A combination of group and individual “schema” psychotherapy for patients with borderline personality disorder (BPD) was found to be more effective in reducing BPD symptoms than group schema therapy alone or other forms of psychotherapy, according to a report in JAMA Psychiatry.
Schema therapy is a structured therapy that integrates elements of cognitive-behavior therapy and psychoanalysis to explore repetitive life patterns and core life themes, called “schemas.” Schema therapists use an inventory to assess the schemas that cause persistent problems in a patient’s life.
Arnaud Arntz, Ph.D., of the University of Amsterdam and colleagues recruited patients aged 18 to 65 years with BPD from 15 sites in five countries (Australia, Germany, Greece, the Netherlands, and the United Kingdom) for the study. They randomly assigned the participants to one of three groups for two years: 125 patients with BPD were assigned to predominantly group schema therapy, 124 patients were assigned to a combination of individual and group schema therapy, and 246 patients received treatment as usual.
Patients assigned to predominantly group schema therapy participated in two group sessions a week for one year and a maximum of 12 individual sessions if requested by patients. The frequency of group therapy sessions diminished progressively during the second year (from once weekly to biweekly to once monthly); patients could request a maximum of five individual sessions.
Patients assigned to individual and group therapy participated in two sessions (one individual and one group) a week for the first year, with the frequency of both diminishing progressively in the second year (from biweekly to once monthly). Patients assigned to treatment as usual were given the optimal psychological treatment available at the site; the most frequently offered treatment was dialectical behavior therapy.
The primary outcome was change in BPD severity as assessed at baseline, six months, 12 months, 18 months, 24 months, and 36 months with the Borderline Personality Disorder Severity Index-IV. Secondary measures included treatment retention and suicidality.
Patients receiving individual and group therapy had a greater reduction in symptoms and were more likely to remain in treatment than those receiving either predominantly group therapy or treatment as usual. Individual and group therapy was significantly superior to treatment as usual in reducing suicide attempts; there was no significant difference in suicide attempts when comparing patients who received individual and group therapy with those who received predominantly group therapy.
“Core emotional needs such as safe attachment and positive attention are often not adequately met during childhood in patients with BPD in both individual and group relationships,” Arntz and colleagues wrote. “The combined [schema therapy] format aimed to meet needs in both contexts, whereas [predominantly group schema therapy] provided less individual attention. Moreover, addressing severe problems and childhood trauma might be easier for therapists in individual treatment than in group treatment.”
For more information, see the Psychiatric News article “Psychotherapy Found Generally Effective for Borderline Personality Disorder.”
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