Prometeo: Project on Metacognition in Borderline Personality Disorder

Borderline Personality Disorder (BPD) is characterized by Metacognition/Mentalization deficits and Emotion Dysregulation (ED). BPD's first-choice treatment is psychotherapy, but a comprehensive model has not yet been formulated, consequently also treatments result controversial. Study 1: Aims: to examine the relationships between Metacognitive Functions and ED and other clinical features in a BPD sample. Methods: Seventy patients were assessed for the inclusion and 45 BPD patients were included. Metacognitive functions were evaluated with Metacognition Assessment Interview (MAI). Specific self-reports measured respectively: ED (Difficulties in Emotion Regulation Scale, DERS), Alexithymia (Toronto Alexithymia Scale, TAS), Impulsiveness (Barratt Impulsiveness Scale, BIS), Mood (Beck Depression Inventory; BDI), Interpersonal Sensitivity (Inventory of Interpersonal Problems, IIP) and general psychopathology (Global Severity Index (GSI) of SCL-90). A Structural Equation Model (SEM) was used to evaluate the relations between variables. Results: SEM showed that TAS score resulted a mediator between MAI total score and DERS score and DERS significantly predicted BIS, BDI, IIP and GSI scores. Conclusions: The general level of psychopathology and the other clinical variables seemed directly linked to ED. ED didn't seem to correlate directly to Metacognition, but indirectly through Alexithymia. Study 2: Aims: to compare the effect of 1-year Metacognitive Interpersonal Therapy (MIT) and Mentalization Based Therapy (MBT) vs TAU (Treatment as usual) on Metacognition functions, ED and other clinical features in a BPD sample. Methods: Forty-five patients were divided in 3 groups: MIT (N=14), MBT (N=16) and TAU (N=15). MAI scores were the primary outcome, DERS, TAS, BIS, BDI, IIP and GSI of SCL-90 scores were the secondary outcomes. Linear Mixed model were used for the longitudinal evaluation of the results. Results: MAI total score improve in both experimental groups. Secondary outcomes improved, but the effect wasn't statistically significant. Conclusions: Differentiation and Integration played a central role both in MIT and MBT.