title: Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?
abstract: OBJECTIVE
  Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses).
  
  
  METHODS
  Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years.
  
  
  RESULTS
  RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program.
  
  
  CONCLUSIONS
  These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: bjornar.antonsen@medisin.uio.no.
authors.forename: Bjørnar T
authors.initials: BT
authors.lastname: Antonsen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: merete.johansen@medisin.uio.no.
authors.forename: Merete S
authors.initials: MS
authors.lastname: Johansen
authors.affiliation: Department of Psychology, University of Oslo, Oslo, Norway. Electronic address: f.g.ro@psykologi.uio.no.
authors.forename: Frida G
authors.initials: FG
authors.lastname: Rø
authors.affiliation: Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: elfridak@online.no.
authors.forename: Elfrida H
authors.initials: EH
authors.lastname: Kvarstein
authors.affiliation: Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway. Electronic address: uxthwi@ous-hf.no.
authors.forename: Theresa
authors.initials: T
authors.lastname: Wilberg
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010551:Personality; D010554:Personality Disorders / Q000523:psychology* / Q000628:therapy*; D011599:Psychopathology; D011613:Psychotherapy / Q000379:methods* / Q000706:statistics & numerical data; D011614:Psychotherapy, Brief / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods; D012649:Self Concept; D056345:Theory of Mind / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome