Top

Published in:

Open Access 01-12-2016 | Study protocol

Mentalization-based treatment for psychotic disorder: protocol of a randomized controlled trial

Authors: Jonas Weijers, Coriene ten Kate, Elisabeth Eurelings-Bontekoe, Wolfgang Viechtbauer, Rutger Rampaart, Anthony Bateman, Jean-Paul Selten

Published in: BMC Psychiatry | Issue 1/2016

Abstract

Background

Many patients with a non-affective psychotic disorder suffer from impairments in social functioning and social cognition. To target these impairments, mentalization-based treatment for psychotic disorder, a psychodynamic treatment rooted in attachment theory, has been developed. It is expected to improve social cognition, and thereby to improve social functioning. The treatment is further expected to increase quality of life and the awareness of having a mental disorder, and to reduce substance abuse, social stress reactivity, positive symptoms, negative, anxious and depressive symptoms.

Methods/design

The study is a rater-blinded randomized controlled trial. Patients are offered 18 months of therapy and are randomly allocated to mentalization-based treatment for psychotic disorders or treatment as usual. Patients are recruited from outpatient departments of the Rivierduinen mental health institute, the Netherlands, and are aged 18 to 55 years and have been diagnosed with a non-affective psychotic disorder. Social functioning, the primary outcome variable, is measured with the social functioning scale. The administration of all tests and questionnaires takes approximately 22 hours. Mentalization-based treatment for psychotic disorders adds a total of 60 hours of group therapy and 15 hours of individual therapy to treatment as usual. No known health risks are involved in the study, though it is known that group dynamics can have adverse effects on a psychiatric disorder.

Discussion

If Mentalization-based treatment for psychotic disorders proves to be effective, it could be a useful addition to treatment.

Trial registration

Dutch Trial Register. NTR4747. Trial registration date 08-19-2014.

Mathers C, Fat DM, Boerma JT. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.

Bellack AS, Morrisson R, Wixted JT, Mueser K. An analysis of social competence in schizophrenia. Br J Psychiatry. 1990;156:809–18.CrossRefPubMed

Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry. 2006;189:373–8.CrossRefPubMed

Bell M, Tsang HW, Greig TC, Bryson GJ. Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia. Schizophr Bull. 2009;35(4):738–47.CrossRefPubMed

Perlick D, Stastny P, Mattis S, Teresi J. Contribution of family, cognitive and clinical dimensions to long-term outcome in schizophrenia. Schizophr Res. 1992;6:257–65.CrossRefPubMed

Adolphs R. The neurobiology of social cognition. Curr Opin Neurobiol. 2001;11:231–9.CrossRefPubMed

Brüne M. “Theory of mind” in schizophrenia: a review of the literature. Schizophr Bull. 2005;31(1):21–42.CrossRefPubMed

Kohler CG, Walker JB, Martin EA, Healy KM, Moberg PJ. Facial emotion perception in schizophrenia: a meta-analytic review. Schizophr Bull. 2010;36(5):1009–19.CrossRefPubMed

Bora EY M, Pantelis C. Theory of mind impairment in schizophrenia: meta-analysis. Schizophr Res. 2009;109(1):1–9.CrossRef

10.

Montag C, Heinz A, Kunz D, Gallinat J. Self-reported empathic abilities in schizophrenia. Schizophrenia Res. 2007;92:85–9.CrossRef

11.

Mizrahi R, Korostil M, Starkstein S, Zipursky RB, Kapur S. The effect of antipsychotic treatment on theory of mind. Psychol Med. 2007;37:595–601.CrossRefPubMed

12.

Moritz S, Woodward TS. Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry. 2007;20(6):619–25.CrossRefPubMed

13.

Roberts DL, Penn DL. Social cognition and interaction training (SCIT) for outpatients with schizophrenia: A preliminary study. Psychiatry Res. 2009;166:141–7.CrossRefPubMed

14.

Combs DR, Adams SD, Penn DL, Roberts D, Tiegreen J, Stem P. Social Cognition and Interaction Training (SCIT) for inpatients with schizophrenia spectrum disorders: preliminary findings. Schizophr Res. 2007;91(1):112–6.CrossRefPubMed

15.

Rocha NB, Queirós C. Metacognitive and social cognition training (MSCT) in schizophrenia: a preliminary efficacy study. Schizophr Res. 2013;150(1):64–8.CrossRefPubMed

16.

Bateman A, Fonagy P. Mentalisation based treatment: a practical guide. Oxford: Oxford University Press; 2006.CrossRef

17.

Rosenbaum B, Valbak K, Harder S, Knudsen P, Køster A, Lajer M, et al. Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia project. World Psychiatry. 2006;5(2):100–3.PubMedPubMedCentral

18.

Rosenbaum B, Harder S, Knudsen P, Køster A, Lindhardt A, Lajer M, et al. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: two-year outcome. Psychiatry. 2012;75(4):331–41.CrossRefPubMed

19.

Donkersgoed RJM, De Jong S, van der Graag M, Aleman A, Lysaker PH, Wunderink L, et al. A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT. BMC Psychiatry. 2014;14:27.CrossRefPubMedPubMedCentral

20.

Brent BK, Fonagy P. A mentalization-based approach to disturbances of social understanding in schizophrenia. Social cognition and metacognition in schizophrenia. Waltham: Academic; 2014. p. 245–57.

21.

Lysaker PH, Buck KD, Ringer J. The recovery of metacognitive capacity in schizophrenia across 32 months of individual psychotherapy: A case study. Psychother Res. 2007;17(6):713–20.CrossRef

22.

Gergely G, Fonagy P, Jurist E, Target M. Affect regulation, mentalization, and the development of the self. London: Karnac Books; 2002.

23.

Bateman A, Fonagy P. Handbook of mentalizing in mental health practice. Washington: American Psychiatric Publishing, Inc.; 2012.

24.

Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatr. 1999;156:1563–9.CrossRefPubMed

25.

Kernberg O. 14. Borderline Personality Organization. In: Stone MH. Essential papers on borderline disorders: One hundred years at the border. New York: NYU Press; 1986.

26.

Yee L, Korner AJ, McSwiggan S, Meares RA, Stevenson J. Persistent hallucinosis in borderline personality disorder. Compr Psychiatry. 2005;46(2):147–54.CrossRefPubMed

27.

Kingdon DG, Ashcroft K, Bhandari B, Gleeson S, Warikoo N, Symons M, et al. Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma. J Nerv Ment Dis. 2010;198(6):399–403.CrossRefPubMed

28.

Clemmensen L, van Os J, Skovgaard AM, Væver M, Blijd-Hoogewys EM, Bartels-Velthuis AA, et al. Hyper-theory-of-mind in children with psychotic experiences. PLoS One. 2014;9(11):e113082.CrossRefPubMedPubMedCentral

29.

Sharp C, Pane H, Ha C, Venta A, Patel AB, Sturek J, et al. Theory of mind and emotion: regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry. 2011;50(6):563–74.CrossRefPubMed

30.

Abu-Akel A, Bailey AL. The possibility of different forms of theory of mind. Psychol Med. 2000;30:735–8.CrossRefPubMed

31.

Auerbach JS, Blatt SJ. Self-representation in severe psychopathology: The role of reflexive self-awareness. Psychoanal Psychol. 1996;13(3):297.CrossRef

32.

Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 2012;38:661–71.CrossRefPubMedPubMedCentral

33.

Brent B. Mentalization-Based Psychodynamic Psychotherapy for Psychosis. J Clin Psychol. 2009;65(8):803–14. In Session.CrossRefPubMed

34.

Fonagy P, Bateman A. Mechanisms of change in mentalization-based treatment of BPD. J Clin Psychol. 2006;62:411–30.CrossRefPubMed

35.

Konstantakopoulos G, Ploumpidis D, Oulis P, Patrikelis P, Nikitopoulou S, Papadimitriou GN, et al. The relationship between insight and theory of mind in schizophrenia. Schizophr Res. 2014;152(1):217–22.CrossRefPubMed

36.

Myin-Germeys I, van Os J. Stress-reactivity in psychosis: Evidence for an affective pathway to psychosis. Clin Psychol Rev. 2007;27:409–24.CrossRefPubMed

37.

Corcoran R, Mercer G, Frith CD. Schizophrenia, symptomatology and social inference: Investigating “theory of mind” in people with schizophrenia. Schizophr Res. 1995;17:5–13.CrossRefPubMed

38.

Greig TC, Bryson GJ, Bell MD. Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates. J Nerv Ment Dis. 2004;192(1):12–8.CrossRefPubMed

39.

Sergi MJ, Rassovsky Y, Widmark C, Reist C, Erhart S, Braff DL, et al. Social cognition in schizophrenia: relationships with neurocognition and negative symptoms. Schizophr Res. 2007;90(1):316–24.CrossRefPubMed

40.

Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse Negl. 1996;20(8):709–23.CrossRefPubMed

41.

Koelen JA, Luyten P, Eurelings-Bontekoe LH, Diguer L, Vermote R, Lowyck B, et al. The impact of level of personality organization on treatment response: A systematic review. Psychiatry. 2012;75(4):355–74.CrossRefPubMed

42.

Eurelings-Bontekoe EHM, Luyten P, Snellen WM. Validation of the theory driven profile interpretation of the Dutch Short form of the MMPI using the TAT Social Cognition and Object relations Scale (SCORS). J Pers Assess. 2009;91:155–65.CrossRefPubMed

43.

Nentjens L, Meijer E, Bernstein D, Arntz A, Medendorp W. Brief Communication: Investigating the Relationship Between Psychopathy and Interoceptive Awareness. J Personal Disord. 2013;27(5):617–24.CrossRef

44.

Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatr. 1996;153:321–30.CrossRefPubMed

45.

Diagnostic and statistical Manual of Mental disorders, (4th ed.). Washington, DC: American Psychiatric Association; 2000.

46.

Andreasen NC, Flaum M, Arndt S. The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. Arch Gen Psychiatry. 1992;49(8):615–23.CrossRefPubMed

47.

Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S. The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry. 1990;157(6):853–9.CrossRefPubMed

48.

Hall RC. Global assessment of functioning: a modified scale. Psychosomatics. 1995;36(3):267–75.CrossRefPubMed

49.

Boyette L-L, van Dam D, Meijer C, Velthorst E, Cahn W, de Haan L, et al. Personality compensates for impaired quality of life and social functioning in patients with psychotic disorders who experienced traumatic events. Schizophr Bull. 2014;40(6):1356–65.CrossRefPubMedPubMedCentral

50.

Murray HA. Thematic apperception test. 1943.

51.

Westen D. Clinical assessment of object relations using the TAT. J Pers Assess. 1991;56:56–74.CrossRefPubMed

52.

Meyer GJ. The reliability and validity of the Rorschach and Thematic Apperception Test (TAT) Compared to other Psychological and Medical procedures: An analysis of systematically gathered evidence. Comprehensive handbook of psychological assessment. Hoboken: Wiley and Sons; 2004. p. 315–42.

53.

Hibbard S, Mitchell D, Porcerelli J. Internal consistency of the object relations and social cognition scales for the thematic apperception test. J Pers Assess. 2001;77(3):408–19.CrossRefPubMed

54.

Luyten P, Fonagy P, Lowyck B, Vermote R. Assessment of mentalization. Handbook of mentalizing in mental health practice. 2012. p. 43–65.

55.

Pinkham AE, Penn DL, Green MF, Harvey PD. Social cognition psychometric evaluation: Results of the initial psychometric study. Schizophrenia bulletin. 2015:sbv056. doi: 10.1093/schbul/sbv056.

56.

Myin-Germeys I, Oorschot M, Collip D, Lataster J, Delespaul P, van Os J. Experience sampling research in psychopathology: opening the black box of daily life. Psychol Med. 2009;39(09):1533–47.CrossRefPubMed

57.

Priebe S, Huxley P, Knight S, Evans S. Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry. 1999;45(1):7–12.CrossRefPubMed

58.

Kay SR, Flszbein A, Opfer LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261.CrossRefPubMed

59.

Wolthaus JE, Dingemans PM, Schene AH. Component structure of the Positive and Negative Syndrome Scale (PANSS) in patients with recent onset schizophrenia and spectrum disorders. Psychopharmacology. 2000;150:399–403.CrossRefPubMed

60.

Luteijn F, Kok AR. NVM, Nederlandse Verkorte MMPI, handleiding, herziene versie. Lisse: Swets & Zeitlinger; 1985.

61.

Eurelings-Bontekoe EHM, Koelen JA. De Somatisatie-Ernstige Psychopathologie combinatie binnen de theoriegestuurde profielinterpretatie van de NVM: Somatisatie als affectregulator en maat voor sociale (in)competentie. Tijdschrift Klinische Psychologie. 2007;37(2):107–22.

62.

Eurelings-Bontekoe EHM, Luyten P, IJssennagger M, Van Vreeswijk M, Koelen JA. Relationship between personality organization and Young’s cognitive model of personality pathology. Personal Individ Differ. 2010;49:198–203.CrossRef

63.

Eurelings-Bontekoe EHM, Luyten P, Remijsen M, Koelen AJ. Association between personality organization as assessed by theory driven profiles of Dutch Short Form of MMPI and self-reported structural personality pathology. J Pers Assess. 2010;92(6):599–609.CrossRefPubMed

64.

Eurelings-Bontekoe EH, Peen J, Noteboom A, Alkema M, Dekker J. Differential treatment response of subtypes of patients with borderline personality organization, as assessed with theory-driven profiles of the Dutch short form of the MMPI: a naturalistic follow-up study. J Pers Assess. 2012;94(4):380–92.CrossRefPubMed

65.

Eurelings-Bontekoe E, Koelen J, Thijssen M, de Ridder P, Kerkhof G. The impact of level of personality organization and somatization on psychological distress, worrying, and coping among patients with sleep disorders. J Sleep Disor:Treat Care. 2014;3:3.

66.

Bifulco A, Brown GW, Harris TO. Childhood Experience of Care and Abuse (CECA): A retrospective interview measure. J Child Psychol Psychiatry. 1994;35:1419–35.CrossRefPubMed

67.

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a Self-Reported Measure of Medication Adherence. Med Care. 1986;24(1):67–74.CrossRefPubMed

68.

Karterud S, Pedersen G, Engen M, Johansen MS, Johansson PN, Schlüter C, et al. The MBT Adherence and Competence Scale (MBT-ACS): development, structure and reliability. Psychother Res. 2013;23(6):705–17.CrossRefPubMed

69.

van der Gaag M, Valmaggia LR, van Meer CR, Slooff CJ. Gedachten uitpluizen: Vaardigheden oefenboek. Cognitieve gedragstherapie bij achterdocht en stemmen. Oegstgeest: Stichting Cognitie en Psychose; 2005.

70.

Van der Gaag M, Nieman D, Van den Berg D. CBT for Those at Risk of a First Episode Psychosis: Evidence-based Psychotherapy for People with an ' at Risk Mental State. New York: Routledge; 2013.

71.

Miti G, Chiaia E. Patterns of attachment and the etiology of dissociative disorders and borderline personality disorder. J Trauma Pract. 2003;2(2):19–35.CrossRef

72.

Leon AC, Mallinckrodt CH, Chuang-Stein C, Archibald DG, Archer GA, Chartier K. Attrition in randomized controlled clinical trials: methodological issues in psychopharmacology. Biol Psychiatry. 2006;59:1001–5.CrossRefPubMed

73.

Altman DG. Missing outcomes in randomized trials: addressing the dilemma. Open Med. 2009;3(2):51–3.

74.

Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8(1):3–15.CrossRefPubMed

75.

Nose M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychol Med. 2003;33(07):1149–60.CrossRefPubMed

76.

Preacher K, Hayes A. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press; 2013.

77.

Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717–31.CrossRefPubMed

78.

Myin-Germeys I, van Os J, Schwartz JE, Stone AA, Delespaul PA. Emotional reactivity to daily life stress in psychosis. Arch Gen Psychiatry. 2001;58:1137–44.CrossRefPubMed

79.

Bateman A, Fonagy P. Randomized controlled trial of outpatients, mentalization based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatr. 2009;166:1355–64.CrossRefPubMed

80.

Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatr. 2001;158:244–51.CrossRef

81.

Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1(1):2.CrossRefPubMedPubMedCentral

Title: Mentalization-based treatment for psychotic disorder: protocol of a randomized controlled trial
Authors: Jonas Weijers
Coriene ten Kate
Elisabeth Eurelings-Bontekoe
Wolfgang Viechtbauer
Rutger Rampaart
Anthony Bateman
Jean-Paul Selten
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-016-0902-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Mentalization-based treatment for psychotic disorder: protocol of a randomized controlled trial

Abstract

Background

Methods/design

Discussion

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2016

Five-year outcomes of western mental health training for Traditional Chinese Medicine practitioners

Adaptation of the Quality Indicator for Rehabilitative Care (QuIRC) for use in mental health supported accommodation services (QuIRC-SA)

Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland

A double-blind randomized controlled trial to assess the effect of bright light therapy on depression in patients with Parkinson’s disease

Differential impact of parental region of birth on negative parenting behavior and its effects on child mental health: Results from a large sample of 6 to 11 year old school children in France

Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial