Mentalization-based therapy for a patient suffering from panic disorder: a systematic single case study

Abstract

This single-case study describes the mentalization-based therapy (MBT) for a woman diagnosed with severe panic disorder with agoraphobia. The aim of the study is to illustrate how MBT contributes to reducing anxiety symptoms and to strengthening the capacity for reflecting in relation to both self and others as part of developing a more coherent sense of self-identity. The findings indicate a significant therapeutic progress including reduction in anxiety symptoms and a higher function in the patient’s everyday life after MBT. Based on the results of this systematic single-case study, we hypothesize that MBT is a promising therapeutic approach for patients suffering from panic disorder who have not responded to previous treatment. We trace the efficacy of MBT to the therapy’s focus on attachment relationships, affect recognition and management, and working with the patient’s mentalizing capacity.

Keywords:

• panic disorder
• mentalization-based therapy
• mentalizing
• psychotherapy
• attachment
• systematic single-case study

Acknowledgements

This work was supported by the Velux Foundation (Grant no. 10384). We thank all employees and psychotherapists at the outpatient clinic for anxiety and personality disorders at Brønderslev Psychiatric Hospital, Denmark, as well as all patients who contributed to the research project.

Author contributions

SSH designed the overall study, wrote the first draft of the introduction, analysis and discussion, as well as the second part of the method section. MBS and MK made the initial analysis of the video sessions, provided descriptions of Ida’s mentalization, delivered comments on the therapeutic interventions, and contributed with edits to the whole manuscript. MBS also made contributions to the discussion. GS made the quantitative analysis and wrote part of the method section and contributed to the discussion and edits to the manuscript. SVS organised the overall data collection, made the session transcripts, wrote the first part of the method section, and contributed with comments and edits to the entire manuscript.

Disclosure statement

GS, together with his team at the Center for Complex Systems developed the Synergetic Navigation System as tool for data acquisition and data analysis in psychotherapeutic research. This tool was used as one of the data collection tools in the current study. We declare that none of the other authors are in receipt of financial support or have any relationship that may pose a conflict of interest in relation to the content presented in the submitted manuscript.

Notes

1. To protect the patient’s identity, this presentation is anonymized. Likewise, a few details in the transcripts in section 4 have been altered for the same reason.

2. All transcriptions are made in accordance with a modified version of Jefferson (2004) transcription guidelines. Square brackets in two adjacent utterances denote an overlap between the bracketed parts of the utterances. Numbers in parentheses denote length of pauses (measured in seconds). Full stop in a parenthesis denotes a micro-pause of less than 0.25 seconds.

3. Not knowing stance means setting one’s own understanding and beliefs aside and try to understand the patient’s perspective in a curious and open-minded way (Bateman & Fonagy, 2016).

4. ‘Authenticity’ refers to the quality of being genuine or true in one’s reactions. ‘Transparency’ refers to the fact that the therapist needs to show appropriate tentativeness of what she thinks about the patient’s mind and share her own mentalizing errors with the patient (Bateman & Fonagy, 2016).

5. ‘Validation’ refers to the therapist recognizing the value of Ida’s feelings and thoughts (Bateman & Fonagy, 2016).

6. For a case study on a client with BPD and dissociative identity disorder see Schiepek, Stöger-Schmidinger et al. (2016).

Additional information

Funding

This work was supported by the Velux Fonden [10384].