Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables - A Pilot study

Psychol Psychother. 2017 Sep;90(3):299-313. doi: 10.1111/papt.12110. Epub 2016 Nov 1.


Objectives: In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects.

Design: A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2).

Methods: A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2).

Results: Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment.

Conclusions: Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia.

Practitioner points: Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up).

Keywords: alexithymia; depression; mentalization; reflective functioning; short term psychodynamic psychotherapy; symptom severity.

MeSH terms

  • Adult
  • Affective Symptoms / therapy*
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Pilot Projects
  • Psychotherapy, Brief / methods*
  • Psychotherapy, Psychodynamic / methods*
  • Theory of Mind*