Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

Faßbinder, Eva; Schuetze, Maren; Kranich, Annika; Sipos, Valerija; Hohagen, Fritz; Shaw, Ida A.; Farrell, Joan M.; Arntz, Arnoud; Schweiger, Ulrich

doi:10.3389/fpsyg.2016.01851

Cited by 27 publications

(31 citation statements)

References 36 publications

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“…Evidence-based treatments for BPD, e.g., dialectical-behavioral therapy (DBT), schema-focused therapy (SFT), and mentalization-based therapy (MBT) utilize group components. Its beneficial effects on social perception and interpersonal skills in various settings, e.g., outpatient and inpatient treatment, have been outlined ( Farrell et al, 2009 ; Bateman and Fonagy, 2010 ; Bloom et al, 2012 ; Karterud and Bateman, 2012 ; Laurenssen et al, 2014 ; Kvarstein et al, 2015 ; Linehan and Wilks, 2015 ; Dimaggio and Brune, 2016 ; Fassbinder et al, 2016 ; Kramer et al, 2016 ; Antonsen et al, 2017 ; Edel et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

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Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients’ social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i.e., the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients’ exclusion bias, therapists may be advised to provide an “inclusive stance,” especially in initial sessions. It is also recommendable to strengthen patient to patient relations.

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Section: Introductionmentioning

confidence: 99%

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

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“…The PRO*BPD study is performed in the outpatient clinic of the Department of Psychiatry and Psychotherapy at Lübeck University, Germany. The Department of Psychiatry treats more than 450 BPD patients/year (internal statistics) and has extensive experience in treating and researching BPD [ 48 , 55 , 57 – 59 ]. DBT has been used in Lübeck since 1999, while ST has been offered since 2009.…”

Section: Method/designmentioning

confidence: 99%

“…A group format (Group schema therapy, GST) was developed by Farrell and Shaw [ 52 ] and was successfully tested in an RCT in the United States: Patients who received GST showed no drop-out, high BPD remission rates, significant reductions in BPD-typical and general psychiatric symptoms as well as improvements in psychosocial functioning, with large effect sizes after only 8 months. Two outpatient pilot studies on GST in the Netherlands [ 47 ] and Germany [ 48 ] used GST in combination with individual ST and found substantial improvements in BPD-symptoms, general psychopathology, quality of life and happiness. To systematically investigate the clinical effectiveness and cost-effectiveness of GST for BPD and to test different formats of GST (GST only vs. a combination of GST with individual ST), a large, international, multicenter RCT on GST for BPD is currently in progress [ 53 ].…”

Section: Introductionmentioning

confidence: 99%

“…To systematically investigate the clinical effectiveness and cost-effectiveness of GST for BPD and to test different formats of GST (GST only vs. a combination of GST with individual ST), a large, international, multicenter RCT on GST for BPD is currently in progress [ 53 ]. A meta-analysis from 2013 (including all published outpatient studies through 2013, which are all mentioned above, except for [ 48 , 49 ]) revealed an overall effect size of d = 2.38 for pre-post change and an overall drop-out rate of 10% for ST in BPD patients. This is a very low drop-out rate compared to the average drop-out rate of 25% for BPD patients for interventions with a minimum duration of 12 months [ 54 ].…”

Section: Introductionmentioning

confidence: 99%

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PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial

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BackgroundBorderline Personality Disorder (BPD) is a severe mental illness that is associated with low quality of life, low psychosocial functioning, and high societal costs. Treatments for BPD have improved in the last decades. Dialectical behavior therapy (DBT) and Schema therapy (ST) have demonstrated efficacy in reducing BPD symptoms and costs. However, research has not compared these two treatment approaches. In addition, there is a lack of ‘real world studies’ that replicate positive findings in regular mental healthcare settings. Thus, the PROgrams for Borderline Personality Disorder (PRO*BPD) study will compare the (cost-) effectiveness of DBT and ST in structured outpatient treatment programs in the routine clinical setting of an outpatient clinic.Methods/DesignWe aim to recruit 160 BPD patients, who will be randomly assigned to either DBT or ST. In both conditions, patients receive one group therapy and one individual therapy session/week for a maximum of 18 months. Both treatment programs have similar frameworks, which guarantee clinical equipoise. The primary outcome is a reduction of BPD-symptoms. Also, the costs related to BPD are assessed and an economic evaluation is performed from a societal perspective. Secondary outcomes examine other measures of BPD-typical and general psychopathology, comorbidity, quality of life, psychosocial functioning and participation. Data are collected prior to the beginning therapy and every six months until the end of therapy, as well as at six months, one year and two years of follow-up after the end of therapy. Finally, we conduct a qualitative study to understand patients’ experiences with the two methods.DiscussionThe PRO*BPD study is the first randomized trial to compare the (cost-) effectiveness of DBT and ST. By examining the clinical effectiveness of a broad spectrum of outcome parameters, conducting an economic evaluation and assessing patients’ experiences, this study will significantly advance our knowledge on psychotherapy for BPD and will provide insight into the treatment approaches that should be offered to different BPD patients from clinical, economic and stakeholder’s perspectives.Trial registrationGerman Clinical Trial Register, DRKS00011534, Date of registration: 11/01/2017, retrospectively registered.

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“…The results validated that in-patient schema therapy can significantly reduce symptoms of severe BPD and global severity of psychopathology. A number of more recent studies have also demonstrated significant symptom reduction following GST whether in a short-term GST in-patient programme (Nenadić et al, 2017), in an out-patient programme lasting a year (Fassbinder et al, 2016), or in an out-patient programme of just 20 sessions (Skewes et al, 2015). However, in all three of these studies, there was no allocation to a no-treatment control or other treatment comparison condition.…”

Section: Group Schema Therapy For Borderline Personality Disordermentioning

confidence: 99%

The Development and Psychometric Evaluation of the Group Schema Therapy Rating Scale – Revised

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Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

Cited by 27 publications

References 36 publications

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial

The Development and Psychometric Evaluation of the Group Schema Therapy Rating Scale – Revised

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