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Implementation of evidence-based treatments for borderline personality disorder: The impact of organizational changes on treatment outcome of mentalization-based treatment

Dawn L. Bales · Reinier Timman · Patrick Luyten · Jan J.V. Busschbach · Roel Verheul · Joost Hutsebaut

93 citations0/0 files storedPersonality and Mental Health

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Personality Disorders and Psychopathology Psychotherapy Techniques and Applications Health Policy Implementation Science

Abstract

The quality of implementation of evidence-based treatment programs for borderline personality disorder (BPD) in routine clinical care is a neglected issue. The first aim of this mixed-method naturalistic study was to explore the impact of organizational changes on treatment effectiveness of a day-hospital programme of mentalization-based treatment. Consecutively referred BPD patients were divided into a pre-reorganization cohort (PRE-REORG) and a cohort during reorganization (REORG). Psychiatric symptoms (Brief Symptom Inventory) and personality functioning (Severity Indices of Personality Problems-118) before treatment and at 18- and 36-month follow-up were compared using multilevel modelling. Effect sizes in the PRE-REORG cohort were approximately twice as large at 18 months (PRE-REORG: range 0.81-1.22; REORG: range 0.03-0.71) and three times as large at 36 months (PRE-REORG: range 0.81-1.80; REORG: range 0.27-0.81). The quantitative results of this study suggest that even when mentalization-based treatment is successfully implemented and the structure of the programme remains intact, major organizational changes may have a considerable impact on its effectiveness. Second, we aimed to explore the impact of the reorganization on adherence at organizational, team and therapist level. The qualitative results of this study indicate that the organizational changes were negatively related to adherence to the treatment model at organizational, team and therapist level, which in turn was associated with a decrease in treatment effectiveness. The implications of these findings for the implementation of effective treatments for BPD in routine clinical practice are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

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1992A power primer.1983The Brief Symptom Inventory: an introductory report 2004Psychotherapy for Borderline Personality Disorder 2012Psychological therapies for people with borderline personality disorder 2010Borderline personality disorder 2013Handbook of Mentalizing in Mental Health Practice 2016Mentalization-Based Treatment for Personality Disorders 1998Structured interview for DSM-IV personality: SIDP-IV

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2018Mentalization‐based treatment and its evidence‐base status: A systematic literature review 2017Barriers and facilitators to the implementation of mentalization‐based treatment (MBT) for borderline personality disorder 2019Mentalization-Based Treatment for Personality Disorders: Efficacy, Effectiveness, and New Developments 2018Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial 2019Fidelity vs. flexibility in the implementation of psychotherapies: time to move on

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