Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions

Abstract

BackgroundTo our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD.Methods/designTwelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up.Trial registrationThe Netherlands National Trial Register NTR5788. Registered 01 April 2016.

Temperament and character in men with autism spectrum disorder: A reanalysis of scores on the Temperament and Character Inventory by individual case matching

“…Clinical implications of this study include the formation of a comprehensive image of individuals with ASD, enriching and deepening our understanding of the person behind the disorder, and developing more effective treatment strategies. Vuijk and Arntz [ 43 ] recently started a study on the treatment of adults with ASD and personality disorder by testing a specific schema therapy program: this is a first study focusing not only on ASD but also on personality (pathology). Further research is required on the temperament and character dimensions of both men and women with ASD, covering the entire range of ages, to improve knowledge on the relationships, the overlap and the differences between these concepts, as well as our understanding of individuals with ASD and their way of functioning in daily life and experiencing the world.…”

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

“…Even though there is a growing body of literature and evidence for the effectiveness of ST, only few of the trials and studies have provided reliable and transferable results. This is mostly due to 1) small sample-sizes [25,26,51], 2) inadequate trial designs because of missing randomization and/or control conditions [40,42,54], 3) inadequate control groups [37], or 4) missing blindness of raters [29,30,41].…”

“…First applied in the field of PD, ST has been proven to be very effective for borderline and cluster C personality disorders [ 23 , 29 – 34 ]. Over the last two decades, the ST concept has been extended and transferred to different disorders such as already mentioned mood disorders [ 24 – 26 ], anxiety disorders [ 35 , 36 ], posttraumatic stress disorder [ 37 ], eating disorders [ 38 , 39 ] such as binge eating, obsessive compulsive disorder [ 40 ], disruptive behavior disorders [ 41 ], autism spectrum disorders [ 42 ], or rather process-oriented transdiagnostic features of psychopathologies such as emotional dysregulation [ 43 , 44 ]. In this context, ST was administered in different settings, mostly to out-patients [ 45 ], partly to in-patients [ 46 , 47 ], to specific age-groups such as older adults [ 48 , 49 ], or forensic settings [ 50 ], and in different forms, such as individual therapy, group therapy [ 35 , 46 , 51 , 52 ] or its combination [ 53 ].…”

A preliminary study of schema therapy for adults with high-functioning autism spectrum disorder: A single-arm, uncontrolled trial

“…The therapeutic purpose of ST is to cultivate a more constructive "healthy adult mode" (instead of schema mode) toward environmental stimuli by gratifying patients' core needs using "limited reparenting." ST, a structured type of psychotherapy, is effective [15,25,26] and suitable for many psychiatric disorders; HF-ASD adults are now considered suitable for ST, as they generally bene t from structured settings [27]. In this study, an author, Oshima, identi ed EMSs speci c to HF-ASD individuals [28].…”