Cited by 1,248Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

Outpatient Psychotherapy for Borderline Personality Disorder: Randomized Trial of Schema-Focused Therapy vs Transference-Focused Psychotherapy

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Giesen-Bloo, Josephine, van Dyck, Richard, Spinhoven, Philip, van Tilburg, Willem, Dirksen, Carmen, van Asselt, Thea, Kremers, Ismay, Nadort, Marjon +1 more·2006·Archives of General Psychiatry

Abstract

CONTEXT: Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented. OBJECTIVE: To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with borderline personality disorder. DESIGN: A multicenter, randomized, 2-group design. SETTING: Four general community mental health centers. PARTICIPANTS: Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score. INTERVENTION: Three years of either SFT or TFP with sessions twice a week. MAIN OUTCOME MEASURES: Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years. RESULTS: Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001). CONCLUSIONS: Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.

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Crossref · 10.1001/archpsyc.63.6.649

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Authors
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A.
Affiliations
  • Maastricht University Medical Centre (NL)
  • Leiden University (NL)
  • Vrije Universiteit Amsterdam (NL)
  • Maastricht University (NL)
Venue
Archives of General Psychiatry
Published
2006-06-01
Volume
63
Issue
6
Pages
649
ISSN
0003-990X (ISSN-L)
OpenAlex
W2096356290
Cited by
1,248
References
8
Citations by year
2026: 27 · 2025: 25 · 2024: 35 · 2023: 40 · 2022: 81 · 2021: 48 · 2020: 62 · 2019: 43 · 2018: 66 · 2017: 52 · 2016: 70 · 2015: 73 · 2014: 87 · 2013: 75 · 2012: 100
FWCI
79.98
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
borderline personality disorder, schema therapy, transference-focused psychotherapy, outpatient psychotherapy, treatment effectiveness, quality of life, treatment discontinuation, long-term recovery
MeSH terms
Ambulatory Care, Borderline Personality Disorder, Chronic Disease, Community Mental Health Centers, Health Status, Humans, Longitudinal Studies, Psychiatric Status Rating Scales, Psychoanalytic Therapy, Psychotherapy, Quality of Life, Severity of Illness Index, Transference, Psychology, Survival Analysis, Treatment Outcome

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