BackgroundMany patients with a non-affective psychotic disorder suffer from impairments in social functioning and social cognition. To target these impairments, mentalization-based treatment for psychotic disorder, a psychodynamic treatment rooted in attachment theory, has been developed. It is expected to improve social cognition, and thereby to improve social functioning. The treatment is further expected to increase quality of life and the awareness of having a mental disorder, and to reduce substance abuse, social stress reactivity, positive symptoms, negative, anxious and depressive symptoms.Methods/designThe study is a rater-blinded randomized controlled trial. Patients are offered 18 months of therapy and are randomly allocated to mentalization-based treatment for psychotic disorders or treatment as usual. Patients are recruited from outpatient departments of the Rivierduinen mental health institute, the Netherlands, and are aged 18 to 55 years and have been diagnosed with a non-affective psychotic disorder. Social functioning, the primary outcome variable, is measured with the social functioning scale. The administration of all tests and questionnaires takes approximately 22 hours. Mentalization-based treatment for psychotic disorders adds a total of 60 hours of group therapy and 15 hours of individual therapy to treatment as usual. No known health risks are involved in the study, though it is known that group dynamics can have adverse effects on a psychiatric disorder.DiscussionIf Mentalization-based treatment for psychotic disorders proves to be effective, it could be a useful addition to treatment.Trial registrationDutch Trial Register. NTR4747. Trial registration date 08-19-2014.

Social functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.

Background Impaired mentalizing ability – an impaired ability to understand one's own and other people's behavior in terms of mental states – is associated with social dysfunction in non-affective psychotic disorder (NAPD). We tested whether adding mentalization-based treatment for psychotic disorder (MBTp) to treatment as usual (TAU) results in greater improvement in social functioning. Methods Multicenter, rater-blinded, randomized controlled trial. Eighty-four patients with NAPD were assigned to TAU or MBTp plus TAU. Patients in the MBTp group received 18 months of MBTp, consisting of weekly group sessions and one individual session per 2 weeks. Social functioning was measured using the Social Functioning Scale. We conducted ANCOVAs to examine the difference between treatment conditions directly after treatment and at 6-month follow-up and performed moderation and mediation analyses. Results Intention-to-treat analyses showed no significant differences between groups post-treatment (p = 0.31) but revealed the MBTp group to be superior to TAU at follow-up (p = 0.03). Patients in the MBTp group also seemed to perform better on measures of mentalizing ability, although evidence of a mediation effect was limited (p = 0.06). Lastly, MBTp treatment was less effective in chronic patients than in recent-onset patients (p = 0.049) and overall symptoms at baseline were mild, which may have reduced the overall effectiveness of the intervention. Conclusion The results suggest that MBTp plus TAU may lead to more robust improvements in social functioning compared to TAU, especially for patients with a recent onset of psychosis.

BackgroundDeficits in mentalizing – i.e. the ability to understand one’s own and another’s behavior in terms of mental states such as beliefs, feelings and intentions – have been widely observed in patients with non-affective psychotic disorder (NAPD). In turn, robust evidence has shown these impairments to be related to social dysfunction and negative symptoms. However, few treatments have been developed to effectively treat impaired mentalizing, in spite of its increased recognition as an important treatment target. Mentalization based treatment (MBT) is a psychodynamic therapy rooted in attachment theory, originally developed and empirically found to be effective in treating borderline personality disorder. MBT for psychotic disorder aims to improve social functioning in NAPD patients by targeting impaired mentalizing.MethodsThe study is a multicenter, rater-blinded, randomized controlled trial. Ninety patients, who were diagnosed with NAPD by a psychiatrist and whose diagnosis was confirmed by researchers with the CASH, were recruited from community treatment teams in the Netherlands. They were randomly allocated to either treatment as usual plus MBT or to treatment as usual only. MBT consisted of 18 months of group therapy (one hour weekly) and individual therapy (30 minutes per two weeks). Patients had a mean age of 31.48 years (SD = 8.87) and a mean duration since onset of psychosis of 5.53 years (SD = 3.65). The primary outcome variable was social functioning (measured with the Social Functioning Scale). Other outcome variables were positive, negative, depressive, and anxious symptoms, as well as insight (PANSS), quality of life (MANSA), substance abuse, social stress reactivity (Experience Sampling Method), and mentalizing capacity (Social Cognition and Object-Relations System; Hinting Task).ResultsThis will be the first presentation of our trial results.DiscussionThe clinical implications of the results and limitations of the trial will be discussed. Theoretical considerations suggest that mentalization-based treatment could be an effective treatment for social dysfunction and impaired mentalizing in NAPD. If Mentalization-based treatment for psychotic disorders proves to be effective at improving social functioning and mentalizing, it may provide a valuable addition to treatment as usual.

Background: Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs would profit from MBT (ii) mentalizing capacity would improve over time; (iii) patients with BPD would profit more from MBT than those with non-borderline PDs Method: Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. Results: Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p’s ≤ .01). Bigger effect sized were observed for BPD patients (n=25) than for patients with non-BPD (n=21), but the difference failed to reach statistical significance (p=0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p=0.01), not in non-BPD (p=0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p=0.01). Mentalizing capacity of the whole group improved over time (dvaried between .68 and 1.46). Discussion: These results suggest that MBT is effective for a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. Trial Registration: The study design was approved by the Leiden University Ethical Committee. Conclusion: Mentalization-based treatment seems to be an effective treatment for patients with a broad range of PDs.

Klachten die voortkomen uit een gecompliceerd rouwproces worden doorgaans behandeld met cognitief-gedragstherapeutische technieken, maar bij een bepaalde groep patie¨nten slaat deze therapievorm onvoldoende aan. Veilig gehechte patie¨nten die rouwklachten ontwikkelen, profiteren vaak goed van behandeling. Zij zijn in staat om de ontstane stress na een verlies te begrijpen en te verwoorden, en om sociale steun te mobiliseren. Onveilig gehechte mensen kunnen dit minder goed. Daarom is het van belang dat bij deze groep allereerst het vermogen om te mentaliseren verbetert met behulp van Mentalization-based treatment (MBT), voordat begonnen wordt met de rouwverwerking. Inleiding

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