Marjon Nadort

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

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. Patients 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.

Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy

BACKGROUND Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial. AIMS To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder. METHOD Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY). RESULTS Mean 4-year bootstrapped costs were euro37 826 for SFT and euro46 795 for TFP (95% uncertainty interval for difference -21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI -0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved euro90 457 for one QALY loss. CONCLUSIONS Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

Implementation of outpatient schema therapy for borderline personality disorder: study design.

BackgroundSchema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD) in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis.Methods/DesignPatient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%.DiscussionThe study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value.Trial RegistrationThe Dutch Cochrane Center, NTR (TC = 1781).

1 Algemene inleiding

Het begrip schema kent een lange voorgeschiedenis: al van eerder dan Jeffrey Young zijn schemamodel ontwikkelde. In de jaren negentig van de vorige eeuw is zijn schemamodel in Nederland geintroduceerd. Schematherapie is de laatste jaren steeds verder ontwikkeld door de inzet van een groeiend aantal wetenschappers en behandelaren.

29 Voorlichting over schematherapie

De belangstelling voor schematherapie (ST) groeit. De afgelopen jaren zijn zowel op nationaal als op internationaal niveau verschillende boeken over schematherapie verschenen voor therapeuten. Deze boeken hebben al dan niet de behandeling van een specifieke patientenpopulatie of manier van werken zoals individuele versus groepstherapie als thema (zie in het Nederlandse taalgebied Young & Pijnaker, 1999; Schacht & Peeters, 2000; Arntz & Bogels, 2000; Young, Klosko & Weishaar, 2005; Van Genderen & Arntz, 2005; Van Vreeswijk & Broersen, 2006).