Design of a multicentered randomized controlled trial on the clinical and cost effectiveness of schema therapy for personality disorders
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BACKGROUND: Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD. METHODS/DESIGN: In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST. DISCUSSION: This trial is the first to compare ST and COP head-to-head with TAU for people with a cluster C, paranoid, histrionic and/or narcissistic PD. By combining clinical effectiveness data with an economic evaluation and with direct information from primary stakeholders, this trial offers a complete and thorough view on ST as a contribution to the improvement of treatment for this PD patient group. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR566.
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There is growing evidence that schema therapy is an effective treatment for patients with avoidant personality disorder.
“Furthermore, there is growing evidence that schema therapy (ST) is an effective treatment for patients with APD [18, 19].”
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 [18]
The Background describes schema therapy as promising for personality disorders and reports evidence of effectiveness for borderline personality disorder. The Discussion says the trial aims to study its effectiveness for avoidant personality disorder, while the Conclusion says effectiveness for most personality disorders was still unknown. The paper therefore does not establish the claimed growing evidence of effectiveness specifically for avoidant personality disorder. (LLM, conf=0.85)
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- Authors
- Bamelis, L. L., Evers, S. M., & Arntz, A.
- Affiliations
- Maastricht University (NL)
- Royal Netherlands Academy of Arts and Sciences (NL)
- Corresponding author
- Bamelis, Lotte LM
- Venue
- BMC Public Health
- Published
- 2012-01-24
- Volume
- 12
- Issue
- 1
- Pages
- 75-75
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC3305366
- OpenAlex
- W2120935935
- Cited by
- 33
- References
- 81
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2020: 4 · 2019: 2 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- ZonMw (945-06-406)
- Universiteit Maastricht
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- schema therapy, personality disorders, cost-effectiveness, cost-utility analysis, psychotherapy effectiveness, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder, paranoid personality disorder, histrionic personality disorder, narcissistic personality disorder, cluster C personality disorders, social functioning, quality of life
- MeSH terms
- Adolescent, Adult, Aged, Cost-Benefit Analysis, Humans, Middle Aged, Netherlands, Personality Disorders, Psychotherapy, Research Design, Young Adult
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