1
|
Hajek Gross C, Oehlke SM, Prillinger K, Goreis A, Plener PL, Kothgassner OD. Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis. Suicide Life Threat Behav 2024; 54:317-337. [PMID: 38279664 DOI: 10.1111/sltb.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.
Collapse
Affiliation(s)
- Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| |
Collapse
|
2
|
Bersani FS, Accinni T, Carbone GA, Corazza O, Panno A, Prevete E, Bernabei L, Massullo C, Burkauskas J, Tarsitani L, Pasquini M, Biondi M, Farina B, Imperatori C. Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults. Healthcare (Basel) 2022; 10:healthcare10050948. [PMID: 35628085 PMCID: PMC9140488 DOI: 10.3390/healthcare10050948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022] Open
Abstract
Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p < 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.
Collapse
Affiliation(s)
- Francesco Saverio Bersani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
- Correspondence:
| | - Tommaso Accinni
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
| | - Giuseppe Alessio Carbone
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.A.C.); (A.P.); (B.F.); (C.I.)
| | - Ornella Corazza
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK;
| | - Angelo Panno
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.A.C.); (A.P.); (B.F.); (C.I.)
| | - Elisabeth Prevete
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
| | - Laura Bernabei
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
- Mental Health Department, ASL Roma 5 Hospital, 00184 Rome, Italy
| | - Chiara Massullo
- Experimental Psychology Laboratory, Department of Education, Roma Tre University, 00185 Rome, Italy;
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 00135 Palanga, Lithuania;
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (T.A.); (E.P.); (L.B.); (L.T.); (M.P.); (M.B.)
| | - Benedetto Farina
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.A.C.); (A.P.); (B.F.); (C.I.)
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Sciences, European University of Rome, 00163 Rome, Italy; (G.A.C.); (A.P.); (B.F.); (C.I.)
| |
Collapse
|
3
|
Levi-Belz Y, Lev-Ari L. Thinking for healing: The role of mentalization deficits as moderator in the link between complicated grief and suicide ideation among suicide-loss survivors. DEATH STUDIES 2022; 47:360-369. [PMID: 35445644 DOI: 10.1080/07481187.2022.2065707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Suicide-loss survivors are an at-risk population for complicated grief and suicide ideation. This study examined mentalization deficits as a possible moderator of the association between complicated grief and suicide ideation. Suicide-loss survivors (N = 152) completed questionnaires on complicated grief, suicide ideation, and mentalization deficits. Mentalization deficits facilitated suicide ideation, beyond the contribution of complicated grief. Complicated grief and suicide ideation were more strongly associated at higher mentalization deficit levels. Limitations include the non-representative cross-sectional nature of the sample and the use of a single item for suicide ideation. The findings highlight the critical link between complicated grief and suicide ideation among suicide-loss survivors and mentalization deficits' role as its possible facilitator.
Collapse
Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
- Behavioral Sciences Department, Ruppin Academic Center, Emek Hefer, Israel
| | - Lilac Lev-Ari
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
- Behavioral Sciences Department, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
4
|
Griffiths H, Duffy F, Duffy L, Brown S, Hockaday H, Eliasson E, Graham J, Smith J, Thomson A, Schwannauer M. Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial. BMC Psychiatry 2019; 19:167. [PMID: 31170947 PMCID: PMC6554935 DOI: 10.1186/s12888-019-2158-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 05/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. METHODS The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables. RESULTS Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm. CONCLUSIONS It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population. TRIAL REGISTRATION NCT02771691 ; Trial Registration Date: 25/04/2016.
Collapse
Affiliation(s)
- Helen Griffiths
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Fiona Duffy
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Louise Duffy
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Sarah Brown
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Harriet Hockaday
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Emma Eliasson
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Jessica Graham
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Julie Smith
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Alice Thomson
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| | - Matthias Schwannauer
- School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Tipperlinn Road, Edinburgh, EH10 5HF UK
| |
Collapse
|