Responding to the Treatment Challenge of Patients with Severe BPD: Results of Three Pilot Studies of Inpatient Schema Therapy

Reiss, Neele; Lieb, Klaus; Arntz, Arnoud; Shaw, Ida A.; Farrell, Joan M.

doi:10.1017/s1352465813000027

Cited by 48 publications

(52 citation statements)

References 28 publications

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“…Thus, our study contributes to the small evidence base regarding treatment approaches in specialized settings, by showing that ACT can be applied to patients with other personality disorders besides borderline personality disorder and can be delivered over 26 weeks using a group‐based format. The overall results, in terms of effect sizes, were slightly lower compared to studies examining structured specialized inpatient treatment programme based on schema therapy for patients with borderline personality disorders that relapsed after previous treatments (Reiss et al, ). One explanation could be the difference in settings: inpatient versus day‐hospital treatment.…”

Section: Discussioncontrasting

confidence: 58%

“…Patients with personality disorders with a history of not responding to previous outpatient treatment interventions are among the most challenging patients to treat, and are often referred to specialized inpatient settings (Verheul & Herbrink, ). However, current treatment approaches for treatment‐resistant patients with various personality disorders are scarce (Duggan, Huband, Smailagic, Ferriter, & Adams, ; Reiss, Lieb, Arntz, Shaw, & Farrell, ), and the few existing studies evaluating treatment approaches for these non‐responding patients have primarily focused on patients with borderline personality disorder (e.g. Reiss et al, ) and/or are complex and of long duration, i.e.…”

mentioning

confidence: 99%

“…However, current treatment approaches for treatment‐resistant patients with various personality disorders are scarce (Duggan, Huband, Smailagic, Ferriter, & Adams, ; Reiss, Lieb, Arntz, Shaw, & Farrell, ), and the few existing studies evaluating treatment approaches for these non‐responding patients have primarily focused on patients with borderline personality disorder (e.g. Reiss et al, ) and/or are complex and of long duration, i.e. mixed residential and community‐based intensive programmes up to 30 months (e.g.…”

mentioning

confidence: 99%

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Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study

Chakhssi

Janssen

Pol

et al. 2015

Personality and Mental Health

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Patients with personality disorders who did not respond to previous outpatient treatment are among the most challenging patients to treat and are often referred to specialized settings. Acceptance and commitment therapy (ACT) is an innovative therapy that has shown effectiveness in treatment-resistant cases with chronic or recurrent depression with or without co-morbid personality disorders. The central role that ACT accords to positive values and experiential avoidance may enhance treatment responsivity in patients with personality disorders that did not respond to previous treatments. The current nonrandomized study explored the effectiveness of a 26-week ACT-based group treatment (n = 60) for personality disorders compared to treatment-as-usual (n = 21) based on cognitive behaviour therapy (CBT-TAU) at a specialized setting for patients with personality disorders. Individuals in both treatment conditions demonstrated small to moderate decreases in general psychological functioning and personality pathology. There was no main effect of therapy condition. Overall, results suggest that ACT is a possible treatment option for individuals with difficult-to-treat personality pathology and further outcome research is warranted.

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Section: Discussioncontrasting

confidence: 58%

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confidence: 99%

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confidence: 99%

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Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study

Chakhssi

Janssen

Pol

et al. 2015

Personality and Mental Health

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“…However, a semi-closed group format might reduce safety and attachment among group members and therefore interfere with the positive effects of GST. A semi-closed group format has already been developed and tested in a pilot study for inpatients (Reiss et al, 2014). As a semi-closed group format might be helpful for implementation and dissemination in routine health care, the protocol needs to be tested in larger clinical trials also for outpatients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Borderline Personality Disorder (BPD) is a severe, challenging to treat mental disorder. Schema therapy (ST) as an individual therapy has been proven to be an effective psychological treatment for BPD. A group format of ST (GST) has been developed and evaluated in a randomized controlled trial in the United States and piloted in The Netherlands. These results suggest that GST speeds up and amplifies treatment effects of ST and might reduce delivery costs. However, feasibility in the German health care system and with BPD patients with high BPD severity and comorbidity, and frequent hospitalization, has not been tested to date. We investigated GST in 10 severely impaired, highly comorbid female patients with BPD, that needed frequent hospital admission. Patients received an outpatient ST-treatment program with weekly group and individual sessions for 1 year. Outcome measures including BPD severity, general psychopathology, psychosocial functioning, quality of life, happiness, schemas, and modes, and days of hospitalization were assessed at the start of treatment and 6, 12, and 36 months later with semi-structured interviews and self-report measures. We observed significant decreases in severity of BPD symptoms, general symptom severity, dysfunctional BPD-specific modes and schemas, and days of hospitalization. Functional modes, quality of live and happiness improved. The results of this feasibility study are promising and encourage further implementation of ST outpatient treatment programs even for patients with severe BPD and high hospitalization risk. However, small sample size and the missing of a control group do not allow the generalizability of these findings.

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“…Schema therapy is a psychotherapy model integrating cognitive, behavioural and experiential interventions (Bamelis, Evers, Spinhoven, & Arntz, 2014;Farrell, Shaw, & Webber, 2009;Young, Klosko, & Weishaar, 2003). Among patients with BPD, both individual and group STs have been implemented and studied increasingly both in outpatient (Dickhaut & Arntz, 2014;Farrel et al, 2009;Giesen-Bloo et al, 2006;Sempértegui, Karreman, Arntz, & Bekker, 2013;van Asselt et al, 2008) and in inpatient treatment settings (Reiss, Lieb, Arntz, Shaw, & Farrell, 2014). However, knowledge of the dysfunctional schemas underlying specific symptoms of BPD patients, such as parasuicidal behaviour, is limited.…”

mentioning

confidence: 99%

Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study

Leppänen

Vuorenmaa

Lindeman

et al. 2015

Personality & Mental Health

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The present study aimed to examine which early maladaptive schemas (EMSs) and schema modes emerged in parasuicidal and non-parasuicidal patients with BPD participating in the Oulu BPD study. The patients' EMSs were assessed using the Young Schema Questionnaire, and schema modes using the Young Atkinson Mode Inventory. Sixty patients with BPD responded to both the schema and schema mode questionnaires; of these, 46 (76.7%) fulfilled the criteria for parasuicidality. In BPD patients with parasuicidality, the EMSs of emotional deprivation, abandonment/instability, mistrust/abuse and social isolation were the most prevalent, and the schema modes of vulnerable child, angry child, detached protector and compliant surrender were prominent. In patients without parasuicidality, the schema modes of healthy adult and happy child were the most prevalent. Significant correlations were observed between the schema modes of detached protector, vulnerable child, punitive parent and angry child and almost every EMS in BPD patients with parasuicidality. Our preliminary findings suggest that associations between certain EMSs and schema modes to parasuicidality in BPD patients may provide valuable information when planning and implementing their treatment.

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Responding to the Treatment Challenge of Patients with Severe BPD: Results of Three Pilot Studies of Inpatient Schema Therapy

Cited by 48 publications

References 28 publications

Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study

Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study

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

Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study

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