PDF
ePub
Citation
Print
Abstract
Objectives
The treatment of borderline personality disorder (BPD) in Korea has been based mainly on individual psychopharmacotherapy and psychotherapy. No quantitative study has examined the effectiveness of group psychotherapy for patients with BPD in Korea. In the present study, the mentalization-based treatment (MBT) program developed from the Anna Freud Center in London was conducted in the author's hospital. This article presents the results of a preliminary analysis of the treatment effects of the Korean MBT for BPD.
Methods
The recruited subjects are patients diagnosed with BPD at Gangnam Severance Hospital. A psychological assessment was conducted at baseline and every six months during the treatment. Statistical analysis was performed using the data of 62 people at the baseline assessment, and the treatment effectiveness was analyzed with the data from 21 people who participated in the treatment group over six months.
Results
Borderline personality features were positively correlated with depressive symptoms, anxious attachment, avoidant attachment, and novelty seeking trait, and negatively correlated with self-directedness. After the 12-month treatment, the depressive symptoms and self-disclosure scores were improved significantly. In addition, the self-directedness, cooperativeness factor scores of the temperament and character inventory, and the self-regulation ability score of the resilience scale were also improved significantly.
Conclusion
This study suggests that the Korean MBT can improve depressive symptoms and induce positive changes in personality functioning. Although the number of people who continued MBT over 12 months was very small due to the high dropout rate, this study is the first quantitative study on the effects of the Korean MBT for BPD patients.
REFERENCES
1). Gunderson JG, Zanarini MC. Current overview of the borderline diagnosis. J Clin Psychiatry. 1987; 48(Suppl):5–14.
2). American Psychiatry Association. Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5. Arlington, VA: American Psychaitry Association;2013.
3). Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J. Treatment histories of borderline inpatients. Compr Psychiatry. 2001; 42:144–150.
4). Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, et al. Treatment utilization by patients with personality disorders. Am J Psychiatry. 2001; 158:295–302.
5). Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, et al. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry. 2002; 159:276–283.
6). Sanislow CA, Grilo CM, McGlashan TH. Factor analysis of the DSM-III-R borderline personality disorder criteria in psychiatric inpatients. Am J Psychiatry. 2000; 157:1629–1633.
7). Fonagy P, Target M, Gergely G. Attachment and borderline personality disorder. A theory and some evidence. Psychiatr Clin North Am. 2000; 23:103–122.
8). Fonagy P, Gergely G, Jurist E, Target M. Affect regulation, mentalization and the development of the self. New York, NY: Other Press;2002.
9). Bateman AW, Fonagy P. Handbook of mentalizing in mental health practice. Arlington, VA: American Psychiatric Publishing, Inc.;2012.
10). National Health and Medical Research Council. Clinical practice guideline for the management of borderline personality disorder. Melbourne: National Health and Medical Research Council;2012.
11). Bateman AW, Fonagy P. Mentalization-based treatment for borderline personality disorder: a practical guide. Oxford: Oxford University Press;2006.
12). Linehan MM. Dialectical behavior therapy for borderline personality disorder. Theory and method. Bull Menninger Clin. 1987; 51:261–276.
13). Gunderson JG. Handbook of good psychiatric management for borderline personality disorder. Arlington, VA: American Psychiatric Publishing;2014.
14). Levy KN, Clarkin JF, Yeomans FE, Scott LN, Wasserman RH, Kern-berg OF. The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. J Clin Psychol. 2006; 62:481–501.
15). Kellogg SH, Young JE. Schema therapy for borderline personality disorder. J Clin Psychol. 2006; 62:445–458.
16). Hoffman PD, Fruzzetti AE, Buteau E, Neiditch ER, Penney D, Bruce ML, et al. Family connections: a program for relatives of persons with borderline personality disorder. Fam Process. 2005; 44:217–225.
17). Morey LC. Personality assessment inventory professional manual. Odessa, FL: Psychological Assessment Resources;1991.
18). Hong SH, Kim YH. A validation study of the Borderline Personality Disorder Scale in Korean university students. Kor J Clin Psychol. 1998; 17:259–271.
19). Rush AJ, Giles DE, Schlesser MA, Fulton CL, Weissenburger J, Burns C. The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Res. 1986; 18:65–87.
20). Yoon JH, Jon DI, Hong HJ, Hong N, Seok JH. Reliability and validity of the Korean version of Inventory for Depressive Symptomatology. Mood Emot. 2012; 10:131–151.
21). Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. Simpson JA, Rholes WS, editors. editors.Attachment theory and close relationships. New York, NY: The Guilford Press;1998. p. 46–76.
22). Fraley RC, Waller NG, Brennan KA. An item response theory analysis of self-report measures of adult attachment. J Pers Soc Psychol. 2000; 78:350–365.
23). Kim SH, Kim CD, Sherry A. Adaptation of the Experiences in Close Relationships-Revised Scale into Korean: Confirmatory Factor Analysis and Item Response Theory Approaches [dissertation]. Seoul: Seoul National University;2004.
24). Reivich K, Shatte A. He resilience factor: 7 Keys to finding your inner strength and overcoming life's hurdles. New York, NY: Broadway Books;2003.
25). Kim JH. Resilience - a pleasant secret replacing hardship with for-tune.Goyang: Wisdomhouse. 2011.
26). Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD. The Temperament and Character Inventory (TCI): a guide to its development and use. Washington, DC: Center for Psychobiology of Personality, Washington University;1994.
27). Min BB, Oh HS, Lee JY. Temperament and Character Inventory-Family Manual. Seoul: Maumsarang Co., Ltd;2007. p. 15–33.
28). Hausberg MC, Schulz H, Piegler T, Happach CG, Klöpper M, Brütt AL, et al. Is a self-rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the mentalization questionnaire (MZQ). Psychother Res. 2012; 22:699–709.
29). Song HJ, Choi HA. Exploration of the Factor Structure of the Mentalization Questionnaire (MZQ) in 16–17-year-old Korean Adolescents. Kor J Clin Psychol. 2017; 36:391–401.
30). Bae SM. Validation of the interpersonal competence questionnaire in Korean Adults. Korean Journal of Counseling. 2015; 16(3):51–65.
31). Bateman AW, Fonagy P. Mentalization-based treatment for personality disorders. A practical guide. Oxford: Oxford University Press;2016.
32). Cornelius JR, Salloum IM, Mezzich J, Cornelius MD, Fabrega H Jr, Ehler JG, et al. Disproportionate suicidality in patients with comorbid major depression and alcoholism. Am J Psychiatry. 1995; 152:358–364.
33). Oquendo MA, Malone KM, Mann JJ. Suicide: risk factors and prevention in refractory major depression. Depress Anxiety. 1997; 5:202–211.
34). Soloff PH, Lynch KG, Kelly TM, Malone KM, Mann JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry. 2000; 157:601–608.
35). Cloninger CR, Svrakic DM, Pryzbeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993; 50:975–990.
Table 1.
Contents of each session of the explicit mentalization based treatment and dialectical behavioral therapy skill training
Table 2.
Demographic characteristics of patients at time of enrollment
Table 3.
Relationship of borderline personality traits with depression, attachment type, temperament, and character factors
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | - | |||||||||
| 2 | 0.604∗∗ | - | ||||||||
| 3 | 0.647∗∗ | 0.439∗∗ | - | |||||||
| 4 | 0.250 | 0.564∗∗ | 0.030 | - | ||||||
| 5 | 0.295∗ | 0.444∗∗ | 0.118 | 0.140 | - | |||||
| 6 | 0.384∗∗ | 0.254 | 0.438∗∗ | 0.168 | -0.031 | - | ||||
| 7 | -0.356∗∗ | -0.079 | -0.666∗∗ | 0.347∗∗ | 0.053 | -0.324∗ | - | |||
| 8 | -0.055 | -0.092 | -0.251 | 0.178 | 0.290∗ | -0.538∗∗ | 0.300∗ | - | ||
| 9 | -0.442∗∗ | -0.372∗∗ | -0.478∗∗ | -0.065 | -0.127 | -0.771∗∗ | 0.214 | 0.536∗∗ | - | |
| 10 | -0.140 | -0.260 | -0.194 | -0.085 | -0.197 | -0.400∗∗ | 0.391∗∗ | 0.199 | 0.200 | - |
| 11 | -0.004 | -0.063 | 0.091 | -0.042 | 0.264 | 0.165 | -0.090 | 0.181 | -0.107 | -0.109 |
1. Korean Version of Quick Inventory of Depressive Symptomatology–Self-Report, 2. Personality Assessment Inventory-Borderline Features Scale, 3. ECR-avoidance attachment, 4. ECR-anxiety attachment, 5. TCI-novelty seeking, 6. TCI-harm avoidance, 7. TCI-eward dependence, 8. TCI-rersistence, 9. TCI-self-directedness, 10. TCI-cooperativeness, 11. TCI-self-transcendence.
Table 4.
Comparison of the results of a major variable between before treatment and 6-month after treatment
| Baseline | 6-month follow up | t/Z∗ | p-value | |
|---|---|---|---|---|
| K-QIDS-SR | 18.24 (8.43) | 14.57 (8.15) | 2.52 | 0.020 |
| PAI-BOR | 37.15 (12.13) | 35.62 (9.56) | 0.70 | 0.497 |
| ECR | ||||
| Avoidance attachment | 76.85 (17.52) | 74.15 (13.54) | 0.80 | 0.442 |
| Anxiety attachment | 81.54 (12.14) | 77.15 (10.78) | 1.86 | 0.088 |
| MZQ | ||||
| Refusing self-reflection | 12.25 (2.80) | 11.58 (2.87) | 0.88 | 0.400 |
| Emotional awareness | 14.17 (3.19) | 14.33 (4.25) | -0.18 | 0.864 |
| Psychic equivalence | 15.00 (2.26) | 13.17 (3.21) | 2.30 | 0.042 |
| Regulation of affect | 11.83 (2.41) | 10.83 (3.43) | 1.27 | 0.231 |
| ICQ | ||||
| Building rapport | 9.25 (1.86) | 8.75 (3.62) | -0.82∗ | 0.411 |
| Self-assertiveness | 8.85 (2.60) | 8.50 (3.58) | -0.47∗ | 0.640 |
| Self-disclosure | 5.00 (2.00) | 5.83 (2.52) | -2.12∗ | 0.034 |
| Empathy and understanding others | 12.42 (1.98) | 12.50 (2.32) | -0.05∗ | 0.959 |
Data are presented as a mean (standard deviation). ∗ : Wilcoxon rank-sum test was done for non-parametric analysis. K-QIDS-SR Korean Version of Quick Inventory of Depressive Symptomatology-Self-Report, PAI-BOR : Personality Assessment Inventory–Border line Features Scale, ECR : Experiences in Close Relationship Questionnaire, MZQ : Mentalization Questionnaire, ICQ : Interpersona Competence Questionnaire
Table 5.
Changes of psychological characteristics after 12-month treatment
| Baseline | 12-month | t/Z∗ | p-value | |
|---|---|---|---|---|
| K-QIDS-SR | 15.38 (9.02) | 9.53 (6.85) | 2.60 | 0.023 |
| PAI-BOR | 37.31 (13.96) | 32.15 (12.95) | 1.43 | 0.177 |
| ECR | ||||
| Avoidance attachment | 70.46 (15.22) | 68.62 (16.05) | 0.37 | 0.719 |
| Anxiety attachment | 79.69 (19.97) | 76.46 (19.98) | 0.84 | 0.416 |
| KRQ-53 | ||||
| Self-regulation | 49.83 (10.06) | 58.50 (14.75) | -2.02∗ | 0.043 |
| Interpersonal relationship | 52.33 (12.52) | 60.00 (12.38) | -1.89∗ | 0.058 |
| positiveness | 49.00 (10.07) | 54.67 (16.06) | -1.08∗ | 0.279 |
| TCI | ||||
| Novelty seeking | 66.31 (12.64) | 63.00 (12.13) | 1.57 | 0.142 |
| Harm avoidance | 64.08 (12.14) | 59.69 (16.77) | 1.50 | 0.160 |
| Reward dependence | 47.00 (11.71) | 51.38 (11.02) | -1.79 | 0.098 |
| Persistence | 43.54 (12.36) | 45.15 (11.46) | -0.56 | 0.588 |
| Self-directedness | 29.54 (12.38) | 39.69 (14.81) | -3.14 | 0.009 |
| Cooperativeness | 37.15 (17.52) | 44.38 (15.03) | -3.43 | 0.005 |
| Self-transcsendence | 52.54 (11.43) | 39.69 (14.81) | 2.38 | 0.035 |
| MZQ | ||||
| Refusing self-reflection | 12.00 (2.45) | 11.29 (2.43) | 1.11 | 0.310 |
| Emotional awareness | 13.57 (3.31) | 12.43 (5.09) | 0.83 | 0.436 |
| Psychic equivalence | 14.57 (2.70) | 13.71 (3.35) | 1.11 | 0.308 |
| Regulation of affect | 11.43 (2.70) | 10.00 (3.32) | 1.59 | 0.162 |
| ICQ | ||||
| Building rapport | 9.86 (1.68) | 9.86 (3.72) | -0.14∗ | 0.892 |
| Self-assertiveness | 8.57 (3.21) | 8.57 (4.08) | -0.11∗ | 0.915 |
| Self-disclosure | 4.86 (1.57) | 6.14 (2.19) | -1.98∗ | 0.047 |
| Empathy and understanding others | 11.86 (1.95) | 11.86 (2.12) | -0.32∗ | 0.750 |
Data are presented as a mean (standard deviation). ∗ : Wilcoxon rank-sum test was done for non-parametric analysis. K-QIDS-SR : Korean Version of Quick Inventory of Depressive Symptomatology-Self-Report, PAI-BOR : Personality Assessment Inventory–Border-line Features Scale, KRQ-53 : Korean Resilience Quotient test-53, TCI : Temperament and Character Inventory, MZQ : Mentalization Questionnaire, ICQ : Interpersonal Competence Questionnaire
XML Download