Effectiveness of Predominantly Group Schema Therapy and Combined Individual and Group Schema Therapy for Borderline Personality Disorder A Randomized Clinical Trial

被引:49
作者
Arntz, Arnoud [1 ]
Jacob, Gitta A. [2 ]
Lee, Christopher W. [3 ]
Brand-de Wilde, Odette Manon [4 ]
Fassbinder, Eva [5 ,6 ]
Harper, R. Patrick [7 ]
Lavender, Anna [8 ]
Lockwood, George [9 ]
Malogiannis, Ioannis A. [10 ]
Ruths, Florian A. [8 ]
Schweiger, Ulrich [5 ]
Shaw, Ida A. [11 ]
Zarbock, Gerhard [12 ]
Farrell, Joan M. [11 ,13 ]
机构
[1] Univ Amsterdam, Dept Clin Psychol, POB 15933, NL-1001 NK Amsterdam, Netherlands
[2] Univ Freiburg, Inst Psychol, Dept Clin Psychol & Psychotherapy, Freiburg, Germany
[3] Univ Western Australia, Fac Hlth & Med Sci, Perth, WA, Australia
[4] Viersprong, Halsteren, Netherlands
[5] Univ Lubeck, Dept Psychiat & Psychotherapy, Lubeck, Germany
[6] Christian Albrechts Univ Kiel, Dept Psychiat & Psychotherapy, Kiel, Germany
[7] Bradford Dist Care NHS Fdn Trust, Bradford, W Yorkshire, England
[8] South London & Maudsley NHS Fdn Trust, London, England
[9] Schema Therapy Inst Midwest, Kalamazoo, MI USA
[10] Athens Univ, Eginit Hosp, Med Sch, Dept Psychiat 1, Athens, Greece
[11] Schema Therapy Inst Midwest, Indianapolis, IN USA
[12] Inst Verhaltenstherapie Ausbildung Hamburg GmbH, Inst Training Cognit Behav Therapy, Hamburg, Germany
[13] Indiana Univ Purdue Univ, Dept Clin Psychol, Indianapolis, IN 46202 USA
关键词
RELIABILITY; INVENTORY; VALIDITY;
D O I
10.1001/jamapsychiatry.2022.0010
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
IMPORTANCE Schema therapy (ST), delivered either in an individual or group format, has been compared with other active treatments for borderline personality disorder (BPD). To our knowledge, the 2 formats have not been compared with treatment as usual (TAU) or with each other. Such comparisons help determine best treatment practices. OBJECTIVE To evaluate whether ST is more effectively delivered in a predominantly group or combined individual and group format and whether ST is more effective than optimal TAU for BPD. DESIGN, SETTING, AND PARTICIPANTS In this multicenter, 3-arm randomized clinical trial conducted at 15 sites in 5 countries (Australia, Germany, Greece, the Netherlands, and the UK), outpatients aged 18 to 65 years who had BPD were recruited between June 29, 2010, and May 18, 2016, to receive either predominantly group ST (PGST), combined individual and group ST (IGST), or optimal TAU. Data were analyzed from June 4, 2019, to December 29, 2021. INTERVENTIONS At each site, cohorts of 16 to 18 participants were randomized 1:1 to PGST vs TAU or IGST vs TAU. Both ST formats were delivered over 2 years, with 2 sessions per week in year land the frequency gradually decreasing during year 2. Assessments were collected by blinded assessors. MAIN OUTCOMES AND MEASURES The primary outcome was the change in BPD severity over time, assessed with the Borderline Personality Disorder Severity Index (BPDSI) total score. Treatment retention was analyzed as a secondary outcome using generalized linear mixed model survival analysis. RESULTS Of 495 participants (mean [SD] age, 33.6 [9.4] years; 426 [86.2%) female), 246 (49.7%) received TAU, 125 (25.2%) received PGST, and 124 (25.0%) received IGST (1 of whom later withdrew consent). PGST and IGST combined were superior to TAU with regard to reduced BPD severity (Cohen d, 0.73; 95% CI, 0.29-1.18; P < .001). For this outcome, IGST was superior to TAU (Cohen d, 1.14; 95% CI, 0.57-1.71; P < .001) and PGST (Cohen d, 0.84; 95% Cl. 0.09-1.59; P = .03). whereas PGST did not differ significantly from TAU (Cohen d, 0.30; 95% CI, -0.29 to 0.89; P = 32). Treatment retention was greater in the IGST arm than in the PGST (1year: 0.82 vs 0.72; 2 years: 0.74 vs. 0.62) and TAU (1 year: 0.82 vs 0.73; 2 years: 0.74 vs 0.64) arms, and there was no significant difference between the TAU and PGST arms (1 year: 0.73 vs 0.72; 2 years: 0.64 vs 0.62). CONCLUSIONS AND RELEVANCE In this randomized clinical trial. IGST was more effective and had greater treatment retention compared with TAU and PGST. These findings suggest that IGST is the preferred ST format, with high retention and continuation of improvement in BPD severity after the completion of treatment.
引用
收藏
页码:287 / 299
页数:13
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