Effectiveness of Mentalization Therapy for BPD Patients Case Study

1. Introduction : Is Mentalisation Based Therapies Effective For Patients With Borderline Personality Disorder

1.1 Background and context the study 

Mental health disruption is a significant public health problem that disrupts the “quality of life (QoL)” of the individual. “Borderline personality disorder (BPD)” has a profound effect on a person's mood, emotions, and other psychological cycles. The main symptoms of “border personality disorder” (BPD) that result in the development of ineffective social relationships with others are emotional instability, disrupted patterns of cognitive distortions, and impulsive behavior (NHS, 2019). To lower the risk of “dialectical behavior therapy (DBT)”, borderline personality disorder, major diagnosis approaches include various forms of cognitive behavioral therapy, physiotherapy and talk therapy (Gunderson et al., 2018). Another successful support intervention that aids in enhancing the mental health of the BPD patient is "systems training for emotional predictability and problem-solving (STEPPS)" (Boccalon et al., 2017).  The efficacy of “mentalization-based therapy” in this study. In the time of pandemic, nearly 51% of youth were facing different types of mental health disruption such as anxiety, depression and as per the psychological aspects the impact was a bit worse (Gagliard, 2023). The foundation of MBT is related to the attachment theory, which highlights the significance of early relationships and how attachment affects the development of the personality (Daubney and Bateman, 2015). The method acknowledges how attachment styles influence the capacity for mentalization in order to overcome the mental health disruption. Furthermore, due to lock-down procedures and a lack of social communication, the prevalence of BPD has considerably increased during the COVID-19 pandemic. 

Figure 1: Mental health disruption of the young people in UK (pandemic) 

(Source: Gagliard, 2023)

1.2 Problem description 

According to Kulacaoglu and Kose (2018), the point relevance rate of BPD is also relatively low at 1.6%. Non-suicidal behavior and self-harm both are negative consequences of BPD that impact on of cognition and emotion of the individual and also unstable self-perception or incapacity (Paris, 2019). Disruption of sense of self and self-image both are the negative consequences of  borderline personality disorder that increase depression, self-doubt, lack of confidence of the youth with  borderline personality disorder. According to Bohus et al. (2021), multi-dimensional healthcare team management and effective support systems are the significant aspects that help to improve the efficiency and agility of sustainable BPD management.

1.3 Aim of the study 

1.3.1 Research aim 

The purpose of the study is to analyse whether “mentalization-based therapies” can effectively reduce the risk of developing “Borderline personality disorder (BPD)”.

1.3.2 Research Question

Is “mentalisation based therapies” effective for patients with “Borderline personality disorder (BPD)”?

2. Methodology 

2.1 Introduction 

The methods chapter, which is based on the study's research questions, is crucial to obtaining the intended results of the investigation. This study examines the effects of “mentalization-based therapy” on symptoms related to anxiety, sadness, and an inadequate sense of self-worth, as well as intense and unstable social connections. In this context, the quasi-systematic review approach has been used to fulfil the aims and objectives of the study. 

2.2 SPIDER framework

Table 1: SPIDER framework 

Research question: Can patients with “Borderline personality disorder (BPD)” benefit from “mentalization-based therapies” in terms of their “quality of life (QoL)”? 

2.3 Justification of the data-based used in this study 

In order to accomplish the objectives of this investigation, a “quasi-”systematic literature review””, based on qualitative secondary data, was carried out. In this sense, choosing trustworthy databases has been essential for obtaining secondary data. Key words have been used to search data from “MEDLINE, PubMed, NCBI, CINAHL”, and other  data sources. According to the review of Timsit, Aboab, and Parienti (2018), it can be helpful to use authentic and reliable data sources to determine how implementation of particular therapies impacts the improvement of health aspects. However, it is more effective to choose the framework for collect secondary data from reliable sources in order to evaluate how “mentalization-based therapies” can be effective to cease the risks of developing “borderline personality disorder”. 

Secondary data can be obtained from a different number of external sources, including authentic journal publications and different government websites. Suiter and Sarli (2019) stated that legitimacy of a journal article must be considered by a thorough analysis. In order to achieve this, suitable sources were used to choose the journal articles that help to achieve the study's aim, and they were carefully analysed. factors like the sample chosen for “primary quantitative studies” and the quantity of research papers reviewed for secondary “qualitative or quantitative” studies were taken into account to proceed with this study. 

2.4 Keywords generation and search strategy 

2.4.1 Boolean operators 

Table 2: Boolean operators

For keyword search in case of “quasi-”systematic literature review”, considering boolean characters are essential. Boolean operators, according to Bramer et al. (2018), are an important part of a “systematic literature review” that helps to conduct an effective article search for the research. Moreover, the “AND, OR, and NOT” are considered as the key “Boolean operators” that help to develop search process more precise and thus the articles can be chosen authentically. In this case, in order to create an effective research method, terms such as “Borderline personality disorder (BPD)”, “self-reflective capacity self-harming behaviour, metallization and “mentalization-based therapy”” have been used for this study.

2.4.2 Inclusion and exclusion criteria 

Table 3: Inclusion-exclusion criteria 

The two mot important factor after from the terms chosen here are the language and the year of publication. It was made sure that the language was clear English and the publication year was not before 2015. Furthermore, availability of the papers was considered guaranteeing that complete access to the data source will be effective for the article search. There are no other articles published after 2015 in the data collected. However, other sources like newspaper articles or any kind of blogs or websites were avoided on this case to maintain the authenticity of the data. Only journals with full access are listed and accepted in this study on the other hand, only abstracts oriented journals are not included in this study. This study includes journal articles with reputable subject matter, such as “mentalization-based therapy”, emotional stimulation, metallization, “Borderline personality disorder (BPD)”, and mentalization. It excludes articles with unrelated content. These are a few of the most important elements that the study's “systematic literature review” used as inclusion and exclusion criteria. 

2.5 Study selection process 

2.5.1 PRISMA framework 

Figure 2: PRISMA framework 

“PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)” is an important framework for study selection used in “systematic literature reviews” that aims to improve choice of articles and their relibility of reporting “meta-analyses and systematic reviews” (Shamseer et al., 2015). Research techniques like “systematic reviews and meta-analyses” are used to precisely analyze and discuss relevant studies in order to synthesise and evaluate the knowledge and information of a specific research area. According to the previously indicated PRISMA framework, 8 studies were selected where initially the choice were 16. Eligible studies were finally selected based on specific exclusion criteria which was used throughout the screening process. This framework is one of the most crucial steps in the process of choosing research process as the whole research is focused on the secondary sources and data extracted from it.

The PRISMA Framework significantly contributes to the understanding of how the topic of the study influences the eligible data selection procedure for the systematic literature review. After first selecting 16 journal articles, 16 studies were chosen initially for the study after the inclusion and exclusion aspects were applied. Proper criteria of paper selection have been followed here for the research and thus the data extraction process have been done. This is important step in systematic review. Ineligible records are eliminated from the research due to duplication and automation. During the initial screening phase, two articles were disqualified for bias risk, irrelevance, and duplication. Nine journal articles have been chosen for more research at the conclusion. The screening process in this case should be done so precisely to make it perfect and choosing the best articles for the review process. 

2.6  Summary of the chapter 

As discussed above, in order to improve the effectiveness and dependability of data collecting, a “secondary qualitative research strategy” has been implemented under the aegis of a systematic literature review, interfering with the methodological approach. The search technique has been made more particular by the use of boolean operators. However, the PRISMA methodology was used to choose the final journal articles that were retrieved, taking into account both critical appraisal and effective risk assessment.

2.6 Summary of the chapter 

As discussed above, in order to improve the effectiveness and dependability of data collection, a secondary qualitative research strategy has been implemented under the aegis of a “systematic literature review”, interfering with the methodological approach. The search strategy has been made more specific by the use of Boolean operators. However, the PRISMA framework was used to select the final journal articles that were retrieved, taking into account both critical appraisal and effective risk assessment. 

3. Critical annotation 

3.1 Data extraction from the selected journal 

Table 4: Data extraction table 

3.2 Key findings from the retrieved table 

Bales et al. (2014) stated that the purpose of this matched control study is to increase the body of evidence supporting MBT's effectiveness for patients with severe borderline personality disorder. Different types of clinical studies are used "to control for confounding or background variables at the study design." This study led to the referral of 41 patients to a day hospital MBT. Treatment conditions for the study include an 18-month maximum MBT program followed by maximum 18-months of mentalist group therapy. MBT has also been used to train individuals to become more skilled in order to identify the interpersonal functionality of the individual with BPD. 

Based on the Warrender's (2015) review, the purpose of this article is to gather additional information about the viewpoints and experiences of staff nurses regarding the importance of MBT skills when working with BPD in acute mental health settings. This study involved nine staff nurses who were all registered mental health nurses (RMNs). Two focus groups were used to collect data, and each participant got MBT-Skills training. Some of the participants had already made arrangements in a clinical setting; the participation rate was approximately 50%. These focus groups run for sixty minutes each. Focus groups are the significant part of the research methodology that helps to improve group discussions strategy to collect data. It is intended to shed light on participants' attitudes and actions. Participants in the study said they felt more able to tolerate it. 

The primary finding of the review by Kjelvik and Schultheis (2019) is that it shows how MBT is beneficial for patients with severe personality disorder and offers some insight into the different mechanisms of the treatment. On the other hand, it has been proposed that MBT may function as a clinically relevant treatment for individuals with severe BPD who may prove difficult to treat with conventional psychotherapy. The approach's semi-structured nature suggests that there was inconsistent conduct throughout all of the interviews, making the study non-replicable. On the other hand, this suggests that the interviewer was able to elicit additional information from the patients by going deeper and asking open-ended questions. It also allows for flexibility throughout the entire session. Semi-structured interviews allow for inadvertent bias to occur.

The critical review states that while the measure may have aided in estimating the therapy's effectiveness, it can also interfere with impulsivity, which may have been detrimental to the participants (Carlyle et al., 2020). Due to its sensitivity, the use of “SA/NSSH (suicide attempts and non-suicidal self-harm)” as a measure in this trial may give rise to ethical questions. The trial's male to female participant ratio 71 female to 1 male could be a source of gender bias. This suggests that the majority of participants are women. Even if the MBT measures in this research are in favour of treatment, long-term support like MBT—which endures longer than therapy—helps to enhance the function and experience of real-world living for patients as well as their results. 

The effectiveness of both “mentalization-based group therapy” and “combined cognitive behaviour therapy” for patients with borderline personality disorder has a significant influence on the quality of life of those with the disease, according to Edel et al. (2016). The two primary therapies that help treat “adolescent BPD are group-based treatment or the MBT-G” and “Borderline Personality Features Scale for Children (BPFS-C)”, according to the review by Jørgensen et al. (2020). 

3.3 Quality and critical appraisal (CASP) 

Table 5: CASP table 

3.3 Quality assessment of the included study (Risk bias) 

Table 6: Risk bias table 

4. Conclusion 

From the above discussion, it can be concluded that MBT is an important evidence based psychotherapy that is helpful for patients with BPD. Nevertheless, the data extraction from the chosen journals provided an explanation for the decline in BPD patients' attempts at suicide and self-harm due to MBT. It can be argued that a sustainable MBT management can significantly improve the quality of life of the person with “Borderline personality disorder (BPD)”, even though it raises some clinical ethical concerns. In the future, though, the trial's overall design and outcomes would have been enhanced with a larger male participant count... Integration of the peer support, exploration of the emotion, integration of the cognition and emotion are the significant aspects of MBT that helps to improve the efficiency of BPD care management. MBT places a strong emphasis on the value of comprehending and interpreting individual own and other mental states, which enhances interpersonal functioning. Individuals who receive MBT frequently exhibit improvements in their capacity to establish and uphold more satisfying and stable relationships.

Different types of methodological aspects of “systematic literature review” such as PRISMA, CASP, and risk bias table have been used in this study. CASP table helps to identify the credibility of chosen articles. The previously mentioned risk bias table has proven to be highly beneficial in ascertaining the dependability of the research data, as it delineates the benefits and drawbacks of the secondary qualitative research study. The study design and study description of the included study are also identified by the risk bias table. Furthermore, it can be claimed that a successful quasi-systematic review contributes to the efficacy and authenticity of the research as well as the identification of the therapeutic interventions based on mentalization that are efficient in reducing the risk of “Borderline personality disorder (BPD)”. Future studies can result in the creation of more focused and efficient BPD treatment plans. This might involve cutting-edge pharmacological therapies, creative psychotherapy approaches, or a mix of the two. On the other hand, effective community-engagement and different types of mental health intervention such as awareness campaign, health education helps to improve the efficiency and reliability of the BPD management. 

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