
Abstract: OBJECTIVE: This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder. METHOD: Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend. RESULTS: Patients who were partially hospitalized showed a statistically significant d...
1,187 citations
"Mentalization-Based Treatment" refers background in this paper
...It has been shown that a manualized mentalization focus in the context of day hospital care serves to reduce impulsive symptoms of BPD including suicidality and self-harm, as well as depression (A. W. Bateman & Fonagy, 1999)....
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