Cited by 259Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsPsychiatric care and mental health services

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Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial

Nadort, Marjon, Arntz, Arnoud, Smit, Johannes H., Giesen-Bloo, Josephine, Eikelenboom, Merijn, Spinhoven, Philip, van Asselt, Thea, Wensing, Michel, van Dyck, Richard·2009·Behaviour Research and Therapy

DOI 10.1016/j.brat.2009.07.013

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Abstract

Objective This study aimed to evaluate the success of implementing outpatient schema focused therapy (ST) for borderline patients in regular mental healthcare and to determine the added value of therapist telephone availability outside office hours in case of crisis (TTA).Methods To enhance the implementation, the following adaptations regarding the original ST protocol were applied: a reduction in the frequency and duration of the therapy; training therapists of eight regular healthcare centers in ST with a structured and piloted program supported by a set of films (DVDs) with examples of ST techniques; training and supervision given by Dutch experts. Telephone availability outside office hours was randomly allocated to 50% of the therapists of each treatment center. Patient's outcome measures were assessed with a semi-structured interview and self-report measures on BPD, quality of life, general psychopathology and an ST questionnaire, before, during and after treatment.Results Data on 62 DSM-IV defined BPD patients were available. Intention-to-treat analyses showed that after 1.5 years of ST 42% of the patients had recovered from BPD. No added value of therapist telephone availability (TTA) was found on the BPDSI score nor on any other measure after 1.5 years of ST.Conclusions ST for BPD can be successfully implemented in regular mental healthcare. Treatment results and dropout were comparable to a previous clinical trail. No additional effect of extra crisis support with TTA outside office hours ST was found.

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Influential
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Fassbinder, E., Schuetze, M., Kranich, A., Sipos, V., Hohagen, F., Shaw, I. A., Farrell, J. M., Arntz, A., & Schweiger, U. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01851 · Cited by 39
“…found to diﬀer people with BPD from people without BPD; our inclusion criterion of > 20 has been used in several studies (Giesen-Bloo et al., 2006a; Nadort et al., 2009; Dickhaut and Arntz, 2013), as it reliable distinguished BPD from non-BPD PDs, and indicates a severe BPD in need of treatment.”
InfluentialSelf-citation
Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT)
van Leeuwen, H., Sinnaeve, R., Witteveen, U., Daele, T. V., Ossewaarde, L., Egger, J. I. M., & van den Bosch, L. M. C. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00165-7 · Cited by 37
“[86] examined the acceptance and feasibility of the computer program MORPHEUS, as a part of a Dialectical Behavior Therapy Post Traumatic Stress Disorder (DBT-PTSD) residential treatment, that allows computer-assisted in sensu exposure and exercise in self-management during the treatment of PTSD.”
Method
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
Fassbinder, E., Assmann, N., Schaich, A., Heinecke, K., Wagner, T., Sipos, V., Jauch-Chara, K., Hüppe, M., Arntz, A., & Schweiger, U. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1905-6 · Cited by 33
Self-citation
Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders
Bamelis, L. L., Evers, S. M., & Arntz, A. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-75 · Cited by 33
“Given the strong positive effect of ST on treatment retention found in earlier studies [37-39], dropout is analyzed with both multilevel logistic regression and survival analysis (to account for development over time).”
BackgroundMethodSelf-citation
Positive schemas in schema therapy with older adults: clinical implications and research suggestions
Videler, A. C., Royen, R. J. J. V., Legra, M. J. H., & Ouwens, M. A. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000077 · Cited by 36
“Several studies have shown the effectiveness of schema therapy, mainly for adult patients with borderline personality disorder (Dickhaut and Arntz, 2014; Giesen-Bloo et al., 2006; Farrell et al., 2009; Nadort et al., 2009), but also as a treatment of other personality disorders (Bamelis et al.”
Background
The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial
Assmann, N., Schaich, A., Arntz, A. R., Wagner, T., Herzog, P., Alvarez‐Fischer, D., Sipos, V., Jauch‐Chara, K., Klein, J. P., Hüppe, M., et al. (2024) · Psychotherapy and Psychosomatics · doi:10.1159/000538404 · Cited by 35
Self-citation
Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study
Leppänen, V., Hakko, H. H., Sintonen, H., & Lindeman, S. M. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9866-4 · Cited by 30
“Schema-focused psychotherapy (SFT, later schema therapy, ST) has been reported to significantly reduce all BPD symptoms and general psycho-pathological dysfunction and to improve quality of life (J. Giesen-Bloo et al. 2006; Jacob and Arntz 2013; Nadort et al. 2009; Sempértegui et al. 2013).”
Background
Schema therapy, motivational interviewing, and collaborative-mapping as treatment for depression among low income, second generation Latinas
Heilemann, M. V., Pieters, H. C., Kehoe, P., & Yang, Q. (2011) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.05.001 · Cited by 30
Schema Therapy in Adolescents with Disruptive Behavior Disorders
van Wijk‐Herbrink, M. F., Broers, N. J., Roelofs, J., & Bernstein, D. P. (2017) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2017.1352053 · Cited by 29
“…has proven to be a clinically effective and cost-effective treatment for adult outpatients with Borderline PD (Asselt et al., 2008; Farrell, Shaw, & Webber, 2009; Giesen-Bloo et al., 2006; Nadort et al., 2009) and Cluster C, Narcissistic, and Paranoid PDs (Bamelis, Evers, Spinhoven, & Arntz, 2014).”
Background
Examining challenging behaviors of clients with borderline personality disorder
Chalker, S. A., Carmel, A., Atkins, D. C., Landes, S. J., Kerbrat, A. H., & Comtois, K. A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.10.003 · Cited by 28
“…to be effective in the treatment of clients with BPD, like Schema-Focused Therapy (Giesen-Bloo et al., 2006), have found out-of-session contacts to be a taxing component (Giesen-Bloo et al., 2006; Nadort et al., 2009a) and show no added benefit to therapy outcomes (Nadort et al., 2009a, 2009b).”
Group-Schematherapy for Adolescents: Results from a Naturalistic Multiple Case Study
Roelofs, J., Muris, P., van Wesemael, D., Broers, N. J., Shaw, I. A., & Farrell, J. M. (2016) · Journal of Child and Family Studies · doi:10.1007/s10826-016-0391-z · Cited by 28
“A number of previous studies support the effectiveness of ST, either provided in a group or an individual format, for treating PD’s in adults (Reiss et al. 2014; Bamelis et al. 2013; Farrell et al. 2009; Giesen-Bloo et al. 2006; Hoffart et al. 2002; Nadort et al. 2009; Nordahl and Nysaeter 2005; van Vreeswijk et al. 2…”
BackgroundResult
Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community
Shanley, D. C., Hawkins, E., Page, M., Shelton, D., Liu, W., Webster, H. H. J., Moritz, K. M., Barry, L. A., Ziviani, J. M., Morrissey, S. A., et al. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4378-5 · Cited by 28
Link between early maladaptive schemas and defense mechanisms
Walburg, V., & Chiaramello, S. (2015) · European Review of Applied Psychology · doi:10.1016/j.erap.2015.07.003 · Cited by 26
Psychometric Properties of the Italian Version of the Young Schema Questionnaire L-3: Preliminary Results
Saggino, A., Balsamo, M., Carlucci, L., Cavalletti, V., Sergi, M. R., Fermo, G. D., Dèttore, D., Marsigli, N., Petruccelli, I., Pizzo, S., et al. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00312 · Cited by 26
“Several studies showed that ST is an evidence-based treatment for personality disorders (e.g., Giesen-Bloo et al., 2006; Gude and Hoffart, 2008; Farrell et al., 2009; Nadort et al., 2009; Sempertegui et al., 2013; Bamelis et al., 2014), as well as for anxiety and depressive disorders (Balsamo, 2010, 2013; Renner et al.”
Background
Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care
Nadort, M., van Dyck, R., Smit, J. H., Giesen-Bloo, J. H., Eikelenboom, M., Wensing, M., Spinhoven, P., Dirksen, C. D., Bleecke, J., Milligen, B. A. L.-V., et al. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.004 · Cited by 25
Self-citation
Integration of e‐Health Tools Into Face‐to‐Face Psychotherapy for Borderline Personality Disorder: A Chance to Close the Gap Between Demand and Supply?
Faßbinder, E., Hauer, A., Schaich, A., Schweiger, U., Jacob, G. A., & Arntz, A. R. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22204 · Cited by 23
“…to be highly effective with a treatment frequency of two face-to-face sessions per week, which may be delivered individually (Giesen-Bloo et al., 2006; Nadort et al., 2009), or in a combination of individual and group treatment (Dickhaut & Arntz, 2013) for a treatment length of 1.5 years or longer.”
InfluentialSelf-citation
Current state of the evidence on community treatments for people with complex emotional needs: a scoping review
Ledden, S., Rains, L. S., Schlief, M., Barnett, P., Ching, B. C. F., Hallam, B., Günak, M. M., Steare, T., Parker, J., Labovitch, S., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04171-z · Cited by 27
Understanding Borderline Personality Disorder Across Sociocultural Groups: Findings, Issues, and Future Directions
Neacsiu, A. D., Eberle, J. W., Keng, S., Fang, C. M., & Rosenthal, M. Z. (2017) · Current Psychiatry Reviews · doi:10.2174/1573400513666170612122034 · Cited by 28
Working with modes in schema therapy.
Rafaeli, E., Maurer, O., & Thoma, N. C. (2015) · Cited by 22
The prevalence of personality disorders in Portuguese male prison inmates: Implications for penitentiary treatment
Brazão, N., da Motta, C., Rijo, D., & Pinto‐Gouveia, J. (2015) · Análise Psicológica · doi:10.14417/ap.975 · Cited by 21
“The developments in effective therapies for Personality Disorders (Bernstein, Arntz, & Vos, 2007; Farrell, Shaw, & Webber, 2009; Nadort et al., 2009; van Asselt et al., 2008) suggest that psychotherapeutic interventions reducing factors underlying antisocial behavior should be a key area of investment when dealing wit…”
Psychological symptoms, early maladaptive schemas and schema modes: predictors of the outcome of group schema therapy in patients with personality disorders
Koppers, D., Van, H. L., Peen, J., & Dekker, J. (2020) · Psychotherapy Research · doi:10.1080/10503307.2020.1852482 · Cited by 29
“Studies of the effectiveness of schema therapy have described clear results for borderline personality disorders (Giesen-Bloo et al., 2006; Nadort et al., 2009) and promising results for samples of personality disorders (PD), mainly in cluster C (Bamelis et al., 2014).”
Background
Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial
Baljé, A. E., Greeven, A., Deen, M., van Giezen, A. E., Arntz, A., & Spinhoven, P. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102860 · Cited by 20
“ST has proven efficacious for BPD (Arntz et al., 2022; Farrell et al., 2009; Giesen-Bloo et al., 2006; Masley et al., 2012; Nadort et al., 2009).”
Self-citation
Schema Modes and Personality Disorder Symptoms in Alcohol-Dependent and Cocaine-Dependent Patients
Boog, M., van Hest, K. M., Drescher, T., Verschuur, M., & Franken, I. (2018) · European Addiction Research · doi:10.1159/000493644 · Cited by 17
Positive Perceptions of Parenting and their Links to Theorized Core Emotional Needs
Louis, J. P., Davidson, A. T., Lockwood, G., & Wood, A. M. (2020) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01807-0 · Cited by 20
Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study
Wibbelink, C. J. M., Venhuizen, A. S. M., Grasman, R. P. P. P., Bachrach, N., van den Hengel, C., Hudepohl, S., Kunst, L. E., de Lange, H., Louter, M. A., Matthijssen, S. J. M. A., et al. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2903 · Cited by 23
Self-citation
Schema Therapy in Forensic Settings
Bernstein, D. P., Clercx, M., & Vos, M. K. (2019) · Wiley eBooks · doi:10.1002/9781119139980.ch41 · Cited by 20
The Good Enough Parenting early intervention schema therapy based program: Participant experience
Louis, J. P., Ortiz, V., Barlas, J., Lee, J. S., Lockwood, G., Chong, W. F., Louis, K. M., & Sim, P. (2021) · PLoS ONE · doi:10.1371/journal.pone.0243508 · Cited by 19
The network structure of schema modes
Aalbers, G., Engels, T., Haslbeck, J. M. B., Borsboom, D., & Arntz, A. R. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2577 · Cited by 20
Self-citation
Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder
Woodbridge, J., Reis, S. L., Townsend, M. L., Hobby, L., & Grenyer, B. F. S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255055 · Cited by 21
From multimodal programs to a new cognitive–interpersonal approach in the rehabilitation of offenders
Brazão, N., da Motta, C., & Rijo, D. (2013) · Aggression and Violent Behavior · doi:10.1016/j.avb.2013.07.018 · Cited by 19
Preliminary evaluation of psychometric properties of the Finnish Borderline Personality Disorder Severity Index: Oulu-BPD-Study
Leppänen, V., Lindeman, S. M., Arntz, A. R., & Hakko, H. H. (2012) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2012.745600 · Cited by 19
Self-citation
Schematherapie
Roediger, E. (2016) · Springer eBooks · doi:10.1007/978-3-642-45028-0_43-1 · Cited by 19
Early Intervention for Borderline Personality Disorder: Psychodynamic Therapy in Adolescents
Salzer, S., Cropp, C., & Streeck-Fischer, A. (2014) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2014.60.4.368 · Cited by 19
Metacognitive Therapy of Early Traumatized Patients With Borderline Personality Disorder: A Phase-II Baseline Controlled Trial
Nordahl, H. M., & Adrian Wells, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01694 · Cited by 18
“The preliminary results of our study compare well with other comprehensive treatments in terms of pre- and post-treatment effects and duration (Linehan et al., 2006; Bateman and Fonagy, 2009; Nadort et al., 2009; Doering et al., 2010).”
MethodResult
Effectiveness Studies
Bamelis, L. L. M., Giesen-Bloo, J. H., Bernstein, D. P., & Arntz, A. R. (2012) · doi:10.1002/9781119962830.ch37 · Cited by 19
Self-citation
Schema Therapy with Emotionally Inhibited and Fearful Patients
Faßbinder, E., & Arntz, A. R. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-018-9396-9 · Cited by 18
Self-citation
The effects of the growing pro-social program on cognitive distortions and early maladaptive schemas over time in male prison inmates: A randomized controlled trial.
Brazão, N., Rijo, D., Salvador, M. D. C., & Pinto‐Gouveia, J. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000247 · Cited by 18
Schema Therapy
Taylor, C. D. J., & Arntz, A. R. (2016) · Wiley eBooks · doi:10.1002/9781118468197.ch30 · Cited by 18
Self-citation
The Influence of Early Maladaptive Schemas on the Causal Links between Perceived Injustice, Negative Affect, and Aggression
van Wijk-Herbrink, M. F., Lobbestael, J., Bernstein, D., Broers, N., Roelofs, J., & Arntz, A. (2020) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2020.1842562 · Cited by 15
“…psychotherapy that has been shown effective for adult patients with personality disorders (Bamelis, Evers, Spinhoven, & Arntz, 2014; Farrell, Shaw, & Webber, 2009; Giesen-Bloo et al., 2006; Nadort et al., 2009), including forensic patients with severe antisocial behaviors (Bernstein 2016).”
Self-citation
Schema therapy for patients with borderline personality disorder and comorbid alcohol dependence: A multiple‐baseline case series design study
Boog, M., Goudriaan, A. E., Wetering, B. J. M. V. D., Franken, I. H. A., & Arntz, A. R. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2803 · Cited by 22
Self-citation
The effectiveness of imagery work in schema therapy with couples: a clinical experiment comparing the effects of imagery rescripting and cognitive interventions in brief schema couples therapy
Roediger, E., Zarbock, G., Frank-Noyon, E., Hinrichs, J., & Arntz, A. R. (2018) · Sexual & Relationship Therapy · doi:10.1080/14681994.2018.1529411 · Cited by 15
“There is an increasing evidence of effectiveness of schema therapy for individuals with various disorders in some studies (e.g. Bamelis, Evers, Spinhoven, & Arntz, 2014; Giesen-Bloo et al., 2006; Gude & Hoffart, 2008; Heilemann, Pieters, Kehoe, & Yang, 2011; Malogiannis et al., 2014; Nadort et al., 2009; Renner, Arntz…”
BackgroundSelf-citation

Authors: Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., van Asselt, T., Wensing, M., & van Dyck, R.
Affiliations: Amsterdam Public Health (NL)
Maastricht University (NL)
Leiden University (NL)
Radboud University Medical Center (NL)
Corresponding author: Nadort, Marjon
ORCID: Arntz, Arnoud
Smit, Johannes H.
Eikelenboom, Merijn
Spinhoven, Philip
Wensing, Michel
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2009-11
Volume: 47
Issue: 11
Pages: 961-973
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2009.07.013
OpenAlex: W2019444600
Cited by: 259
References: 54
Citations by year: 2026: 2 · 2025: 5 · 2024: 15 · 2023: 11 · 2022: 16 · 2021: 22 · 2020: 21 · 2019: 9 · 2018: 15 · 2017: 15 · 2016: 19 · 2015: 23 · 2014: 21 · 2013: 17 · 2012: 28
FWCI: 17.01
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Research Publications (Maastricht University) (submittedVersion)
Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Data Archiving and Networked Services (DANS) (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 › Psychiatric care and mental health services
Keywords: schema therapy, borderline personality disorder, outpatient care, crisis support, therapist training, treatment implementation, treatment discontinuation, quality of life, psychopathology, long-term treatment outcomes
MeSH terms: Adult, Behavior Therapy, Borderline Personality Disorder, Female, Humans, Male, Outpatients, Treatment Outcome, Remote Consultation

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Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial

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