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12/12/2012
Mentalisation-Based Therapy (MBT) - Is there an evidence base
for its use in the field of substance misuse?
Catriona Matheson and Niamh Fingleton
Academic Primary Care, University of Aberdeen
Background
Mentalisation-based therapy is a psychological therapy which was first used in French
psychoanalysis in the sixties. Since then it has been more widely used in autism,
schizophrenia and borderline personality disorder. Mentalisation is defined as “the
competence to envisage mental states in self and others and to understand behaviour in
terms of mental state”. CERGA requested that the literature be searched to establish if there
was an evidence base for its use in substance misuse (alcohol and drugs).
Importantly, mentalisation-based therapy is a separate concept and approach from
mindfulness meditation/therapy. There is published literature available in relation to
mindfulness meditation in substance misuse, including a systematic review (Zgierska et al.
2009). Mindfulness is defined in the review as the intentional, accepting and nonjudgemental focus on one’s emotions, thoughts and sensations in the present moment.
Method
An electronic database search was initially conducted using MEDLINE; however, this search
did not identify any relevant papers and was therefore repeated in Embase, Scopus and
PsycINFO. The terms ‘mentalisation’ or ‘mentalization’, and ‘based’, were used, with the
two terms needing to be adjacent to one another. The concept of substance misuse was not
included in order to keep the search as broad as possible due to the limited number of
results initially retrieved using MEDLINE. Following the search of electronic databases, an email was circulated via the Drug Misuse Research Network to identify any unpublished
research or implementation of mentalisation-based therapy. An additional search of the
Drug and Alcohol Findings database was also conducted.
Results
The results were as follows:
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MEDLINE retrieved 36 results, none of which pertained to substance misuse.
Embase retrieved 50 results, none of which pertained to substance misuse.
PsycINFO retrieved 103 results, two of which referred to substance misuse. These
were:
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1. Söderström, K. & Skårderud, F. 2009, "Mentalization-based treatment in families
with parental substance use disorder: Theoretical framework.", Nordic
Psychology, vol. 61, no. 3, pp. 47.
2. Fewell, C.H. 2011, "An attachment and mentalizing perspective on children of
substance-abusing parents" in Children of substance-abusing parents: Dynamics
and treatment., eds. S.L.A. Straussner & C.H. Fewell, Springer Publishing
Company, New York, pp. 29-47.
Scopus retrieved 64 results, one of which referred to substance misuse; however,
this reference had already been identified using PsycINFO (Söderström & Skårderud
2009).
The search of the Drug and Alcohol Findings database revealed no relevant papers.
The Drug Misuse Research Network e-mail revealed no relevant research or
implementation.
Many of the irrelevant papers were in relation to borderline personality disorder, with no
reference to substance misuse. A brief overview of the article by Söderström & Skårderud
(2009) is included below. The other reference was a chapter in a book and therefore we
were unable to access it. CERGA’s view will be sought regarding whether to proceed with
this.
Söderström & Skårderud 2009
This is a theoretical paper describing how mentalisation could be used in family therapy. It
specifically relates to a programme in Norway, called ‘Minding the baby’, in which
mentalisation is being used to improve the parenting competence of young mothers. It
specifically focuses on ‘keeping the babies mind in mind’ as a means of creating a ‘secure
and nourishing environment’ for young children so that developmental risks are minimised.
It is based on the premise that substance misusers can be ‘absent-minded’ when it comes to
considering their children’s mental development thus putting them at developmental risk.
The paper provides a useful overview of the concept of mentalisation and how this might
apply to substance misuse generally. It describes concepts such as ‘alexithymia’ (literally
meaning no words for feelings). This is currently taken to mean difficulty identifying feelings
and describing them to others, and difficulty distinguishing feelings from other
manifestations of emotional arousal. The paper describes the overlap between
mentalisation, alexithymia, symbolisation and disordered affect regulation which the
authors suggest are also features of substance use disorders.
Presumably there may be publications evaluating the ‘minding the baby’ programme in time
but this was not clear from the paper.
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Conclusion
No research was found on the use of mentalisation-based therapy in either alcohol or drug
misuse despite an expansive search of the literature.
References
Fewell, C.H. 2011, "An attachment and mentalizing perspective on children of substanceabusing parents" in Children of substance-abusing parents: Dynamics and treatment., eds.
S.L.A. Straussner & C.H. Fewell, Springer Publishing Company, New York, pp. 29-47.
Söderström, K. & Skårderud, F. 2009, "Mentalization-based treatment in families with
parental substance use disorder: Theoretical framework.", Nordic Psychology, vol. 61, no. 3,
pp. 47.
Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R. & Marlatt, A. 2009,
"Mindfulness meditation for substance use disorders: A systematic review", Substance
Abuse, vol. 30, no. 4, pp. 266-294.
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