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The effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents: a randomized controlled trial

Projectomschrijving

Kenmerken van borderline persoonlijkheidsstoornissen (BPS)

Kenmerken van een borderline persoonlijkheidsstoornis (BPS), zoals zelfverwonding, beginnen zich te ontwikkelen vanaf de puberteit. Signalering en behandeling van BPS in een vroeg stadium is essentieel, omdat problemen dan beter te behandelen zijn en ernstigere problemen voorkomen kunnen worden. Denk hierbij aan maatschappelijke uitval, risicovolle levensstijl en een verminderde levensverwachting. Door stigma worden kenmerken in de puberteit vaak miskend, waardoor behandelingen doorgaans ingezet worden op andere klachten, zoals angst en depressie.

Doel

Deze studie gaat na of Mentalization Based Treamtment (MBT-early ), een vroege interventie op de kenmerken van BPS, beter geschikt is om de ontwikkeling van deze aandoening te stoppen en duurzame behandelresultaten te bereiken dan Cognitieve Gedragstherapie (CGT), een klassieke behandeling op de angst en depressie.

Verwachte resultaten

Omdat onderliggende problemen worden aangepakt, verwachten we uit dit onderzoek dat de effecten duurzamer zijn en jongeren beter geholpen worden hun ontwikkeling gezond verder te zetten.

Verslagen


Samenvatting van de aanvraag

BACKGROUND: Symptoms of borderline personality disorder (BPD) typically emerge in adolescence, are prevalent in young people referred for mental health problems and are highly predictive of long-term unfavorable symptomatic and functional outcomes. The burden of disease associated with BPD is high both for young people and for their families. However, symptoms of BPD are often underdiagnosed and undertreated in adolescence because of fear of stigmatization among professionals and because young people in an early stage of BPD often show presenting symptoms of depression and/or anxiety. Although clinical guidelines prioritize the treatment of depression and anxiety in these cases, there is accumulating evidence that the presence of BPD features in young people is associated with limited effectiveness of these treatments, as evidenced by higher relapse rates and poor long-term outcomes. These findings emphasize the need for the detection and intervention of early-stage BPD in young people with presenting symptoms of anxiety and depression to improve treatment outcome and prevent the high burden associated with untreated late-stage BPD. One promising approach in this context is mentalization-based treatment (MBT), an empirically supported treatment for adults and adolescents with BPD. MBT is characterized by a focus on improving personality functioning and social cognition and may therefore be well suited to reduce the symptoms of BPD and associated personality features, and also to improve social and academic functioning. OBJECTIVE: The aim of this study is to investigate the effectiveness of an early intervention program for BPD (MBT-early), compared with a standard protocolized treatment for symptom (i.e. depressive and/or anxiety) disorders, cognitive-behavioral therapy (CBT), in adolescents with depressive/anxiety disorders in combination with emerging BPD symptoms. HYPOTHESIS: We hypothesize that MBT-early will be superior to standard protocolized CBT in reducing symptoms of BPD (primary outcome) and in improving personality, social, and academic functioning (secondary outcomes), and as effective as standard protocolized CBT in reducing symptoms of depression and anxiety (secondary outcomes). DESIGN: Randomized controlled trial (RCT) POPULATION: Adolescents (12–18 years) with a depressive/anxiety disorder as assessed with the Structured Clinical Interview for DSM-5 Syndrome Disorders (SCID-5-S) and early-stage BPD, defined as having 3–6 BPD symptoms as assessed with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). INTERVENTIONS: CBT is the standard intervention for young people with depressive and/or anxiety disorders in the Netherlands. CBT is a protocolized, time-limited, individual intervention, which may be accompanied by supportive interventions for parents. MBT-early is an early intervention program for BPD that has been developed as an adaptation of MBT, an empirically supported treatment for BPD. MBT-early builds upon the theory and methods of MBT but integrates the principles of early intervention approaches such as Helping Young People Early (HYPE). MBT-early is a time-limited intervention that has been designed for early-stage BPD and focuses on improving personality functioning. MBT-early is a two-phase treatment that integrates interventions at the individual, family, and context level. RESEARCH SETTINGS: This study will be conducted at Mentaal Beter and GGz Breburg, two mental health care centers for young people with emerging mental health problems, enabling the recruitment of young people in an early stage of BPD. MEASURES: The primary outcome is the severity of BPD symptoms; secondary outcomes are level of personality functioning, level of social and academic functioning, and severity of depressive/anxiety symptoms. SAMPLE SIZE: two groups of 66 randomized adolescents DATA ANALYSIS: Multilevel modeling TIME SCHEDULE: Inclusion: 12/2020 – 7/2022; assessments at start of treatment, end of treatment, and 12, 18, and 24 months after start of treatment (end of data collection: 7/2024) CLIENT PARTICIPATION: A client board, consisting of four client representatives of the Client Council of de Viersprong, and two young people and one parent who have been involved in the MBT-early program recently. This client board has been involved in the design of the study and will continue to meet with the research team at least twice a year. They will be updated about the progress of the project and will provide the research team with input throughout the duration of the trial. The chair of the Client Council is member of the trial steering committee.

Onderwerpen

Kenmerken

Projectnummer:
636310021
Looptijd: 93%
Looptijd: 93 %
2020
2024
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. D.J. Feenstra
Verantwoordelijke organisatie:
De Viersprong