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

BackgroundGroup schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster-C PDs. Individual ST has proven to be effective for Cluster-C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster-C PD. Moreover, differ- ences between the specific Cluster-C PDs (avoidant PD, dependent PD and obsessive-compulsive PD) were explored.MethodsA multicentre open trial was conducted, including 137 patients with a Cluster-C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive- compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster-C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD-related beliefs, self-esteem, self- ideal discrepancy, schemas and schema modes were assessed at baseline until 2-year follow-up with semi-structured interviews and self-report measures. Change over time and differences between the specific Cluster-C PDs were analysed with mixed regression analyses.ResultsThe outcome measures showed significant improvements for all Cluster-C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster-C PDs in severity at baseline, change trajectories and effectiveness of GST. ConclusionsThis study demonstrated that GST is a promising treatment for Cluster-C PDs. The following step is a randomized controlled trial to further document the (cost-)effectiveness of GST. <br/

Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy

Background Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. Methods The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. Discussion The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on “Which treatment – DBT or ST – works the best for which BPD patient, and why?”, which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments)

The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018

Fitting three-level meta-analytic models in R: A step-by-step tutorial

Applying a multilevel approach to meta-analysis is a strong method for dealing with dependency of effect sizes. However, this method is relatively unknown among researchers and, to date, has not been widely used in meta-analytic research. Therefore, the purpose of this tutorial was to show how a three-level random effects model can be applied to meta-analytic models in R using the rma.mv function of the metafor package. This application is illustrated by taking the reader through a step-by-step guide to the multilevel analyses comprising the steps of (1) organizing a data file; (2) setting up the R environment; (3) calculating an overall effect; (4) examining heterogeneity of within-study variance and between-study variance; (5) performing categorical and continuous moderator analyses; and (6) examining a multiple moderator model. By example, the authors demonstrate how the multilevel approach can be applied to meta-analytically examining the association between mental health disorders of juveniles and juvenile offender recidivism. In our opinion, the rma.mv function of the metafor package provides an easy and flexible way of applying a multi-level structure to meta-analytic models in R. Further, the multilevel meta-analytic models can be easily extended so that the potential moderating influence of variables can be examined

Fitting three-level meta-analytic models in R: A step-by-step tutorial

Applying a multilevel approach to meta-analysis is a strong method for dealing with dependency of effect sizes. However, this method is relatively unknown among researchers and, to date, has not been widely used in meta-analytic research. Therefore, the purpose of this tutorial was to show how a three-level random effects model can be applied to meta-analytic models in R using the rma.mv function of the metafor package. This application is illustrated by taking the reader through a step-by-step guide to the multilevel analyses comprising the steps of (1) organizing a data file; (2) setting up the R environment; (3) calculating an overall effect; (4) examining heterogeneity of within-study variance and between-study variance; (5) performing categorical and continuous moderator analyses; and (6) examining a multiple moderator model. By example, the authors demonstrate how the multilevel approach can be applied to meta-analytically examining the association between mental health disorders of juveniles and juvenile offender recidivism. In our opinion, the rma.mv function of the metafor package provides an easy and flexible way of applying a multi-level structure to meta-analytic models in R. Further, the multilevel meta-analytic models can be easily extended so that the potential moderating influence of variables can be examined

Do impression management and self-deception distort self-report measures with content of dynamic risk factors in offender samples? A meta-analytic review

Self-report measures provide an important source of information in correctional/forensic settings, yet at the same time the validity of that information is often questioned because self-reports are thought to be highly vulnerable to self-presentation biases. Primary studies in offender samples have provided mixed results with regard to the impact of socially desirable responding on self-reports. The main aim of the current study was therefore to investigate—via a meta-analytic review of published studies—the association between the two dimensions of socially desirable responding, impression management and self-deceptive enhancement, and self-report measures with content of dynamic risk factors using the Balanced Inventory of Desirable Responding (BIDR) in offender samples. These self-report measures were significantly and negatively related with self-deception (r = −0.120, p < 0.001; k = 170 effect sizes) and impression management (r = −0.158, p < 0.001; k = 157 effect sizes), yet there was evidence of publication bias for the impression management effect with the trim and fill method indicating that the relation is probably even smaller (r = −0.07). The magnitude of the effect sizes was small. Moderation analyses suggested that type of dynamic risk factor (e.g., antisocial cognition versus antisocial personality), incentives, and publication year affected the relationship between impression management and self-report measures with content of dynamic risk factors, whereas sample size, setting (e.g., incarcerated, community), and publication year influenced the relation between self-deception and these self-report measures. The results indicate that the use of self-report measures to assess dynamic risk factors in correctional/forensic settings is not inevitably compromised by socially desirable responding, yet caution is warranted for some risk factors (antisocial personality traits), particularly when incentives are at play

A meta-analysis of the association between mental disorders and juvenile recidivism

To investigate the association between mental disorders and recidivism in juveniles, a three-level meta-analysis of 20 manuscripts (17 independent studies, N = 5737 juveniles) was conducted. The study focused on internalizing disorders, externalizing disorders, and comorbid disorders (combinations of an internalizing and externalizing disorder). Small to moderate mean effect sizes were found for externalizing disorders (d = 0.415, p < 0.001) and comorbid disorders (d = 0.366, p < 0.001), and no relation was found between internalizing disorders and recidivism (d = 0.016, p = 0.877). For comorbid disorders, no significant variation was found between studies and between effect sizes within studies. Therefore, moderator analyses were only conducted for studies on internalizing and externalizing disorders. These analyses revealed that type of recidivism (e.g., rearrest, reincarceration), type of delinquency (e.g., overt and covert delinquency), and gender influenced the direction and magnitude of the associations between recidivism and internalizing and externalizing disorders

A meta-analysis of the association between mental disorders and juvenile recidivism

To investigate the association between mental disorders and recidivism in juveniles, a three-level meta-analysis of 20 manuscripts (17 independent studies, N = 5737 juveniles) was conducted. The study focused on internalizing disorders, externalizing disorders, and comorbid disorders (combinations of an internalizing and externalizing disorder). Small to moderate mean effect sizes were found for externalizing disorders (d = 0.415, p < 0.001) and comorbid disorders (d = 0.366, p < 0.001), and no relation was found between internalizing disorders and recidivism (d = 0.016, p = 0.877). For comorbid disorders, no significant variation was found between studies and between effect sizes within studies. Therefore, moderator analyses were only conducted for studies on internalizing and externalizing disorders. These analyses revealed that type of recidivism (e.g., rearrest, reincarceration), type of delinquency (e.g., overt and covert delinquency), and gender influenced the direction and magnitude of the associations between recidivism and internalizing and externalizing disorders