Mentalization-based treatment in groups for adolescents with Borderline Personality Disorder: 3- and 12-month follow-up of a randomized controlled trial.

Mentalization-based treatment in groups (MBT-G) has never been tested in adolescents with Borderline Personality Disorder (BPD) in a randomized controlled trial. The current study aimed to test the long-term effectiveness of MBT-G in an adolescent sample with BPD or BPD features (≥ 4 DSM-5 BPD criteria). Hundred and eleven patients with BPD (n = 106) or BPD features (n = 5) were randomized to either (1) a 1-year modified MBT-G program comprising three MBT introductory sessions, five individual case formulation sessions, 37 weekly MBT group sessions, and six MBT-Parent sessions, or (2) treatment as usual (TAU), defined as at least 12 individual monthly treatment sessions with follow-up assessments at 3 and 12 months post treatment. The primary outcome was the score on the Borderline Personality Features Scale for Children (BPFS-C), and secondary outcomes included clinician-rated BPD symptoms and global level of functioning as well as self-reported self-harm, depression, externalizing and internalizing symptoms, and caregiver reports. There were no statistically significant differences between MBT-G and TAU on the primary outcome measure or any of the secondary outcomes. Both groups showed improvement on the majority of clinical and social outcomes at both follow-up points, although remission rates were modest with just 35% in MBT-G and 39% in TAU 2 years after inclusion into the study. MBT-G was not superior to TAU in improving borderline features in adolescents. Although improvement was observed equally in both interventions over time, the patients continued to exhibit prominent BPD features, general psychopathology and decreased functioning in the follow-up period, which points to a need for more research and better understanding of effective components in early intervention programs. The ClinicalTrials.gov identifier is NCT02068326.

Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial.

BACKGROUND: Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. METHOD: A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30 weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. RESULTS: At EOT, the primary outcome was 71.3 (SD = 15.0) in the MBT-G group and 71.3 (SD = 15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval -6.3 to 7.1, p = .91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. CONCLUSIONS: There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.

Differential coactivation in a redundant signals task with weak and strong go/no-go stimuli.

When participants respond to stimuli of two sources, response times (RTs) are often faster when both stimuli are presented together relative to the RTs obtained when presented separately (redundant signals effect [RSE]). Race models and coactivation models can explain the RSE. In race models, separate channels process the two stimulus components, and the faster processing time determines the overall RT. In audiovisual experiments, the RSE is often higher than predicted by race models, and coactivation models have been proposed that assume integrated processing of the two stimuli. Where does coactivation occur? We implemented a go/no-go task with randomly intermixed weak and strong auditory, visual, and audiovisual stimuli. In one experimental session, participants had to respond to strong stimuli and withhold their response to weak stimuli. In the other session, these roles were reversed. Interestingly, coactivation was only observed in the experimental session in which participants had to respond to strong stimuli. If weak stimuli served as targets, results were widely consistent with the race model prediction. The pattern of results contradicts the inverse effectiveness law. We present two models that explain the result in terms of absolute and relative thresholds.

First empirical evaluation of outcomes for mentalization-based group therapy for adolescents with BPD.

Adolescent borderline personality disorder (BPD) is a devastating disorder, and it is essential to identify and treat the disorder in its early course. A total of 34 female Danish adolescents between 15 and 18 years old participated in 1 year of structured mentalization-based group therapy. Twenty-five adolescents completed the study, of which the majority (23) displayed improvement regarding borderline symptoms, depression, self-harm, peer-attachment, parent-attachment, mentalizing, and general psychopathology. Enhanced trust in peers and parents in combination with improved mentalizing capacity was associated with greater decline in borderline symptoms, thereby pointing to a candidate mechanism responsible for the efficacy of the treatment. The current study provides a promising rationale for the further development and evaluation of group-format mentalization-based treatment for adolescents with borderline traits. (PsycINFO Database Record

Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial.

BACKGROUND: Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages in diagnosing adolescent BPD, there is a lack of cost-effective evidence-based treatment programs for adolescents. Mentalization-based treatment is an evidence-based program for BPD, originally developed for adults. AIMS/HYPOTHESES: We will investigate whether a specifically designed mentalization-based treatment in groups is an efficacious treatment for adolescents with BPD or subthreshold BPD compared to treatment as usual. The trial is a four-center, two-armed, parallel-group, assessor-blinded randomized clinical superiority trial. One hundred twelve patients aged 14 to 17 referred to Child and Adolescent Psychiatric Clinics in Region Zealand are randomized to 1 year of either mentalization-based treatment in groups or treatment as usual. Patients will be included if they meet at least four DSM-5 criteria for BPD. The primary outcome is self-reported borderline features at discharge. Secondary outcomes will include self-harm, depression, BPD criteria, externalizing and internalizing symptoms, and social functioning, together with parental reports on borderline features, externalizing and internalizing symptoms. Measures of attachment and mentalization will be included as mediational variables. Follow-up assessment will take place at 3 and 12 months after end of treatment. DISCUSSION: This is the first randomized controlled trial to test the efficacy of a group-based mentalization-based treatment for adolescents with BPD or subthreshold BPD. If the results confirm our hypothesis, this trial will add to the treatment options of cost-effective treatment of adolescent BPD. TRIAL REGISTRATION: Clinicaltrials.gov NCT02068326 , February 19, 2014.

Unimodal and crossmodal gradients of spatial attention: Evidence from event-related potentials.

Behavioral and event-related potential (ERP) studies have shown that spatial attention is gradually distributed around the center of the attentional focus. The present study compared uni- and crossmodal gradients of spatial attention to investigate whether the orienting of auditory and visual spatial attention is based on modality specific or supramodal representations of space. Auditory and visual stimuli were presented from five speaker locations positioned in the right hemifield. Participants had to attend to the innermost or outmost right position in order to detect either visual or auditory deviant stimuli. Detection rates and event-related potentials (ERPs) indicated that spatial attention is distributed as a gradient. Unimodal spatial ERP gradients correlated with the spatial resolution of the modality. Crossmodal spatial gradients were always broader than the corresponding unimodal spatial gradients. These results suggest that both modality specific and supramodal spatial representations are activated during orienting attention in space.

Modality shift effects mimic multisensory interactions: an event-related potential study.

A frequent approach to study interactions of the auditory and the visual system is to measure event-related potentials (ERPs) to auditory, visual, and auditory-visual stimuli (A, V, AV). A nonzero result of the AV - (A + V) comparison indicates that the sensory systems interact at a specific processing stage. Two possible biases weaken the conclusions drawn by this approach: first, subtracting two ERPs from one requires that A, V, and AV do not share any common activity. We have shown before (Gondan and Röder in Brain Res 1073-1074:389-397, 2006) that the problem of common activity can be avoided using an additional tactile stimulus (T) and evaluating the ERP difference (T + TAV) - (TA + TV). A second possible confound is the modality shift effect (MSE): for example, the auditory N1 is increased if an auditory stimulus follows a visual stimulus, whereas it is smaller if the modality is unchanged (ipsimodal stimulus). Bimodal stimuli might be affected less by MSEs because at least one component always matches the preceding trial. Consequently, an apparent amplitude modulation of the N1 would be observed in AV. We tested the influence of MSEs on auditory-visual interactions by comparing the results of AV - (A + V) using (a) all stimuli and using (b) only ipsimodal stimuli. (a) and (b) differed around 150 ms, this indicates that AV - (A + V) is indeed affected by the MSE. We then formally and empirically demonstrate that (T + TAV) - (TA + TV) is robust against possible biases due to the MSE.