Metacognitive Training for Borderline Personality Disorder (B-MCT)

Metacognitive Training for Borderline Personality Disorder (B-MCT) is derived from Metacognitive Training for Psychosis (MCT). B-MCT was developed as a low-threshold, add-on group intervention for evidence-based treatment. B-MCT targets cognitive biases that play a role in the formation and maintenance of the disorder. Empirical studies confirm its feasibility and efficacy (see, for example, Schilling et al., 2015a; Schilling et al., 2018).

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What is Metacognitive Training Borderline (B-MCT)

Borderline personality disorder (BPD) is characterized by sudden states of intense emotional arousal that are often followed by self-harming behavior or dissociative phenomena. Along with the cardinal symptom of affect dysregulation, BPD may also manifest as an instabile sense of identity and fluctuating self-esteem, problems with social interaction, and dysfunctional behavioral patterns (especially self-harm), as well as deficits in cognitive functioning and biased information-processing patterns. Dysfunctional thinking styles (e.g., an altered attributional style) also seem to play an important role in the development and maintenance of BPD symptoms. In prior studies, we have confirmed that individuals with BPD have cognitive distortions concerning, for example, social cognition and attributional style (for a more detailed presentation of our findings, see the manual and the reference list below).

To improve therapeutic options, we focus on some recently identified BPD-specific dysfunctional thinking styles (e.g., overconfidence in emotion recognition), as well as already well-examined cognitive biases (e.g., dichotomous thinking). B-MCT was developed by our team. Based on our own preliminary studies (e.g., Moritz et al., 2011; Schilling et al., 2012) and numerous studies in the field of basic cognitive research, we adjusted the training units from MCT for psychosis and MCT for depression to address the disorder-specific dysfunctional thought patterns of BPD patients. We also added new examples, with the help of our patients.

B-MCT is a low-threshold add-on intervention for evidence-based standard treatments (especially dialectical behavior therapy, DBT) that specifically targets cognitive biases. The aim of this low-threshold CBT-oriented group intervention is to increase patients’ awareness of their dysfunctional thinking patterns and help them reduce cognitive distortions. A preliminary study has demonstrated the acceptance and effectiveness of the training. The evaluation clearly showed a large beneficial effect on symptoms as measured by the Borderline Symptom List (BSL-23). Recently, a controlled randomized study with the modified B-MCT was carried out, and this study confirmed its efficacy in comparison with a relaxation strategy group (Schilling et al., 2018).

Please also note that we have developed e-learning programmes for the MCT and D-MCT: www.uke.de/e-mct | www.uke.de/e-dmct

Principle Investigators

  • Dipl.-Psych. Lisa Schilling (Asklepios Klinik Nord)
  • Dipl.-Psych. Julia Bierbrodt
  • M.Sc. Katharina Kolbeck
  • Prof. Dr. Steffen Moritz

Co-Investigators

  • PD Dr. Matthias Nagel
  • Dr. Andreas Schindler
  • Prof. Dr. Carsten Spitzer
Publications

Moritz, S., Schilling, L., Wingenfeld, K., Köther, U., Wittekind, C., Terfehr, K., & Spitzer, C. (2011). Psychotic-like cognitive biases in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 42, 349–354.

Schilling, L., Köther, U., Nagel, M., Agorastos, A., & Moritz, S. (2013a). Kognitive Verzerrungen bei Patienten mit einer Borderline-Persönlichkeitsstörung und deren Behandlung durch das „Metakognitive Training – Borderline“. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 61, 239–246.

Schilling, L., Moritz, S., Kriston, L., Krieger, M., & Nagel, M. (2018). Efficacy of Metacognitive Training for patients with borderline personality disorder: preliminary results. Psychiatry Research, 262, 459–464.

Schilling, L., Moritz, S., Köther, U., & Nagel, M. (2015a). Preliminary results on acceptance, feasibility, and subjective efficacy of the add-on group intervention Metacognitive Training for borderline patients. Journal of Cognitive Psychotherapy, 29, 153–164.

Schilling, L., Moritz, S., Schneider, B. C., Bierbrodt, J., & Nagel, M. (2015b). Attributional ‘tunnel vision’ in patients with borderline personality disorder. Journal of Personality Disorders, 29, 839–846.

Schilling, L., Wingenfeld, K., Spitzer, C., Nagel, M., & Moritz, S. (2013b). False memories and memory confidence in borderline patients. Journal of Behavior Therapy and Experimental Psychiatry, 44, 376–380.

Schilling, L., Wingenfeld, K., Löwe, B., Moritz, S., Terfehr, K., Köther, U., & Spitzer, C. (2012). Normal mind-reading capacity but higher response confidence in borderline personality disorder patients. Psychiatry and Clinical Neurosciences, 66, 322–327.


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