Brief historical summary
Mentalization-Based Treatment (MBT) was developed by Professor Anthony Bateman and Professor Peter Fonagy in the early 1990s for the treatment of patients with Borderline Personality Disorder (BPD). It is a psychodynamically informed therapy rooted in attachment theory and psychoanalytic concepts - primarily object relations theory. The MBT was developed at St. Ann's Hospital in London, UK and its main training center is the Anna Freud National Center for Children and Families.
Originally developed for BPD, MBT is now used for a variety of disorders such as eating disorders, depression, addictions, and antisocial personality disorder (ASPD).
The focus of MBT is to increase the patient's ability to mentalize. According to Bateman and Fonagy (2010), “mentalization is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes”. In other words, it is the ability to reflect on one's own and others' mental states (thoughts, emotions, needs) and their impact on interpersonal interaction. It is the awareness of oneself and the other as independent human beings. This ability depends profoundly not only on individual genetic factors but also on the quality of early object relations and attachments. Bateman and Fonagy (2010) argued that patients with BPD have a fragile mentalizing capacity—that is, they have difficulty thinking about their thoughts, feelings, desires, and actions, poor emotional regulation, and inconsistent and inaccurate perceptions of themselves and of Other. These make them prone to very painful general difficulties in social and interpersonal interactions, resulting in unstable and chaotic relationships.
The core feature of MBT is to create a safe attachment environment in which inner states can be enacted, reflected upon and discussed, and thus the patient's mentalizing ability can be developed and strengthened, resulting in patients being more able to deal with their heightened emotional states and to respond more adaptively to life's challenges.
Mentalization and superimposition of concepts
The concept of mentalization is complex, has certain limitations, and relates to fundamental phenomena of human interaction. It is therefore not surprising that it bears similarities with some other terms. We will give here some terms to differentiate the concept of mentalization:
Be aware of mental states in yourself and others and interpret behavior accordingly.
to sealcognitiveDevelopment and provides a conceptual framework for mentalization.
Mainly focuses onTo knownot me.
seal notGiftand isnot limitedto mental states.
Focused on others and stressedemotionalConditions.
It refers to the way of thinking ofEmotionin yourself and in others.
characterizedarrangementmentalize - very broad.
Intellectual content, that's theProductsthe mentalization process.
Theory of Mind term that appliesOthersand focuses onTo know, thereby omitting the self and emotions. The term also has connotations of delusions of telepathy – of “knowing” another's thoughts directly.
antithesisto mentalize; The term was originally used to characterize autism.
The MBT builds on a wealth of research in attachment, emotion and neurobiology and underscores the importance of the emotional component in thinking, emotional processing and behavior. It is a very compelling and coherent treatment model suggesting that mentalization is the core process of all effective psychotherapies. In addition, MBT aims to build on previously acquired therapeutic skills rather than just being a treatment method in its own right. Psychodynamic, cognitive, systemic and other therapists can learn and integrate MBT into their practice. If anyone wants to implement MBT protocols - they are readily available. It's a well-researched treatment modality—particularly for borderline personality disorder, which is now showing evidence of effectiveness in treating other common psychiatric conditions as well.
The treatment is organized according to the one-team model and is a combination of group and individual therapy. Intensities range from daily sessions to two sessions per week for up to 18 months. Adults, children and young people have access to the MBT.
MBT is a relatively new psychological treatment and as such more research is needed to clarify its effectiveness, although there is already evidence that it may be beneficial for framed clinicians working with patients with BPD (Daubney and Bateman, 2015). Randomized clinical trials have shown that MBT interventions can reduce psychiatric symptoms in patients with personality disorders such as suicide and hospitalization (Bateman and Fonagy, 2009). Vogt and Norman (2018) published a systematic review of the evidence for the effectiveness of MBT in treating BPD. They included 14 articles and the results showed superior or equivalent outcomes in treating mental health symptoms, but the authors emphasized the need for high-quality articles and limited knowledge of MBT mechanisms.
"The inability to mentalize creates a sort of psychological version of an autoimmune deficiency state that makes these individuals extremely vulnerable to later, sometimes quite brutal, social environments."Psychotherapy for borderline personality disorder: mentalization-based treatment.
Anthony Bateman und Peter Fonagy
Comments from interns
"The most useful theory we've learned so far."
“I will definitely apply the MBT principles in my practice. They make sense.”
Anonymous feedback from in-service general practitioner (GP) psychiatric trainees who received a pilot teaching session on the basic principles of MBT.
Degree programs in Europe and links to societies
Online-MBT-Trainingg at the Anna Freud Center. The link opens a one-page PDF with instructions.
Department of Mentalization-www.institutformentalisering.dk
MBT-F(Mentalization-based treatment for families). In collaboration with the Anna Freud National Center for Children and Youth.
Basic training and training at practitioner level inUniversity of Heidelberg
basic training inThessaloniki
InternationalMBT centerIn Dublin.
Italian MBT group-www.gimbt.it
Norwegian Institute for Mentalization-www.inst-mbt.no
basic training inPosen
Switzerland, France and Belgium
Basic training in Paris, Brussels and Geneva:
Francophone network of mentalization-based therapies-mentalisation.org
University of Geneva:MBT International Center-mentalisierung.unige.ch
Anna Freud National Center for Children and Families-www.annafreud.org
Other international centers are located in Australia and the USA. Training courses are also offered in Mexico.
Research study on MBT as an intervention for children in nursing homes.https://www.ucl.ac.uk/pals/were-starting-first-research-study-mbt-intervention-children-foster-care
Mentalization for Offensive Adult Males (MOAM). A randomized controlled trial at 13 sites. Men diagnosed with ASPD receive weekly group MBT treatment. This is a five year project that started in 2016.https://tavistockandportman.nhs.uk/research-and-innovation/our-research/research-projects/mentalization-based-treatment-antisocial-personality-disorder/
Ongoing research projects on MBT in Norway.http://sigmundkarterud.no/index.php/hva-er-mbt/information-in-englishehttps://www.annafreud.org/media/4468/mbt-research-2016-karterud.pdf.
References and recommended resources
Aspen Folmo. n.d.Mentalize and MBT. Accessed June 22, 2019.https://www.youtube.com/watch?v=kxUHILbZNaY.
Bateman, AW Mentalization-Based Treatment: Clinical Training Slides.http://www.ucl.ac.uk/psychoanalysis/people/bateman(Video) Your Fantastic Mind Season 2 Episode 4: Evidenced-Based Treatments
Bateman, Anthony W., Dawn Bales, and Joost Hutsebaut. 2014A quality manual for MBT.https://www.annafreud.org/media/7863/quality-manual-2018.pdf.
Bateman, Anthony, and Peter Fonagy. 2010. “Mentation-Based Treatment of Borderline Personality Disorder”.world psychiatry9 (1): 11.
Bateman, Anthony und Peter Fonagy. 2016.Mentalization-based treatment of personality disorders: a practical guide. Oxford University Press.
Daubney, Michael and Anthony Bateman. 2015. 'Mentation-based therapy (MBT): an overview'.Australasian Psychiatry23 (2): 132–135. doi:10.1177/1039856214566830.
Vogt, Katharina Sophie and Paul Norman. 2018. “Is mentalization-based therapy effective in treating symptoms of borderline personality disorder? A systematic review”.Psychology and psychotherapy: Theory, research and practice. doi:10.1111/papt.12194
Allen, Jon G., Peter Fonagy, and Anthony W. Bateman. 2008Mentalizing in clinical practice. American Psychiatric Pub.
Bateman, Anthony, and Peter Fonagy. 2009. 'Randomized controlled trial of mentalization-based outpatient treatment versus structured clinical management in borderline personality disorder'.American Journal of Psychiatry166 (12): 1355–1364.
Dr. Foteini Papouliis a Lecturer in Psychiatry and currently works for the Northumberland Tyne and Wear NHS Foundation Trust (Newcastle-upon-Tyne, UK). His experience is working with criminals suffering from personality disorder(s).
Dr. Barbara Almeidais a psychiatric trainee at the Magalhães Lemos Hospital, Porto, Portugal.
Dr. Roberts Klotinswas a psychiatric trainee in London at the time of writing this chapter and has just completed his residency in medical psychotherapy. He started out as a consultant psychiatrist for psychotherapy at the Halliwick Unit, St Ann's Hospital, where MBT was developed.
What are brain-based therapies? ›
Brain-based therapy incorporates knowledge from neuroscience research, and combines this knowledge with well-known aspects of attachment theory to help clients rewire their brains so as to improve their moods and effectively change their behaviors.What is treatment of the mind? ›
Psychological treatment is sometimes called 'psychotherapy' or 'talking therapy'. It involves talking about your thoughts with a professional to: better understand your own thinking and behaviour. understand and resolve your problems.What is mind therapy called? ›
Cognitive behavioural therapy (CBT) is a type of talking therapy. It is a common treatment for a range of mental health problems. CBT teaches you coping skills for dealing with different problems. It focuses on how your thoughts, beliefs and attitudes affect your feelings and actions.What is an example of mind body therapy? ›
Mind and body practices are a large and diverse group of procedures or techniques that are administered or taught by a trained practitioner or teacher. Examples include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, tai chi, and yoga.What is mind based cognitive therapy? ›
Mindfulness-based cognitive therapy (MBCT) is a therapy approach designed to help people manage symptoms of depression. It combines meditation practice with clinical applications. The goal of mindfulness-based cognitive therapy is to break the cycle of depression that reoccurs.What are 3 different types of treatments for most mental illness? ›
- Drug Therapy.
- Electroconvulsive Therapy.
- Psychotherapy or counseling. This also is called talk therapy. ...
- Prescription medicine. ...
- Support groups. ...
- Other therapies. ...
- ECT or other brain stimulation therapy. ...
- Eye Movement Desensitization and Reprocessing (EMDR) therapy. ...
- Hospital or residential treatment program.
Mind–body CHAs are essential components of mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy, which are also widely used to treat depression and anxiety.What type of therapy is best for anxiety? ›
Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you've avoided because of anxiety.What is the most effective form of therapy? ›
In this paper, we argue that CBT is the gold-standard psychological treatment—as the best standard we have in the field currently available—for the following reasons [see also Hofmann et al. (2)]: (1) CBT is the most researched form of psychotherapy.
Is EMDR a mind body therapy? ›
EMDR is a mind and body therapy that will help you address both sides of the problem. As our understanding of trauma is increasing we recognize that stressful life events have a very powerful impact on the body. When you experience a traumatic event your body can hold onto that experience in a very real way.When is CBT not appropriate? ›
it may not be suitable for people with more complex mental health needs or learning difficulties. it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable.What is alternative to EMDR? ›
CBT is an alternative to EMDR therapy because it focuses on thoughts, emotions, and behaviors and places more attention on how an individual's perspective affects their reactions. They are given controlled exposure to the traumatic memory, without reliving it, while trying new methods of coping at the same time.What are 5 mind body exercises? ›
While many exercises can benefit both the mind and body, five easily accessible and popular mind-body exercises include yoga, Pilates, tai chi, swimming, and gardening.What is the most important mind body intervention? ›
Mind–body interventions are the most commonly used form of complementary and alternative medicine in the United States, with yoga and meditation being the most popular forms.What are the three therapies of mind body medicine? ›
Mind-body therapies include:
Cognitive behavioral therapy. Guided imagery. Biofeedback.
Cons of Being Mindful: It takes work, practice, and personal effort. Its just another thing you should do. Sometimes, being more aware can actually increase personal frustration or judgment. It doesn't always help.What is the difference between MBCT and DBT? ›
DBT is a comprehensive treatment for borderline personality disorder (BPD). MBCT was developed for prevention of relapse in individuals with a history of depressive episodes. Both have considerable empirical support for their efficacy.What are examples of CBT automatic thoughts? ›
For example, we may text a friend and not receive a response right away. The automatic thoughts pop into our head saying, “She must not even like me. She's totally ignoring me right now, I know it. She'll never text me back.What is the toughest mental illness to treat? ›
Personality disorders are some of the most difficult disorders to treat in psychiatry. This is mainly because people with personality disorders don't think their behavior is problematic, so they don't often seek treatment.
Which mental disorder is least likely to be treated? ›
By contrast, teens suffering from phobias or anxiety disorders were the least likely to be treated.What is the easiest mental illness to treat? ›
Anxiety disorder is the most treatable of all mental illnesses. Anxiety disorder produces unrealistic fears, excessive worry, flashbacks from past trauma leading to easy startling, changes in sleep patterns, intense tension and ritualistic behavior.What are 4 common mental disorders? ›
- Anxiety Disorders. ...
- Depression. ...
- Bipolar Disorder. ...
- Post-Traumatic Stress Disorder (PTSD) ...
- Schizophrenia. ...
- Eating Disorders. ...
- Disruptive behaviour and dissocial disorders. ...
- Neurodevelopmental disorders.
mood disorders (such as depression or bipolar disorder) anxiety disorders. personality disorders. psychotic disorders (such as schizophrenia)What are 5 serious mental illness? ›
SMI includes major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress (PTSD) and borderline personality disorder (VA).What are four mind and body therapies? ›
The most prevalent mind body therapies include prayer, relaxation techniques, guided imagery, hypnosis, and biofeedback.What are the 7 principles of mindfulness? ›
- Non-judging. Be an impartial witness to your own experience. ...
- Patience. A form of wisdom, patience demonstrates that we accept the fact that.
- Beginner's Mind. Remaining open and curious allows us to be receptive to new.
- Trust. Develop a basic trust with yourself and your feelings. ...
- Non-Striving. ...
- Acceptance. ...
- Letting Go.
Mind-body approaches include progressive muscle relaxation, meditation, laughter, mindfulness based approaches, hypnosis, guided imagery, yoga, biofeedback and cognitive behavioural therapy.Is there a chemical imbalance that causes anxiety? ›
Epinephrine is just one chemical involved in your body's response to anxiety. Other chemicals may also play a role. For example, a serotonin imbalance¹ may contribute to anxiety, as can high cortisol levels. However, epinephrine is the primary chemical because it is directly involved in your anxiety symptoms.What is the fastest anxiety treatment? ›
Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour. That makes them very effective when taken during a panic attack or another overwhelming anxiety episode.
What is a drug that calms you down? ›
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).How do you treat mental illness without medication? ›
- Staying active and getting physical exercise. ...
- Stay connected and get out more. ...
- Try to get better sleep. ...
- Avoid unhealthy coping mechanisms.
Studies have shown that cognitive therapy is an effective treatment for depression and is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy. The combination of cognitive therapy and antidepressants has been shown to effectively manage severe or chronic depression.What therapy is best for stress? ›
Meditation and mindfulness-based stress reduction (MBSR) are therapies proven to help manage anxiety and depression. Meditation is an ancient practice that helps you reach a relaxed state by focusing on breathing and awareness of the body in the present.What is the deepest form of therapy? ›
What is depth psychotherapy? Depth psychotherapy refers to the process of bringing to light those parts of the self that have been hidden in the unconscious, parts which are often difficult to surface alone.Which therapy has the highest success rate? ›
1. Inpatient treatment. Inpatient treatment is one of the most effective mental health treatment options available.What is the newest form of therapy? ›
Today, rather than using ECT to treat treatment-resistant depression, mental health providers now have the option of leveraging transcranial magnetic stimulation (TMS). This technology utilises magnetic fields to stimulate neurons in a beneficial, non-invasive way.Who is not a good candidate for EMDR? ›
There are some people for whom EMDR is not a good choice. Clients with a bipolar disorder or personality disorder diagnosis are not good candidates for EMDR.What are the 8 stages of EMDR? ›
EMDR is an eight-phase treatment method. History taking, client preparation, assessment, desensitization, installation, body scan, closure and reevaluation of treatment effect are the eight phases of this treatment which are briefly described.What is the criticism of EMDR? ›
Pseudoscience. EMDR has been characterized as pseudoscience, because the underlying theory is unfalsifiable. Also, the results of the therapy are non-specific, especially if the eye movement component is irrelevant to the results. What remains is a broadly therapeutic interaction and deceptive marketing.
Why do some therapists not like CBT? ›
First, the sort of issues CBT draws attention to – bias, false beliefs, poor inferences – are all relatively common, even in mentally healthy people. As a great deal of psychological research has shown, we are all prone to poor reasoning.Is CBT Gaslighting? ›
CBT as a modality is based around gaslighting. It's all about telling a patient that the world is safe, bad feelings are temporary, and that pain (emotional or physical) is a “faulty or unhelpful” distortion of thinking. That's literally in CBT's definition on the APA website.Who is not a candidate for CBT? ›
The potential efficacy of CBT is evaluated on a case-by-case basis. Those who have maladaptive coping mechanisms that greatly impact their mental health are typically good candidates for CBT. However, individuals who experience mental health issues due to racism, classism, ableism, etc. may not find relief with CBT.Do patients cry during EMDR? ›
EMDR Therapy sessions brings all that stuff bubbling to the surface so your brain can process it in a healthy way. After your sessions unfortunately, you may find yourself shedding a few tears. Or maybe feeling super hollow. Or for some people, fuming white-hot angry.What disorder is EMDR most commonly used to treat? ›
The most widespread use of EMDR is for treating post-traumatic stress disorder (PTSD). Mental healthcare providers also use it in the treatment of the following conditions: Anxiety disorders: Generalized anxiety disorder, panic disorder, phobias and social anxiety/phobia.What is the failure rate of EMDR? ›
Several studies have shown that Eye Movement Desensitization and Reprocessing (EMDR) is incredibly effective for those suffering from PTSD, with some showing as much as a 77% success rate.What are the three types of brain-based learning? ›
Retrieval practice, elaboration, and concept mapping help students make richer, more meaningful connections between ideas.What are the 10 brain-based strategies? ›
Strengthens learning Improves memory retrieval Enhances learners confidence Movement increases blood flow and oxygenates the brain What Should Be Done Active learning Go outside Move around Stretch Role Playing Get oxygen flowing to the brain, go outside, move around, stretch, role playing….. mitosis act out.What are the most common forms of brain stimulation therapy? ›
ECT and TMS are the most widely used brain stimulation therapies, but there are two other options available: Vagus Nerve Stimulation and Deep Brain Stimulation [VNS and DBS]. Research continues to accumulate, offering insight to these treatment options.What are the four basic elements of brain-based learning? ›
The four principles are: (1) the brain is uniquely organized; (2) the brain is continually growing; (3) a ''brain-compat- ible'' classroom enables connection of learning to positive emotions; and (4) children's brains need to be immersed in real-life, hands-on, and meaningful learning experiences.
What is the most well known brain-based learning theory? ›
One of the most well-known brain-based learning theories comes from Howard Gardner's 1983 theory of "multiple intelligences." Gardner suggested that humans have different intellectual abilities, challenging commonly held beliefs that we all think the same way and intelligence is measurable according to a single ...What are the 6 strategies used in whole brain teaching? ›
- Brain Engager.
- Direct Instruction.
- Collaborative Learning.
Activities which can be described as cognitive strategies include making mind maps, visualisation, association, mnemonics, using clues in reading comprehension, underlining key words, scanning and self-testing and monitoring.What are examples of brain training? ›
- Try puzzles.
- Play cards.
- Build vocabulary.
- Use your senses.
- Learn a new skill.
- Teach a skill.
- Listen to music.
Typical challenges involved in brain-based learning include: finding people and sources you can trust to learn from (websites, famous people, etc.) deciding on the format or vehicle for learning (in person, on-line, books?) prioritizing the time to make it happen (learning plus the implementation)What are the 7 essential brain activities? ›
- Focus Time. When we closely focus on tasks in a goal-oriented way, taking on challenges that make deep connections in the brain.
- Play Time. ...
- Connecting Time. ...
- Physical Time. ...
- Time In. ...
- Down Time. ...
- Sleep Time.
- Drink water.
- Eat a well-balanced diet.
- Be social.
- Solve puzzles.
Important distinctions group mental phenomena together according to whether they are sensory, qualitative, propositional, intentional, conscious, occurrent or rational.What is the best mind stimulation? ›
Get mental stimulation
Any mentally stimulating activity should help to build up your brain. Read, take courses, try "mental gymnastics," such as word puzzles or math problems Experiment with things that require manual dexterity as well as mental effort, such as drawing, painting, and other crafts.
Noninvasive brain stimulation (NIBS) is painless and safe, it has minimal side effects, and it has been used in thousands of people worldwide.
Who is a candidate for deep brain stimulation? ›
Three types of PD patients typically benefit from DBS: Patients with uncontrollable tremor for whom medications have not been effective. Patients with symptoms that respond well to medications but who, when the drugs wear off, experience severe motor fluctuations and dyskinesias, despite medication adjustments.