A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

Farrell, Joan M.; Shaw, Ida A.; Webber, Michael A.

doi:10.1016/j.jbtep.2009.01.002

Cited by 428Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

Farrell, Joan M., Shaw, Ida A., Webber, Michael A.·2009·Journal of Behavior Therapy and Experimental Psychiatry

DOI 10.1016/j.jbtep.2009.01.002

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Abstract

This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N=32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p<.001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning.

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Farrell 2009 reported very large, statistically significant effects for all reported pathology-related outcomes, that is, BPD severity, affective instability, impulsivity, interpersonal problems, dissociative/psychotic symptoms, general psychopathology, and overall mental health status.
“The authors report findings resulting in very large, statistically significant effects for all reported pathology-related outcomes, that is, BPD severity, affective instability, impulsivity, interpersonal problems, dissociative/psychotic symptoms, general psychopathology, and overall mental health status.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 used treatment adherence safeguards: weekly supervision meetings, random videotape fidelity review by program developers, and a manual as an additional fidelity check.
“Weekly supervision meetings took place during the course of the study and random videotapes of sessions were reviewed for fidelity by the program developers.The manual developed for the study acted as an additional fidelity check.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 data indicate a very large, statistically significant difference in favour of SFT-G for mental health status/functioning (SMD 1.20; N = 28, 95% CI 0.38 to 2.03; Analysis 2.15).
“Again, Farrell 2009 report data indicating a very large, statistically significant difference in favour of SFT-G (SMD 1.20; N = 28, 95% CI 0.38 to 2.03; Analysis 2.15).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
In Farrell 2009, observer-rated outcomes were not assessed by blind raters.
“(Farrell 2009, p. 319) Overall, observer-rated outcomes were not assessed by blind raters.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
In Farrell 2009, two of the three groups had the two program developers as therapists and the third had one developer and one clinical psychologist.
“Two of the three groups had the two program developers as therapists and the third had one developer and one clinical psychologist”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009

Farrell 2009 found a very large, statistically significant effect in favour of SFT-G for BPD total severity (SMD -1.66; N = 28, 95% CI -2.54 to -0.78).
“Farrell 2009 report data indicating a very large, statistically significant effect in favour of SFT-G (SMD -1.66; N = 28, 95% CI -2.54 to -0.78; Analysis 2.1).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 reported that interviewers were not blind to treatment allocation, and its risk of bias was judged likely.
“One trial (Farrell 2009) providing mainly interviewer-assessed outcomes reported that the interviewers were not blind to treatment allocation, and the risk of bias was judged likely.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
In Farrell 2009, therapists were not blind to their patients' group membership and no inter-rater reliability was possible.
“They were chosen as raters since they were removed from the hypotheses of the study, although not blind to their patients's group membership and no inter-rater reliability was possible.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 reported a very large, statistically significant difference between SFT-G and control in general psychopathology, with better outcomes for SFT-G (SMD -1.06, N=28, 95% CI -1.87 to -0.25).
“Farrell 2009 report data indicating a very large, statistically significant difference between the two conditions with better outcomes for the SFT-G group (SMD -1.06, N = 28, 95% CI -1.87 to -0.25; Analysis 2.14).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 had high risk of bias for blinding of outcome assessment.
“High risk”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
In Farrell 2009, allocation concealment was unclear because no further details were reported.
“Allocation concealment (selection bias) Unclear risk No further details.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
Farrell 2009 found a very large, statistically significant difference favouring SFT-G for BPD-specific impulsivity (SMD -1.92; N = 28, 95% CI -2.85 to -1.00; Analysis 2.5).
“Farrell 2009 found a very large, statistically significant difference favouring SFT-G with regard to BPD-specific impulsivity (SMD -1.92; N = 28, 95% CI -2.85 to -1.00; Analysis 2.5).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
In Farrell 2009, patients were randomly assigned using a random number table, indicating low risk of selection bias from random sequence generation.
“Patients were randomly assigned using a random number table”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Farrell 2009
The RCT of Farrell et al. compared the effectiveness of adding 30 group sessions of ST to TAU and TAU alone in patients with BPD and found significantly greater reductions in BPD symptoms and global severity of psychiatric symptoms in the GST.
“the RCT of Farrell et al. [80] compared the effectiveness of adding 30 group sessions of ST to TAU and TAU alone in patients with BPD and found significantly greater reductions in BPD symptoms and global severity of psychiatric symptoms in the GST.”
From Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial. (2016) · cites this paper as [80]
Both treatments are well documented and have been implemented in scientific research before in treatment studies for GCBT and individual and group ST.
“Both treatments are well documented [17, 24, 75] and have been implemented in scientific research before in treatment studies for GCBT (e.g. [76–79]) and individual and group ST (e.g. [19, 43, 80, 81]).”
From Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial. (2016) · cites this paper as [80]
Several studies have shown that treatment based on the ST model is very effective for patients with BPD, but also for other personality disorders.
“Several studies have shown that treatment based on that model is very effective for patients with BPD (Giesen-Bloo et al., 2006; Farrell et al., 2009; Nadort et al., 2009; Dickhaut and Arntz, 2013), but also for other PDs (Bamelis et al., 2013).”
From Emotion regulation in schema therapy and dialectical behavior therapy. (2016) · cites this paper as Farrell et al., 2009

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Authors: Farrell, J. M., Shaw, I. A., & Webber, M. A.
Affiliations: Indiana University Hospital (US)
Corresponding author: Farrell, Joan M.
Venue: Journal of Behavior Therapy and Experimental Psychiatry
Publisher: Elsevier BV
Published: 2009-06
Volume: 40
Issue: 2
Pages: 317-328
ISSN: 0005-7916 (ISSN-L)
DOI: 10.1016/j.jbtep.2009.01.002
OpenAlex: W2156247218
Cited by: 428
References: 38
Citations by year: 2026: 12 · 2025: 17 · 2024: 19 · 2023: 20 · 2022: 30 · 2021: 27 · 2020: 42 · 2019: 22 · 2018: 25 · 2017: 28 · 2016: 29 · 2015: 30 · 2014: 29 · 2013: 26 · 2012: 36
FWCI: 25.17
Type: journal article
Language: en
Update notices: erratum (2018-09-01)
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health
Topics: Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: schema therapy, borderline personality disorder, group therapy, outpatient care, individual psychotherapy, treatment discontinuation, psychiatric symptom severity, global functioning
MeSH terms: Adult, Borderline Personality Disorder, Female, Humans, Interview, Psychological, Middle Aged, Outpatients, Psychiatric Status Rating Scales, Psychotherapy, Group, Socioeconomic Factors, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

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