Clinical management of common presentations of patients diagnosed with BPD during the COVID-19 pandemic: The contribution of the MBT framework

The coronavirus (COVID-19) pandemic has both a profound effect on mental health and affects how psychosocial interventions are delivered. In this paper, we outline particular difficulties patients with Borderline Personality Disorder (BPD) may encounter as a result of the pandemic. We also consider changes in the provision of treatment, specifically the transition from face to face encounters to remotely delivered sessions. Building on a mentalization-based developmental framework, we use clinical vignettes to chart some of these challenges for patients, clinicians and teams. We then make practical recommendations for adaptations to work during the pandemic via the phone or video-link with BPD patients and other groups characterized by a vulnerability to unstable and imbalanced mentalizing. We conclude that the response to these challenges benefits from an existing treatment context that aims at fostering mentalizing and resilience, in which practitioners address the hierarchy of patient needs and their individual responses to the experience of remote treatment during the COVID-19 pandemic

Dynamic interpersonal therapy for moderate to severe depression: A pilot randomized controlled and feasibility trial

Background: Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated. Methods: 147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion. Results: The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.ConclusionsDIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs