Effectiveness of mentalisation-based treatment for improving social cognition and emotional regulation in adults with borderline personality disorder or autism spectrum disorder: a systematic review
TL;DR
Across trials, MBT was consistently associated with improvements in emotional regulation, while effects on social cognition and mentalisation outcomes were more heterogeneous and dependent on the type of assessment used, with clearer effects observed in interpersonal and reflective functioning than in performance-based measures.
Abstract
This study aims to evaluate the effectiveness of mentalisation-based treatment (MBT) for emotional regulation and social cognition in adults with borderline personality disorder (BPD), and to determine the extent and quality of the available evidence on MBT in adults with autism spectrum disorder (ASD), characterising the imbalance in the evidence between these two diagnostic groups. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials assessing MBT in adults (≥18 years) were identified through searches of APA PsycInfo, CINAHL with Full Text and MEDLINE Complete. Studies reporting outcomes related to emotional regulation and/or social cognition were included. Risk of bias was assessed using the Critical Appraisal Skills Programme randomised controlled trial checklist, and findings were synthesised narratively due to heterogeneity in study designs and outcome measures. One non-randomised study examining MBT in adults with ASD was included as preliminary evidence. Seven randomised controlled trials (n = 707), all conducted in adult BPD populations, met inclusion criteria. Across trials, MBT was consistently associated with improvements in emotional regulation, while effects on social cognition and mentalisation outcomes were more heterogeneous and dependent on the type of assessment used, with clearer effects observed in interpersonal and reflective functioning than in performance-based measures. Evidence regarding MBT in ASD was limited to a single non-randomised study, which reported pre–post improvements in social cognition and emotional awareness. The absence of randomised controlled trials of MBT in ASD populations, confirmed by a search updated to June 2026, represents a key finding of this review. Rather than adding to the existing reviews of MBT in BPD, the contribution of this review is to document systematically the near-absence of controlled evidence for MBT in adults with ASD, set against the established BPD evidence base. By appraising the two literatures side by side, it characterises what is known, what is not and where high-quality trials are most needed.