Background Mentalization-Based Treatment Introduction (MBT-I) is a psychoeducational group module preceding long-term Mentalization-Based Treatment (MBT) for patients with borderline personality disorder (BPD). MBT-I aims to increase knowledge of mentalizing and BPD, prepare patients for treatment, clarify diagnosis, and assess mentalizing capacities. However, empirical evidence remains limited. This study examined whether MBT-I was associated with improved mentalizing capacity and attainment of its clinical goals. Methods A naturalistic, non-randomized one-group pre-post study was conducted in a Dutch mental health care institute. Patients attended ten weekly MBT-I group sessions. Of 60 included patients, 51 were analyzed. Most had a primary BPD diagnosis; others had personality disorders with comparable difficulties in relational functioning, self-image, and mentalizing. Mentalizing capacity was assessed using the Reflective Functioning Questionnaire, Interpersonal Reactivity Index, and Toronto Alexithymia Scale. MBT-I goals were measured using visual analogue scales. Results MBT-I was associated with significant improvement in difficulty identifying feelings and a small improvement in imaginative perspective-taking. Patients reported significantly increased knowledge of mentalizing and BPD, both with large effects. Motivation for long-term MBT did not significantly increase. Therapists reported reduced diagnostic uncertainty regarding BPD. Conclusion MBT-I may have psychoeducational value, but its incremental clinical benefit requires further controlled investigation
Routine outcome monitoring (ROM) is an important common factor in psychotherapy that can increase the effectiveness of psychotherapy and personalize patient-therapist matching. An International Consortium for Health Outcomes Measurement workgroup proposed a set of questionnaires for annual ROM for patients suffering personality disorders (PD). This data set was not validated. In addition, this set is extensive and time-consuming and therefore less applicable for frequent ROM. Therefore, the psychometric properties of the original item set was investigated in a sample of Dutch students earning course credits, and a brief version of the PD ROM set was developed, which was in line with the current views on PD's of the Alternative model of PD and the World Health Organization. The psychometric properties of this brief PD ROM questionnaire were investigated in a sample of students. The results showed that the psychometric properties of the original long International Consortium for Health Outcomes Measurement questionnaire set were poor, a six-factor structure instead of the purposed four-factor structure with a bad fit was found. The brief PD ROM questionnaire showed good psychometric properties and appears to be a reliable and valid instrument within this analog population. Further research in diverse clinical populations is needed to validate the brief PD ROM and ensure its reliability and usability in clinical practice. It demonstrated acceptable to good internal consistency and promising construct validity. A short ROM questionnaire that covers important health domains might ultimately provide a possibility for frequent monitoring of PD treatments, thereby increasing the effectiveness and efficiency of PD treatment.
OBJECTIVE:Posttraumatic stress disorder (PTSD) frequently co-occurs with acquired brain injury (ABI), yet limited evidence guides treatment for this population. This study aimed to establish expert consensus on the applicability of trauma-focused PTSD treatments for adults with ABI, identify commonly used adaptations, and clarify treatment challenges. METHOD:A Delphi study was conducted with Dutch clinicians experienced in delivering PTSD treatment to adults with ABI across mental health, rehabilitation, and hospital settings. Through two iterative survey rounds, participants evaluated statements regarding feasibility, safety, and modifications of psychological therapies for PTSD after ABI. Quantitative agreement ratings were supplemented with qualitative comments. RESULTS:Consensus across two Delphi rounds (51 and 50 experts) indicated that trauma-focused treatments were feasible for adults with ABI. Core therapeutic principles were considered valid, and procedural adaptations, such as shorter sessions, slower pacing, and simplified language, were sometimes recommended for cognitive or sensory impairments. Structural modifications were less commonly endorsed. Opinions diverged regarding side-effect profiles: some reported similarities to non-ABI patients, whereas others noted increased fatigue, irritability, or somatic complaints. No consensus emerged on the adequacy of current PTSD assessment instruments, with concerns about symptom overlap and a need for ABI-specific validation or adapted administration. CONCLUSIONS:Clinicians agreed that trauma-focused treatments can be feasible for adults with ABI when adaptations are applied on a case-by-case basis. The study also highlights uncertainty regarding PTSD assessment tools and the need for systematic evaluation of treatment adaptations and adverse effects. These practitioner-informed findings provide direction for clinical practice and guideline refinement.
Although schema therapy (ST) is an effective intervention for individuals with personality disorders (PDs), its mechanisms of change are not yet well delineated. Understanding these mechanisms is essential for determining the key processes that optimize treatment efficacy. This study investigated mechanisms of change in day treatment group ST (DT-GST) for patients with severe PDs. PD severity was the primary outcome in a multiple-baseline single-case design, assessed before and after DT-GST, alongside idiosyncratic negative core beliefs measured weekly over 30 weeks. Secondary outcomes were early maladaptive schemas (EMS) and schema modes (SMs), measured pre- and post-treatment. Mechanisms of change were examined through visual inspection, correlations and randomization tests. Changes in PD severity moderately correlated with changes in negative core beliefs (r = 0.57), but not with SMs. Negative core beliefs correlated positively with the Vulnerable Child (r = 0.76), Punitive Parent (r = 0.78), Demanding Parent (r = 0.61) and Detached Self-Soother (r = 0.58) modes and negatively with the Happy Child (r = -0.77) and Healthy Adult (r = -0.57) modes. Meaningful change occurred across all treatment phases, with the greatest therapeutic progress in the second and third phases. This study highlights the central role of idiosyncratic negative core beliefs in reducing PD severity while also underscoring the importance of changes in SMs. Findings suggest that ST should prioritize reducing the Vulnerable Child mode and its associated EMS while reinforcing adaptive Healthy Adult and Happy Child modes and diminishing maladaptive Parent and detachment-related coping modes. Further longitudinal research with repeated assessments is needed to clarify mechanisms of change in ST.
Background University students are at elevated risk of developing an eating disorder. The dissonance-based Body Project effectively reduces body dissatisfaction and thin-ideal internalization. Digital adaptations might enhance scalability and accessibility. Objective The present manuscript describes the study protocol for a randomized controlled trial among university women in the Netherlands that applies a digitalized version of the Body Project within a preventive framework. Methods Dutch university students (N = 180) will be randomized to the experimental condition, the Digitalized Body Project, or a waitlist control condition. The intervention includes four weekly web-based group sessions supported by a digital platform offering psychoeducation and exercises. Primary outcomes will be changes in body dissatisfaction and thin-ideal internalization; secondary outcomes will be reduction in eating disorder symptoms, restrained eating, negative affect and self objectification. Feasibility and acceptability will be evaluated by both participants and by the group facilitators. Assessments take place at baseline (week 0), at post-intervention (week 4), and at 4-week (week 8) and 8-week (week 12) follow-up. Results The experimental condition is hypothesized to show greater reductions in body dissatisfaction and thin-ideal internalization compared to the waitlist control group. Feasibility and acceptability data will inform future implementation strategies. Conclusion The present study could provide preliminary evidence on the short-term efficacy, feasibility, and acceptability of a clinician- and peer-facilitated digital Body Project in the Dutch university context. The findings can inform refinements for future large-scale trials and practical implementation.
