In adults there is a growing body of evidence for psychotherapeutic interventions such as Transference Focussed Psychotherapy, Mentalization-Based Treatment and Dialectic Behavioural Therapy for patients who self harm. In the teenage population, there has been limited evidence to show that interventions are better than the treatment already provided.

MBT has developed from psychodynamic psychotherapy and attachment theory. The key principle is that the actions of ourselves and others can be understood in terms of thoughts and feelings, our internal mental state. Enhancing mentalization improves self-control and decreases self-harm.

This study in North East London recruited consecutive cases presenting with self-harm to community mental health services or acute hospital emergency rooms. It examines the effectiveness of Mentalization Based Treatment-Adolescents, involving weekly individual sessions and a monthly family appointment.

Methods

• Single blind randomised control trial
• Manualised MBT-A program vs treatment as usual (TAU)
• 12-17 year olds presenting with at least one episode of intentional self harm in the previous month
• 40 patients were allocated to each group, 20/40 completed the MBT-A program and 17/40 the TAU interventions
• Baseline demographics were similar in each group
• The primary outcome measure was a decrease in self harm measured by the self-harm scale of the Risk-Taking and Self-Harm Inventory.
• Risk taking behaviours, characteristics of borderline personality disorder, mentalizing capacity and attachment behaviour were recorded as secondary measures
• Participants were followed up for 12 months with research measurements taken at 3 monthly intervals by researchers blinded to the participants treatment group
• TAU was with a CAMHS service providing a wide range of interventions

Results

Here’s what they found:

• Self-harm and risk taking significantly decreased from baseline to 12 months in both groups
• MBT-A showed a significantly greater reduction in self-harm and depression compared at 12 months with this becoming apparent at 9 months
• This difference was due to improvements in mentalization and attachment behaviour

Conclusions

The authors conclude:

• This is the first study to show that a treatment program specifically for self-harm in adolescents is more effective than TAU in reducing self harm and depression
• The difficulties in mentalizing for adolescents who self-harm is a potential treatment focus with this age group
• MBT-A is an important treatment option for teenagers who self harm

This small study, with a high drop out rate, from the centre of excellence for MBT shows promising findings. Larger studies, including other treatment centres, are required to confirm the effectiveness and widespread applicability of MBT-A.

Links

Rossouw T, Fonagy P. Mentalization-Based Treatment for Self-Harm in Adolescents: A Randomized Controlled Trial. J. Am. Acad. Child Adolesc. Psychiatry; 2012; 51(12):1304-1313. [Pubmed abstract]

Crick NR, Murray-Close D, Woods K. Borderline personality features in childhood: a short-term longitudinal study. Dev Psychopathol. 2005;17:1051-1070. [Pubmed abstract]

Bateman A, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008 May;165(5):631-8. [Pubmed abstract]