Mentalization-Based Treatment for Adolescents (MBT-A)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Low
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Mentalization-Based Treatment for Adolescents (MBT-A) has been rated by the CEBC in the area of: Depression Treatment (Child & Adolescent).

Target Population: Adolescents who present with self-harm

For children/adolescents ages: 12 – 17

Brief Description

MBT-A with self-harm provides weekly individual MBT therapy to the young person and monthly Mentalization-Based Treatment for Families (MBTF). Mentalization is the capacity to understand actions in terms of thoughts and feelings. Its enhancement is assumed to strengthen self-control in those with affect dysregulation and impulse control problems. The developers have suggested that self-harm in adolescents occurs in response to relationship stress, when the individual fails to represent the social experience in terms of mental states. When mentalizing is compromised, self-related negative cognitions are experienced with great intensity, leading to both intense depression and an urgent need for distraction. Furthermore, when non-mentalizing engenders social isolation, engaging in manipulative behavior and self-harm may aid reconnection. When mentalization of social experience fails, impulsive (poorly regulated) behaviors and subjective states triggering self-harm become prominent.

Program Goals:

The overall goals of Mentalization-Based Treatment for Adolescents (MBT-A) are:

  • Improvement in ability to mentalize which implies an ability for self- regulation
  • An ability for understanding action and thoughts from others as well as their own impact on others in a more realistic manner
  • Greater impulse control and less acting out behavior such as self-harm

Essential Components

The essential components of Mentalization-Based Treatment for Adolescents (MBT-A) include:

  • The work is a combination of individual and family sessions.
  • The work is relational-based.
  • The focus of the work is on affect (i.e., emotions) and not on behavior.
  • The work explicitly addresses mentalization.
  • The work is not focused on cognition or on unconscious material.
  • The work is focused in the here and now.
  • The therapist takes responsibility for their contribution in how a patient may feel.

Child/Adolescent Services

Mentalization-Based Treatment for Adolescents (MBT-A) directly provides services to children/adolescents and addresses the following:

  • Exhibiting self-harm, depression, relationship stress

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Mentalization-Based Treatment for Adolescents (MBT-A) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

The family work can require additional resources, but that will depend on the therapist. There are no absolute requirements about this.

Minimum Provider Qualifications

Training in a primary mental health qualification followed by training in MBT-A for adolescents.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • Anna Freud Centre
    London
Training is obtained:

At the Anna Freud in London although it has been provided in Yale and at UCLA in the past

Number of days/hours:

3 days

Implementation Information

Since Mentalization-Based Treatment for Adolescents (MBT-A) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Mentalization-Based Treatment for Adolescents (MBT-A).

Formal Support for Implementation

There is no formal support available for implementation of Mentalization-Based Treatment for Adolescents (MBT-A).

Fidelity Measures

There are fidelity measures for Mentalization-Based Treatment for Adolescents (MBT-A) as listed below:

There is a fidelity measure in the manual. Please contact Trudie Rossouw at Trudie.rossouw@nelft.nhs.uk for more information.

Implementation Guides or Manuals

There are implementation guides or manuals for Mentalization-Based Treatment for Adolescents (MBT-A) as listed below:

Please contact Trudie Rossouw at Trudie.rossouw@nelft.nhs.uk for more information.

Research on How to Implement the Program

Research has not been conducted on how to implement Mentalization-Based Treatment for Adolescents (MBT-A).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Rossouw, T., & Fonagy, P. (2012). Mentalization-Based Treatment for Self-Harm in Adolescents: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51(12), 1304-1313.

Type of Study: Randomized controlled trial
Number of Participants: 80

Population:

  • Age — 12 to 17 years
  • Race/Ethnicity — Not stated
  • Gender — 85% Female
  • Status — Participants were adolescents that presented with at least one episode of confirmed self-harm.

Location/Institution: Northeastern London

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine whether Mentalization-Based Treatment for Adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm. Participants consecutively presenting to mental health services with self-harm and co-occurring depression were randomly allocated to either MBT-A or TAU. Measures utilized include the Risk-Taking and Self-Harm Inventory (RTSHI), the Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD), the 13-item Mood and Feelings Questionnaire (MFQ), the How I Feel (HIF) questionnaire, and the Experience of Close Relationships Inventory (ECR). Results indicated MBT-A was more effective than TAU in reducing self-harm and depression. Limitations include small sample size and the generalizability of the study may be limited, given that the first author was the supervisor of all three teams.

Length of postintervention follow-up: None.

References

Rossouw, T. (2013). Mentalization-Based Treatment: Can It be translated into practice in clinical settings and teams?. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3), 220-222.

Contact Information

Name: Dr. Trudie Rossouw, MBChB, FFPsych, MRCPsych MD (Res)
Agency/Affiliation: North East London NHS Foundation Trust
Email:
Phone: +004 430 0555 1156

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: June 2015

Date Program Originally Loaded onto CEBC: July 2014