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Volume 25, Issue 4 (Autumn 2019)                   Intern Med Today 2019, 25(4): 324-339 | Back to browse issues page


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Einy S, Narimani‎ M, Sadeghi Movahhed‎ F. Comparing the Effectiveness of Mentalization-Based Therapy and Cognitive-Analytic Therapy on Ego Strength and Defense Mechanisms in People With Borderline Personality Disorder. Intern Med Today 2019; 25 (4) :324-339
URL: http://imtj.gmu.ac.ir/article-1-3183-en.html
1- Department of Psychology, Faculty of Education and Psychology, Mohaghegh Ardabili University, Ardabil. , sanaz.einy@yahoo.com
2- Department of Psychology, Faculty of Education and Psychology, Mohaghegh Ardabili University, Ardabil.
3- Department of Dermatology, Neurology and Psychiatry and Radiology, School of Medicine and Paramedical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran.
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1. Introduction
Borderline personality disorder (BPD) is one of the most common personality disorders in psychiatric settings characterized by emotional dysregulation, identity confusion, impulsivity, and interpersonal problems [1]. Different psychological approaches have examined the causes of BPD since birth and how parental relationships have affected this disorder, but the most profound one is the psychoanalytic approach. According to this approach, the character consists of three bases: The Id, the ego and the superego. Since Ego is responsible for managing the mental system, all mental problems arise when Ego is unable to fulfill his responsibilities. The ego strength is the ability to maintain one's identity, regardless of psychological stress, suffering and conflict between inner needs and external demands [4]. Low ego strength makes people with BPD use a variety of defense mechanisms in their interpersonal relationships that emphasize interpersonal dependency and a tendency to direct aggression [5]. Studies also have reported that BPD is characterized by the greater use of dysfunctional and distorting defense mechanisms (e.g. splitting), and the use of less effective defenses compared to other disorders [9 ,8]. Defense mechanisms are self-regulating processes that act to reduce cognitive dissonance and to minimize sudden changes in internal and external reality by affecting how threatening events are perceived [10]. This study aimed to compare the Effect of Mentalization-Based Therapy (MBT) and Cognitive Analytical Therapy (CAT) on ego strength and defense mechanisms of people with BPD.
2. Methods
This is a quasi-experimental study with pretest/posttest design using control group. The study population consisted of all men with BPD admitted to Isar Psychiatric Hospital and psychiatric ward of Fatemi Hospital in Ardabil, Iran in 2017 (n=80). Of these, 45 were selected based on inclusion criteria and using convenience sampling technique. They were randomly divided into three groups; two experimental (MBT and CAT) and one control. During treatment, three patients from MBT group and 1 patient from CAT group left the study. In the control group, 1 patient did not continue participation in the follow-up period. At the end, 40 patients entered into the study.
3. Results
The mean age in the MBT group was 42.91±1.53 years; in the CAT group, 44.21±1.20 years and in the control group, 45.14±1.60 years. There were 5 married, 2 single and 5 divorced in the MBT group; 7 married, 2 single and 5 divorced in the CAT group; and 6 married, one single and 7 divorced in the control group. In the MBT group, 7 had high school diploma, 3 with bachelor's degrees and 2 with a degree higher than bachelor's; in the CAT group, 8 had high school diploma and 6 with bachelor's degrees; and in the control group, 6 had high school diploma, 7 with bachelor’s degrees, and one with a degree higher than bachelor's. In the MBT group, 5 were unemployed, 5 were self-employed, one was employed and one disabled; in the CAT group, 3 were unemployed, 5 self-employed, 2 employees, one retired, and 3 disabled; and in the control group, 4 unemployed, 3 self-employed, 3 employees, 2 retired and 2 disabled.
Before using mixed ANOVA, its assumptions were examined. The mean and standard deviation of ego strength and defense mechanisms are presented in Table 3. Kolmogorov-Smirnov test was used to evaluate the normality of the data distribution. Its results showed that the distribution of dependent variables in pretest, posttest and follow-up phases was normal (p>0.05). According to non-significance of Levene’s test results, between group variance equality was observed (P>0.05). To test the assumption of sphericity, the Mauchly's test was used. The results showed homogeneity of covariance variance matrix in the study variables (P>0.05). Therefore, the row related to the sphericity assumption was used, the results of which are presented in Table 4. As can be seen, the effect of group on ego strength, neurotic defense mechanism, and underdeveloped defense mechanism was significant (P <0.05).
4. Discussion
The purpose of this study was to compare the effectiveness of MBT and CAT on improving ego strength and defense mechanisms in people with BPD. The results showed that both treatment methods had significant effect on improvement of ego strength and defense mechanisms disorder at posttest and follow up phases. Scheffe test results also showed a significant difference between the two treatments in terms of ego strength and underdeveloped defense mechanism in patients, where the effectiveness of MBT was higher; however, there was no significant difference between the two experimental groups in terms of neurotic defense mechanism.
5. Conclusion
It can be concluded that MBT and CAT are appropriate methods for improving ego strength and defense mechanisms in people with BPD, and they can be used as effective interventions in psychiatric hospitals for treatment of these patients, but the MBT is more effective.
Ethical Considerations
Compliance with ethical guidelines

This study has obtained its ethical approval from the Research Ethics Committee of Ardabil University of Medical Sciences (code: IR.ARUMS.REC.1396.134). Informed consent was obtained from the participants.

Funding
This paper was extracted from a PhD. thesis approved by the Faculty of Physical Education and Sport Science, University of Mohaghegh Ardabili.
Authors' contributions
Conceptualization, methodology, and investigation by Sanaz Einy; writing and data analysis: Mohammad Narimani; writing: Fariba Sadeghi Movahed.
Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Original | Subject: Mental Health
Received: 2019/03/24 | Accepted: 2019/08/13 | Published: 2019/10/1

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