Mentalization-based treatment for adults with attention-deficit/hyperactivity disorder: a pilot study

Research in Psychotherapy: Psychopathology, Process and Outcome 2018; volume 21:149-154 Mentalization-based treatment for adults with attention-deficit/hyperactivity disorder: a pilot study Deborah Badoud,1,2 Eva Rüfenacht,1 Martin Debbané,2,3 Nader Perroud1 Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland; Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, Geneva, Switzerland; 3 Research Department of Clinical, Educational and Health Psychology, University College London, London, UK 1 2 ABSTRACT on ly Recent literature suggests that, in addition to its core cognitive and behavioural symptoms, socioemotional difficulties represent key characteristics of adult attention-deficit/hyperactivity disorder (ADHD). Importantly, these deficits not only contribute negatively to the low social functioning and poorer professional achievements of ADHD patients relative to healthy individuals, they also respond poorly to medication and are not specifically addressed by current evidence-based psychological treatments. Mentalization-based treatment (MBT) is a psychological intervention focused on promoting the imaginative capacity to understand human behaviour as being driven by mental states. MBT has been shown to be effective in patients with chronic emotional dysregulation; it may therefore represent a valuable approach to address sociocognitive deficits and shape adaptive functioning in ADHD. In this study, we tailored the timelimited MBT program developed for borderline personality disorder to the specific clinical needs of individuals with ADHD. We report on the first eight patients with ADHD included in our programme at the Geneva University Hospitals. Preliminary results support the feasibility and relevance of the MBT model for ADHD. We discuss conceptual and clinical implications of the current data. us e Key words: Emotion regulation; Social cognition; Attention-deficit/hyperactivity disorder; Psychotherapy; Psychoeducation. al Introduction om m er ci Correspondence: Deborah Badoud, Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 40 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland. Tel.: +41.223798030. E-mail: on -c Citation: Badoud, D., Rüfenacht, E., Debbané, M., & Perroud, N. (2018). Mentalization-based treatment for adults with adult attention-deficit/hyperactivity disorder: a pilot study. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(3), 149-154. doi: 10.4081/ripppo.2018.317 N Contributions: DB, NP, MD and ER contributed to the conception and design of the study. DB and NP analysed and interpreted the data. DB, NP and MD drafted the article. Conflict of interest: the authors declare no potential conflict of interest. Funding: none. Received for publication: 12 July 2018. Revision received: 3 September 2018. Accepted for publication: 4 October 2018. This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0). ©Copyright D. Badoud et al., 2018 Licensee PAGEPress, Italy Research in Psychotherapy: Psychopathology, Process and Outcome 2018; 21:149-154 doi:10.4081/ripppo.2018.317 Mentalizing – that is, linking one’s own and other people’s actions to mental states – makes the world, other people and oneself more predictable and understandable. It therefore represents a powerful tool for self-regulation and for navigating the social realm (Fonagy, Gergely, Jurist, & Target, 2002). The development and functioning of mentalizing requires attention, and is fuelled by how significant others lend meaning to actions, as underlain by intentional mental states (Fonagy et al., 2002). Thus, a neurodevelopmental condition such as attention-deficit/hyperactivity disorder (ADHD) can breach the foundations of mentalizing by perturbing the individual’s capacity to attend to the underlying facets of his/her own behaviour, and by exhausting the mentalizing capacities of significant others to help the individual grow emotionally. This places ADHD patients at a higher risk of emotion dysregulation and social dysfunction. In this context, psychological interventions that intend to promote mentalizing skills [i.e. mentalizationbased treatment (MBT)] could be valuable in improving individual and interpersonal functioning in people with ADHD (Perroud et al., 2017). ADHD has been characteristically defined by the presence of attention deficits, hyperactivity and/or impulsivity, but is currently best conceptualized as a broad disorder of self-regulation (Barkley, 1997). Although ADHD usually begins in childhood, epidemiological studies show that it affects 3.4% of adults (Fayyad et al., 2007). Even for the majority of individuals who do not [Research in Psychotherapy: Psychopathology, Process and Outcome 2018; 21:317] [page 149] Article ci al us e on ly distrust when faced with strong emotions (Fonagy & Luyten, 2009). Thus, mentalizing fosters self-regulation and social functioning, notably by helping one to cope with distressing feelings. Importantly, mentalizing is not a given but is a progressive achievement, rooted in early interactions with close others. Its acquisition, as well as its adaptive functioning along the lifespan, critically relies upon attention control and emotion regulation skills (Fonagy & Luyten, 2009). Consequently, the neurodevelopmental aetiology of ADHD may weaken the building blocks of mentalizing processes, while the core features of the disorder will continue to challenge its adaptive functioning into adulthood. Indeed, several studies have demonstrated the disruptive role of ADHD symptoms along the developmental cascade of acquisitions in social cognition (Herrmann et al., 2009; Ibáñez et al., 2011; Uekermann et al., 2010), in turn contributing to social dysfunction (Caillies, Bertot, Motte, Raynaud, & Abely, 2014; Ibáñez et al., 2011). Building on the clinical, developmental and experimental data showing the need to target socioemotional processes in adults with ADHD, and capitalizing on the positive outcomes of MBT in the emotional and social domains, the current study aims to provide the first adaptation of MBT for ADHD (MBT-At). In this report, we will start by describing the implementation and feasibility of this new application of MBT. We will then provide preliminary results of its effects in terms of the reduction of ADHD-related problems. According to the European guidelines for the management of ADHD, the MBT programme for ADHD starts with an initial introductory phase, MBT-Introductory (MBT-I), psychoeducation, adapted from the original manual for BPD (Karterud & Bateman, 2011). MBT-I aims to provide patients with knowledge about the principles and concepts of mentalizing that underlie MBT. It is designed as a precursor to a combination of individual and group MBT. N on -c (...truncated)