Schema therapy for borderline personality disorder.

The Rockefeller University, NY, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 04/2006; 62(4):445-58. DOI: 10.1002/jclp.20240
Source: PubMed

ABSTRACT This article presents the Schema Therapy (Young, Klosko, & Weishaar, 2003) approach to the treatment of borderline personality disorder. Schema therapy draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have borderline personality disorder as being under the sway of five modes or aspects of the self. The goal of the therapy is to reorganize this inner structure. To this end, there are four core mechanisms of change that are used in this therapy: (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking. These interventions are used during the three phases of treatment: (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy.

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    ABSTRACT: BackgroundBorderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes.Methods/DesignAn international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients inverted question mark and therapists inverted question mark experiences with GST, and studies on variables that might influence the effectiveness of GST.DiscussionThis trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation and additional investigations, it will contribute to an evidence-based understanding of which treatment should be offered to patients with BPD from clinical, economic, and stakeholders inverted question mark perspectives.Trial registrationNetherlands Trial Register NTR2392. Registered 25 June 2010.
    BMC Psychiatry 11/2014; 14(1):319. DOI:10.1186/s12888-014-0319-3 · 2.24 Impact Factor
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    ABSTRACT: Zusammenfassung Diese Arbeit analysierte die Thera-pieprozesse sowie die Techniken und Verhaltensweisen der Therapeuten (d. h., " therapeutenspezifische Wirkfak-toren ") von Psychoanalyse, psychoanalytisch orientier-ter Psychotherapie und kognitiver Verhaltenstherapie. 639 Therapiesitzungen der Münchner Psychotherapie-studie wurden mit dem Psychotherapie-Prozess-Q-Sort (PQS) und der Qualität der Objektbeziehungs-Skala (QORS) analysiert. Anhand der Hauptkomponentenana-lyse wurden zwölf PQS-Item-basierte Faktoren gefun-den, die 39 % der Varianz erklären (KMO-und Bart-lett-Test: ,73; p = ,000). Neutrale vs. supportiv-direktive Haltung, Empathie, einsichtsorientierte Techniken und Arbeit an der therapeutischen Beziehung stellten thera-peutenspezifische Wirkfaktoren dar, wobei diese in den Behandlungsmethoden und in den Anfangs-, Mitte-und Endstunden unterschiedlich ausgeprägt vorkamen. Die KVT verwendete neben kognitiv-verhaltenstherapeuti-schen auch Elemente der psychoanalytischen Technik, d. h. einsichtsorientierte Techniken und die Arbeit an der therapeutischen Beziehung. Die neutrale Haltung war spezifisch für die psychoanalytischen Therapien, nahm jedoch gegen Ende der Therapie ab. In der Gesamtstich-probe zeigte sich kein direkter Zusammenhang zwischen den vier Wirkfaktoren und der Verbesserung des QORS der Patienten. Jedoch profitierten Patienten mit schwe-ren interpersonellen Schwierigkeiten von einsichts-orientierten Techniken und einer supportiv-direktiven Haltung jeweils zu unterschiedlichen Zeitpunkten der Therapie. Abstract This project analysed the therapeutic processes and especially the techniques and therapist behaviour (i.e., " therapeutic factors ") of psychoanalysis, psychoanalytic oriented psychotherapy and cognitive behavioural therapy. Data are obtained from the Munich Psychotherapy Study. Process analyses were based on audio recordings of therapy sessions by means of the Psychotherapy Process Q-Sort (PQS) and the Quality of object relation scale (QORS). A total of 639 sessions were examined. Based on the principal component analysis, twelve factors displaying specific PQS-item combinations were found explaining 39 % of the variance (KMO-and Bartlett-Test: .73; p = .000). Neutral vs. supportive-directive attitude, empathy, insight-oriented techniques and work on therapeutic relationship represented therapeutic factors. Some therapeutic factors differed distinctly between treatment modality in the early, middle and late sessions. In addition to cognitive-behavioural techniques CBT also used ingredients of psychoanalytic technique, i. e., insight-oriented Diese Arbeit ist Teil des Leitthemas " Psychotherapieforschung " .
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    ABSTRACT: Rationale. The new area of health system research requires a revision of the taxonomy of scientific knowledge that may facilitate a better understanding and representation of complex health phenomena in research discovery, corroboration and implementation. Method. A position paper by an expert group following and iterative approach. Results. ‘Scientific evidence’ should be differentiated from ‘elicited knowledge’ of experts and users, and this latter typology should be described beyond the traditional qualitative framework. Within this context ‘framing of scientific knowledge’ (FSK) is defined as a group of studies of prior expert knowledge specifically aimed at generating formal scientific frames. To be distinguished from other unstructured frames, FSK must be explicit, standardized, based on the available evidence, agreed by a group of experts and subdued to the principles of commensurability, transparency for corroboration and transferability that characterize scientific research. A preliminary typology of scientific framing studies is presented. This typology includes, among others, health declarations, position papers, expert-based clinical guides, conceptual maps, classifications, expert-driven health atlases and expert-driven studies of costs and burden of illness. Conclusions. This grouping of expert-based studies constitutes a different kind of scientific knowledge and should be clearly differentiated from ‘evidence’ gathered from experimental and observational studies in health system research.
    Journal of Evaluation in Clinical Practice 11/2014; 20(6). DOI:10.1111/jep.12286 · 1.58 Impact Factor


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May 22, 2014