Mentalization-based treatment (MBT) for borderline personality disorder (BPD) involves helping people understand their own mental state and the feelings of others. This helps people regulate their emotions and behavior.
This article discusses MBT, including how it works for BPD, what it entails, the benefits, and the downsides. It also compares this treatment to other therapies for BPD.
Mentalization is a person’s ability to make sense of their own mental state and the mental states of others. It involves being aware of one’s own feelings and identifying the feelings of others by noticing:
- facial expression
- tone of voice
- body language
For example, if a person notices that their heart is beating faster than usual, this is not mentalization. But if they realize that the reason for their elevated heart rate is that they are anxious, this is mentalization. They have become aware of their emotions and understand how emotions are affecting their body and behavior.
If a person finds it hard to mentalize, they may have thoughts and emotional responses that do not have basis in truth. For example, they may think their rapid heartbeat is a symptom of a heart attack, and this may cause further anxiety.
During MBT, a therapist helps a person learn how to practice this skill more consistently, particularly in situations where a person finds it challenging. This helps a person regulate their emotions.
Many mental health conditions can involve difficulties with mentalization. As a result, therapists may use it to address numerous conditions, although its original purpose was specifically to help with BPD.
People with BPD often have trouble with mentalization. Experts link this to poor attachment to a caregiver in early life. Attachment is a person’s bond with the person mainly responsible for caring for them, such as a parent.
The theory behind MBT is that healthy attachment to a caregiver helps a person develop their ability to mentalize. If the relationship is not healthy, they may not gain this skill. This can make it difficult for a person to interpret other peoples’ feelings and intentions, leading to anxiety and insecurity.
The aim of MBT is to stabilize a person’s emotions, since intense emotions can lead to impulsive behavior. Another goal of MBT is to help a person learn how to continue mentalizing during times of distress, as this can be difficult for people with BPD.
An MBT therapist will address this by helping a person reinstate mentalization when it disappears and teaching a person to maintain it in situations that may provoke its disappearance.
The authors of a
According to the review, MBT can:
- significantly reduce the severity of BPD symptoms such as interpersonal problems and suicidal behaviors
- significantly decrease co-occurring mental health conditions such as anxiety and depression
- increase quality of life
Despite these benefits, the authors urge caution in interpreting the results and emphasize the need for higher quality research.
MBT begins with a few assessment sessions that allow the therapist to understand a person’s difficulties. During an assessment, people may need to complete questionnaires about their symptoms and the impact of those symptoms.
After this stage, MBT therapy sessions move on to teaching a person how to focus on their own thoughts and identify their feelings and what they believe others are thinking. It especially focuses on scenarios that produce strong emotional reactions, which may lead to unhelpful behavior.
As the person becomes more aware of their thoughts and feelings and those of others, they can interpret the world around them in a more balanced and accurate way. This allows them to regulate their emotions, manage their impulses, and improve their relationships.
MBT group therapy sessions typically last 75–90 minutes, while an individual therapy session lasts 60 minutes. The treatment duration is typically 12–18 months.
Dialectical behavior therapy (DBT) is a type of talk therapy that clinicians also use to treat BPD. Although it has similar aims to MBT, different theories underlie it.
DBT draws less from attachment theory than MBT does, and DBT does not pinpoint mentalization as the underlying cause of the condition. Instead, DBT focuses more on unhelpful behaviors and how they affect a person’s life.
Although DBT has more scientific evidence to support it, a small but significant amount of research indicates the value of MBT.
In a 2017 study, researchers compared three common therapies for BPD: DBT, MBT, and schema-based therapy. They found that all three were effective in decreasing symptoms such as suicidal behavior but that, in many cases, emotional regulation did not respond to treatment.
MBT is a safe, evidence-based treatment that can help with BPD symptoms. However, like any other form of talk therapy, it can be a challenging process at times.
MBT can prompt people to talk about and examine their emotions in a way that they have not done before. This may be uncomfortable at first. Some people may also feel anxious about discussing their feelings in group therapy.
This treatment takes time to work, but the same is true of many other talk therapies. Because BPD is a long-term condition, a person may need support for a long period.
Anyone who thinks they may have BPD or wants to access treatment can discuss their options with a doctor or a mental health professional.
It is especially important to seek help if a person has thoughts of harming themselves or of taking their own life. If a person has these symptoms, they should reach out to a doctor, therapist, or crisis line as soon as they can.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
MBT aims to help a person develop awareness of their feelings and thoughts. It also helps them learn to interpret the facial expressions and tone of voice of others, leading to more accurate identification of others’ feelings and intentions.
This may help people with BPD develop a more balanced view of their own mental state and the motivations behind other peoples’ behavior. As a result, they may develop better impulse control and stronger relationships, as well as better quality of life.
MBT is one of several therapies that can help with BPD. A person can discuss the options with a mental health professional to get a sense of what each treatment involves and the potential benefits.