The efficacy of Mentalization-Based Treatment for Children with internalizing and externalizing problems: a randomized controlled trial

Abstract

Objective: High comorbidity in childhood emotional and behavioral disorders calls for transdiagnostic interventions that can address both internalizing and externalizing problems. Mentalization-Based Treatment for Children (MBT-C) is a transdiagnostic, time-limited individual child psychotherapy with parallel parent sessions that aims to promote mentalization and emotion regulation. This pragmatic randomized controlled superiority trial investigated the efficacy of MBT-C compared with a group-based parenting and child social skills intervention (PSSG) at 12 weeks (primary end point) and 36-week follow-up (secondary end point). Method: The trial included 222 children (mean age = 7.89; 34% girls) at clinical levels of internalizing, externalizing, or co-occurring internalizing and externalizing problems and their families equally randomized to MBT-C or PSSG. Assessments took place at baseline, 8 and 12 weeks, and 24- and 36-week follow-up. Primary outcomes were children's internalizing, externalizing, and total problems. Secondary outcomes were parent and child emotion regulation, child global function, parent mentalizing, and parenting stress. Results: There were no statistically significant differences between MBT-C and PSSG in reducing children's total, internalizing, or externalizing problems at 12 weeks; however, MBT-C was superior at 36 weeks on total problems with a small effect (d = 0.479, 95% CI [0.105, 0.854]). MBT-C was also superior in improving emotion regulation of parents (d = 0.248, 95% CI [0.002, 0.493]) and children (d = −0.221, 95% CI [−0.435, −0.006]) and child-reported problems (d = 0.331, 95% CI [0.029, 0.633]) at 12 weeks with small effects. These differential treatment effects were maintained during follow-up. Conclusion: MBT-C demonstrated a small superior effect to PSSG in treating overall problems over the longer term, but not immediately after the intervention, in school-age children with internalizing and externalizing problems. However, as a single-site study, generalizability is limited, and further research supporting treatment efficacy is warranted.