Adaptive mentalization-based integrative therapy for severe personality disorder and mental illness: study protocol for a controlled longitudinal cohort study

Background: Personality Disorders that meet the criteria for a Severe Mental Illness (SMI-PD) tend to coincide with a greatly reduced quality of life and a lower life expectancy. Despite the numerous and complex needs of patients with SMI-PD, effective treatments for this group have not yet been established. Traditional treatments often fail to address the multitude of problems patients with SMI-PD struggle with and there is limited understanding about the treatment needs and effects. SMI-PD is associated with high economic costs to both the individual and society. Adaptive Mentalization-based Integrative Therapy (AMBIT) is a mentalization-based systematic approach designed to support teams in their care for people with multiple needs who distrust help. This study will investigate the effectiveness and cost-effectiveness of AMBIT in treating patients with SMI-PD. Methods: Patients aged 18 or older with SMI-PD receiving care at GGZ Rivierduinen and GGZ Altrecht (n = 160), mental health facilities in the Netherlands, will be recruited for this controlled naturalistic longitudinal cohort study. To assess treatment effectiveness and cost-effectiveness, self-report questionnaires will be administered and an electronic diary through the Experience Sampling Method will be used at three time points: at baseline (T0; start of treatment), and after 9 (T1) and 18 (T2) months of treatment. The questionnaires and diary will assess demographics, personality, social, and societal functioning, mentalizing capacity, epistemic mistrust, childhood trauma, attachment security, suicidality, and psychological resilience. A qualitative interview will be held at the end of treatment to evaluate treatment experiences. Additionally, therapists will complete questionnaires to evaluate the effectiveness of AMBIT. Data will be analysed using intention-to-treat multilevel regression analysis. Discussion: Little is known about the treatment needs of patients with SMI-PD and the effectiveness and cost-effectiveness of an AMBIT approach on this group of patients. The results of the present study will therefore contribute to the development of more tailored and effective psychological treatment for this complex group of patients. Trial Registration: Research Portal of CCMO Onderzoek met mensen, Trial Registration Number NL-010303, https://www.onderzoekmetmensen.nl/en/trial/57877, registered on June 27, 2025. OSF Registries, https://doi.org/10.17605/OSF.IO/QHYCW, preregistered on May 7, 2025.