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

Study Overview
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Brief Summary
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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.

Official Title
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Comparaison d'Une thérapie basée Sur la Mentalisation et d'un Traitement inspiré de la thérapie Comportementale Dialectique Sur l'Utilisation Des Services et Sur le Taux d'Abandon Dans Une Population Clinique Adulte Atteinte d'un Trouble de la personnalité du Groupe B

Conditions
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Cluster B Personality Disorder (Diagnosis), Borderline Personality Disorder

Intervention / Treatment
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* Behavioral: Mentalization-based Treatment
* Behavioral: Dialectical Behavior Therapy-inspired Treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 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 Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mentalization-based Treatment<br>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<br>* 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.<br>|
| Dialectical Behavior Therapy-inspired Treatment<br>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<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dropout rate | The comparison of the dropout rate between mentalization-based treatment and dialectical behavior therapy. | From the beginning until the end of the psychotherapy treatment. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cluster B personality disorder, mentalization-based treatment, dialectical behavior therapy, borderline personality disorder, service utilization, dropout rate, naturalistic study