Shame during Mentalization-Based Treatment

Proneness to shame (i.e. the tendency to experience shame in various situations) is thought to be linked with core borderline personality disorder (BPD) symptoms including chronic suicidality, self harm, impulsivity, and inappropriate anger. Recognizing the impact of intense and chronic shame, and helping persons with BPD to reduce or regulate aversive states of shame may contribute to successful psychotherapeutic treatment. With respect to Mentalization-Based Treatment (MBT), a 18-month treatment program developed for patients with borderline personality pathology, it can be hypothesized that MBT fosters recognizing feelings of shame and changing maladaptive shame into more adaptive shame regulation during treatment. However, empirical evidence about proneness to shame among patients with borderline personality pathology at the start of MBT and during MBT is as yet not available.

Main objective:
To study the level of (proneness to) shame among patients with a borderline personality disorder following MBT at a general mental health institution in the south of the Netherlands (GGz Breburg) at the start of treatment as well as during treatment (primary objective)

Secondary objectives:
Cross-sectional: To study associations between shame and indicators of (borderline personality) pathology (symptom distress, personality functioning, social and interpersonal functioning, acts of self-harm and suicide attempts). Longitudinal: To study during MBT the level of improvement regarding level of symptom distress, social and interpersonal functioning, personality pathology and functioning, and number of suicide attempts, acts of self-harm

1. Cross-sectional:
1.1 At baseline (the start of MBT), we expect a positive association between (level of) shame proneness and measures relevant for/related to mentalization based treatment and/or borderline personality pathology, i.e. measures of levels of symptom distress, social and interpersonal functioning, personality pathology and functioning, and number of suicide attempts, acts of self-harm
2. Longitudinal:
2.1 (the level of) shame proneness will improve (decrease) during treatment (MBT);
2.2 this improvement of (the level of) shame proneness (hypothesis 2.1) is related to improvement in the measures reported in hypothesis 1.1 (i.e. measures of levels of symptom distress, social and interpersonal functioning, personality pathology and functioning, and number of suicide attempts, acts of self-harm), as well as to a higher level of treatment commitment (including improvement in the therapeutic relationship), and a lower level of care consumption elsewhere (besides MBT)

Patients will be interviewed and self-report questionnaires and a computer task will be administered before treatment and every three months during treatment, i.e. after 3, 6, 9, 12, 15 and 18 months after the start of treatment. Except for the IAT computer task, all measurements are part of diagnostic and routine outcome monitoring at the start of MBT and during MBT. Maximum duration for the IAT assessments is 105 minutes (7 measurements * maximum duration of 15 minutes for each IAT).