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Day hospital versus intensive outpatient mentalization-based treatment: 3-year follow-up of patients treated for borderline personality disorder in a multicentre randomized clinical trial

Published online by Cambridge University Press:  30 June 2020

Maaike L. Smits Open the ORCID record for Maaike L. Smits [Opens in a new window] ,
Dine J. Feenstra ,
Dawn L. Bales ,
Matthijs Blankers ,
Jack J. M. Dekker ,
Zwaan Lucas ,
Jan H. Kamphuis ,
Jan J. V. Busschbach ,
Roel Verheul  and
Patrick Luyten
Maaike L. Smits*
Affiliation:
Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
Dine J. Feenstra
Affiliation:
Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
Dawn L. Bales
Affiliation:
Expertcentre MBT-Nederland, Bergen op Zoom, The Netherlands
Matthijs Blankers
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
Jack J. M. Dekker
Affiliation:
Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Zwaan Lucas
Affiliation:
Lentis, Groningen, The Netherlands
Jan H. Kamphuis
Affiliation:
Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
Jan J. V. Busschbach
Affiliation:
Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
Roel Verheul
Affiliation:
CEO De Viersprong, Halsteren, The Netherlands
Patrick Luyten
Affiliation:
Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
*
Author for correspondence: Maaike L. Smits, E-mail: maaike.smits@deviersprong.nl
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Abstract

Background

Two types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment.

Methods

All 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle.

Results

Patients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up.

Conclusions

Patients in both conditions showed similar large improvements over the course of 36 months, despite large differences in treatment intensity. MBT-DH and MBT-IOP were associated with different trajectories of change. Cost-effectiveness considerations and predictors of differential treatment outcome may further inform optimal treatment selection.

Keywords

Borderline personality disorderlong-term follow-upmentalization-based treatmentrandomized clinical trialtreatment intensity
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 3 , February 2022 , pp. 485 - 495
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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