Group schema therapy for cluster-C personality disorders: A multicentre open pilot study

The effectiveness of an unified transdiagnostic intervention based on common mechanisms on the obsessive-compulsive personality pattern

BACKGROUND

Obsessive-compulsive personality disorder is a chronic condition characterized by a maladaptive pattern of excessive perfectionism, preoccupation with rules and details, and the urge to control the environment, which results in significant distress or impairment, especially in interpersonal functioning. Individuals diagnosed with the mentioned disorder are often seen as rigid, inflexible, and highly controlling. Therefore, the present study aims to investigate the effectiveness of unified transdiagnostic interventions based on common mechanisms of obsessive personality patterns.

MATERIALS AND METHOD

This quantitative research is a semi-experimental single-case and multiple-base design with asynchronous participants. Five participants were selected using purposive sampling through semi-structured interviews based on DSM-5 among patients who visited the clinics during 2022-2023. The research included the Millon Clinical Multiaxial Inventory. Moreover, the treatment intervention was administered individually throughout 12 sessions with one session a week. Data analysis involved visual inspection or graphical representation of each case's improvement percentage and change index.

RESULT

The results from visual representation indicated that the transdiagnostic intervention based on common mechanisms significantly influenced the obsessive personality patterns at baseline, during treatment, and at follow-up. There was a significant change in the reliable change index compared to the baseline for all five participants. During the treatment phase, participants showed a mean score of 30.28 for the obsessive personality pattern, indicating a significant level of effectiveness. However, the mean score increased to 57.50 at the follow-up stage.

CONCLUSION

According to Blanchard and Schwartz's classification, the unified transdiagnostic interventions based on common mechanisms and their effectiveness on obsessive personality patterns fell into the improvement category during treatment and into the success category at the follow-up stage of the study. Overall, the findings suggest a bright future for the treatment of individuals with obsessive personality patterns, as unified diagnostic interventions show great potential for significant impact.

The societal costs of avoidant personality disorder

The study aims to estimate the societal costs of avoidant personality disorder (AvPD). Cross-sectional data on AvPD patients during 2017-2020 were retrieved from the quality register of the Norwegian Network for Personality Disorders. Cost estimations were based on a bottom-up approach, using a structured interview covering the 6-month period prior to initial assessment. Unit costs were retrieved from public records. The human capital approach was used to calculate productivity losses. Diagnoses were determined according to DSM-5 by semi-structured diagnostic interviews (SCID-5-PD). Mean societal costs were €19,378 for the total group (N = 410). The subgroup with a single diagnosis (n = 270) incurred €18,818, whereas the subgroup with at least one comorbid PD (n = 140) incurred €20,458. The difference between the two subgroups was not statistically significant. The largest cost component was productivity loss (69%), whereas health service costs constituted 31%. The main contributors to societal costs from the health service cost components were inpatient treatment (18%) and individual outpatient treatment (11%). In conclusion, societal costs for AvPD patients were high, on the same level as borderline PD, schizotypal PD, and schizophrenia, and higher than anxiety disorders, depression, and rheumatoid arthritis. In the future, development of effective AvPD treatment programs enhancing personality functioning and workforce participation is important in order reduce the cost of illness.

Psychotherapies for the treatment of personality disorders: the state of the art

PURPOSE OF REVIEW

To provide an update of systematic reviews, meta-analyses and recent clinical outcome studies for personality disorder (PD) in order to investigate the state of the art of the evidence of psychotherapy for personality disorders.

RECENT FINDINGS

Few outcome studies in patients with Cluster A and Cluster C PD have been conducted, which limits the conclusions which can be drawn. Most recently published research has been conducted with borderline PD. There is limited evidence that dialectical behavior therapy (DBT), mentalization based therapy and schema therapy are more effective than treatment as usual. There is no convincing evidence that long and intensive therapy is more effective than short and less intensive therapy. Drop-out is rather high for patients with borderline PD. Group therapy results in more drop-outs than individual therapy.

SUMMARY

There is a clear need of studies evaluating whether psychotherapies developed for PDs are more effective than CBT for patients with Cluster C PD. Given that studies with patients with Cluster B PD suggest that longer treatment of DBT and mentalization-based treatment is not more effective than shorter treatment this needs to be studied with other evidence-based therapies as well. Serious efforts are needed to evaluate therapies for patients with Cluster A PDs.

Effectiveness of Day Treatment Group Schema Therapy for Personality Disorders: A Multiple Baseline Single-Case Study

BACKGROUND

Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking.

AIMS

This study aimed to investigate the effectiveness of day treatment GST for patients with PDs.

METHODS AND PROCEDURES

Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures.

OUTCOMES AND RESULTS

A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes.

CONCLUSIONS AND IMPLICATIONS

This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.