Comparing Mentalization-based Treatment And A Dialectical Behavior Therapy-inspired Treatment On The Utilization Of Services And The Dropout Rate In A Clinical Adult Population With A Cluster B Personality Disorder

NCT05014217 | Completed

• 1 other identifier: STRP1 2020-2193
• Study Type: observational
• Target: 403
• Locations: 0 countries
• Sites: N/A

Brief Summary

Cluster B personality disorders (borderline, narcissistic, antisocial and/or histrionic) are an important clinical consideration because of their high prevalence and associated morbidity. Although many studies examine borderline personality disorder, few of them explore cluster B personality disorders as a whole. In clinical practice, personality disorders are frequently comorbid. Patients who receive services in specialized clinics for these disorders often have a complex diagnosis that include many cluster B personality disorders. Therefore, our study globally examines patients with cluster B personality disorders even though borderline personality disorder is empirically the most studied psychopathology. Previous data suggests that borderline personality disorder has a prevalence of 2% in the general population, of 25% in the clinical psychiatric population and of 15% in all visits to the emergency room. Furthermore, it is associated with social costs estimated from 15,000$ to 50,000$ USD per patient per year. In Quebec, this psychopathology is associated with an increased mortality rate compared to the general population, totaling a loss of nine years for women and 13 years for men of life expectancy. Other studies suggest that borderline personality disorder is often comorbid with other personality disorders, including those in cluster B. The population with comorbid personality disorders have a worse prognosis and a lower chance of reaching symptomatic remission, which is the reason why it is crucial to better understand and study patients with cluster B personality disorders. The study compares the effectiveness of two psychotherapies for borderline personality disorder, mentalization-based therapy and a modified version of Linehan's dialectical behavior therapy, in a retrospective naturalistic study of patients with at least one cluster B personality disorder who have undergone either treatment. The scarcity of data on cluster B personality disorders and on the comparison between MBT and DBT further highlights the necessity of a naturalistic study like ours to examine both aspects and bring research closer to the clinical setting. Based on clinical observations, the investigators believe that there will be no statistically significant difference between either treatment.

Conditions

Cluster B Personality Disorder (Diagnosis); Borderline Personality Disorder

Keywords

cluster B personality disorder; mentalization-based treatment; dialectical behavior therapy; borderline personality disorder; service utilization; dropout rate; naturalistic study

Outcome Measures

Primary Outcomes (2)

• Number of Visits To The Emergency Room

  A comparison of the difference between a patient's number of visits to the emergency room in the year prior to and the year following the index date for each treatment.

  One year before the index date (first group therapy meeting) to one year after the index date.

• Number of Hospitalizations

  A comparison of the difference between a patient's number of hospitalizations in the year prior to and the year following the index date for each treatment.

  One year before the index date (first group therapy meeting) to one year after the index date.

Secondary Outcomes (1)

• Dropout rate

  From the beginning until the end of the psychotherapy treatment.

Study Arms (2)

Mentalization-based Treatment

Participants who have been oriented to the mentalization-based treatment among the clinical adult population with a cluster B personality disorder.

Behavioral: Mentalization-based Treatment

Dialectical Behavior Therapy-inspired Treatment

Participants who have been oriented to the dialectical behavior therapy-inspired treatment among the clinical adult population with a cluster B personality disorder.

Behavioral: Dialectical Behavior Therapy-inspired Treatment

Interventions

Mentalization-based Treatment BEHAVIORAL

An empirically-validated intervention for personality disorders based on the attachment theory and on knowledge from developmental psychology and cognitive neuroscience (Bateman and Fonagy, 2004). Patients assist psychoeducative group meetings beforehand, along with a pretreatment of four to six individual meetings (over four to eight weeks), followed by bi-weekly individual follow-ups and weekly group follow-ups. The treatment lasts two years. Patients have an assessment meeting with their individual therapist and one of the group therapists at the end of each session. Psychiatric follow-up appointments are on an as-needed basis and every patient has a treatment contract with specific and measurable treatment objectives.

Mentalization-based Treatment

Dialectical Behavior Therapy-inspired Treatment BEHAVIORAL

A psychotherapy developed by M. Linehan for patients with borderline personality disorder that combines cognitive behavioral therapy techniques (emotional regulation, practical exercises) with Buddhist meditation principles (stress tolerance, acceptance, open-mindedness) (Linehan, M. M. \& Dimeff, L., 2001). As opposed to Linehan's model, individual meetings are bi-weekly, no emergency phone service is offered, the mindful meditation module is reorganized into life habits modules, and every module includes mindfulness exercises. Patients assist psychoeducative group meetings beforehand, along with a pre-treatment of 4-6 individual meetings (over 4-8 weeks), followed by bi-weekly individual follow-ups and weekly group follow-ups. The treatment lasts one year, but can be extended to two years for eligible patients who are interested. Psychiatric follow-up appointments are on an as-needed basis. Every every patient has a treatment contract with specific and measurable treatment objectives.

Dialectical Behavior Therapy-inspired Treatment

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with at least one cluster B personality disorder and admitted to the Service of personality and relational disorders at the Institut universitaire de Santé Mentale de Montréal after being referred to the program and oriented to mentalization-based treatment or dialectical behavior therapy. Patients with comorbid personality disorders are also included to better represent clinical practice.

You may qualify if:

• Meet the general criteria for a personality disorder
• Be diagnosed with at least one cluster B personality disorder
• Be admitted to the Service of personality and relational disorders and referred to mentalization-based treatment or a treatment inspired from dialectical behavior therapy

You may not qualify if:

• None

Sponsors & Collaborators

• Ciusss de L'Est de l'Île de Montréal: lead

Related Publications (24)

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  BACKGROUND

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MeSH Terms

Conditions

Disease; Borderline Personality Disorder

Interventions

Mentalization-Based Therapy

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms; Personality Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• Simon Poirier, MD

  Ciusss de L'Est de l'Île de Montréal

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 13, 2021
• First Posted: August 20, 2021
• Study Start: January 1, 2015
• Primary Completion: December 31, 2019
• Study Completion: August 4, 2021
• Last Updated: October 13, 2021

Record last verified: 2021-08

Data Sharing

• IPD Sharing: Will not share