Mentaliseringsbasert terapi (MBT) for antisosial personlighetsforstyrrelse (ASPD)

Nasjonal kompetansetjeneste for personlighetspsykiatri (NAPP)Sikkerhets-, fengsels- og rettspsykiatri nasjonalt kompetansesenternettverk SIFER

Seminar 31. mars 2017, Ullevål

Foto: Oslo universitetssykehus

Øyvind Urnes Leder NAPP

SEMINAR OM MENTALISERINGSBASERT TERAPI (MBT) FOR INDIVIDER MED ANTISOSIAL PERSONLIGHETSPSFORSTYRRELSE (ASPD)

Dyssosial/antisosial personlighets-forstyrrelse (APF) utgjør et betydelig helseproblem for de som har denne personlighetsforstyrrelsen og for deres familier og for samfunnet. Forekomsten av APF er litt under 1%, i rusinstitusjoner hyppig forekommende, og i fengsler opp mot 60%. Cochrane-oversikten fra 2010 konkluderer med at det ikke foreligger kontrollerte studier som kan vise til redusert antisosial atferd selv om kognitiv atferdsterapi er vist å kunne redusere kokainavhengighet.

Det etterlyses forskning (”urgently needed”) og flere studier som forsøker å anvende psykologiske metoder for APF. Den eneste nasjonale retningslinjen for APF er den engelske NICE clinical guideline fra 2009 og

NICE quality standards for emosjo-nelt ustabil PF og APF fra 2015. Her anbefales det strukturert utredning og psykologiske terapier. Men det er altså ikke så mye å vise til.

Nå har Anthony Bateman, som er gründeren av mentaliseringsbasert terapi, MBT, (Peter Fonagy er teoretikeren) for emosjonelt ustabil PF, arbeidet systematisk de senere årene med å anvende mentalise-ringstenkning ved ASPD, og i England er man nå kommet i gang med et stort RCT med 13 sites. Anthony Bateman og Peter Fonagy har oppdatert sin MBT-manual for emosjonelt ustabil PF med å inkludere APF (Mentalization-based treatment for personality disorders. Oxford University Press 2016). For

informasjon om Anthony Bateman (http://www.annafreud.org/training-research/training-and-conferences-overview/tutors/b/anthony-bate-man/).

Sammen med Peter Fonagy og Jessica Yakeley arrangerer han et to-dagers kurs i MBT for ASPF. NAPP og SIFER planlegger å sette i gang et pilotprosjekt i spesialisthelsetjensten i Norge for å se om MBT for APF kan fungere også her. Det er i denne sammenheng vi inviterer til dette seminaret som forhåpentligvis vil inspirere klinikere og institusjonsle-dere til å sette i gang behandling for denne pasientgruppen.

In the seminar a theoretical under-standing of ASPD from a mentalizing perspective will be discussed. Treatment interventions consequ-ent on this understanding will be outlined using illustrative clinical examples and video. Participants will engage in role plays to practise clinical techniques.

Mentalization Based Treatment for ASPD integrates cognitive and rela-tional components of therapy and has a theoretical basis in attachment theory. MBT was developed for people with borderline personality disorder and therefore focused on mentalizing problems associated with high emotional arousal in the context of attachment relationships. Interventions addressing these pro-blems will be discussed. Adaptation of this basic model is necessary for people with ASPD not only because their mentalizing problems differ from those found in BPD but also for a number of other descriptive reasons.

Firstly, people with ASPD are more likely to demonstrate over-control of their emotional states within well-structured, schematic attachment relationships rather than under-control in chaotic attachment relationships, which are more commonly found in people with BPD.

Second, people with ASPD tend to seek relationships which are organized hierarchically with each person knowing their place whereas people with BPD aim for, but tend to struggle to reach, consensus and shared respect.

Third, it is, specifically, threats to the hierarchical order of relationships that lead to arousal within the attachment system in people with ASPD; this triggers an inhibition of mentalizing. Loss of status is devastating as it potentially reveals shameful internal states that threaten to overwhelm, so any threat of loss of status becomes firmly rooted as a dangerous reality which

has to be dealt with by physical force. Momentary inability to mentalize reduces the effectiveness of inhibitory mechanisms prohibiting aggression.

Fourth, if the reduction in ability to recognise others’ emotions is more pervasive than being restricted to fear and sadness, then a focus in treatment on recognition of all emotions in others is essential. Finally, fear for the self is often absent and violent impulses are uninfluenced by the emotional expressions of others, which go unrecognised. Indeed the consequences and dangers of aggression become secondary.

Anthony Bateman skriver om seminaret:

Program

08.15 Registration with coffee/tea and fruit 09.00 Welcome. Øyvind Urnes09.15 Anthony Bateman: Is there any evidence for the effectiveness og psychotherapeutic treatment for individuals with ASPD?10.00 Break10.15 Why is mentalization a treatment target in individuals with ASPD? 11.15 Structure and principles for MBT for individuals with ASPD12.00 Lunch13.00 Video-demonstrations14.15 Experiences from the English RCT: Mentalization-based therapy (MBT) for individuals with antisocial personality disorder Patient selection. Therapist selection. Supervision.15.00 Break15.15 Discussion16.00 Finished

Nasjonal kompetansetjeneste for personlighetspsykiatri (NAPP) Oslo universitetssykehus HF, Seksjon for personlighetspsykiatri, Nasjonal kompetansetjeneste for personlighetspsykiatri (NAPP)

Postboks 4959 Nydalen, 0424 Oslo. E-post: napp@ous-hf.no. Mobil: 91 75 76 71

https://oslo-universitetssykehus.no/Arrangementer

Nasjonal kompetansetjeneste for personlighetspsykiatri (NAPP)Arrangerer seminaret i samarbeid med SIFER Sted: Auditorium Øyeavdelingen, bygg 36, UllevålTid: 31. mars 2017Klokkeslett: 08:15 - 16:00Pris: 1000kr per person. Prisen inkluderer lunsj, frukt, kaffe og te.

Godkjent av Norsk Psykologforening og Norsk Legeforening.

Bindende påmelding til seminaret skjer via Questback link på våre hjemmeside www.personlighetspsykiatri.no

Direkte link til Mentaliseringsbasert terapi (MBT) for antisosial personlighetsforstyrrelse (ASPD) seminaret.Her ligger all informasjon, og link til Questback påmelding.

Målgruppen: Seminaret henvender seg til de ansatte på DPS, og som jobber med MBT. De som jobber for Alternativ til Vold, innen fengselspoliklinikker, eller de som er i kontakt med pasienter med antisosiale trekk.

Prof Anthony W Bateman MA, FRCPsych is Consultant Psychiatrist and Psychotherapist and MBT co-ordinator, Anna Freud Centre, London; Visiting Professor University College, London; Honorary Professor in Psychotherapy University of Copenhagen.

He developed mentalization based treatment with Peter Fonagy for borderline personality disorder and studied its effectiveness in research trials. Adapted versions are now being used in multi-centre trials for antisocial personality disorder, eating disorders, and drug addiction. He was an expert member of National Institute for Clinical Excellence (NICE) development group for treatment guidelines for Borderline Personality Disorder in UK and is currently Chair of the National Guideline Development Group for Ea-ting Disorders. His NHS clinical services

are recognised by the Department of Health as a national demonstration site for the treatment of personality disorder. He was President of the European Society for the Study of Personality Disorders (ESSPD) from 2012-2015.

He has authored 14 books including Psychotherapy for Borderline Perso-nality Disorder: mentalization based treatment and, most recently, Mentali-zation Based Treatment for Personality Disorder: a practical guide (2016) (with Peter Fonagy), numerous book chapters, and over 150 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.

ANTHONY W BATEMAN

Foto: Anthony Bateman