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New research into schema therapy for borderline patients

Researchers at Maastricht University have received a subsidy of more than 600,000 euros to study the cost-effectiveness of Group Schema Therapy for Borderline Personality Disorders. In parallel with this study, specific brain responses and brain networks using neuroimaging techniques (fMRI) will be investigated within the same patient population, together with the University of Freiburg.

Previous research has already shown that schema therapy is highly effective, with a significant possibility of full recovery. However given the long duration and intensity of this therapy (three years of twice-weekly sessions), treatment costs are high. Not only is group therapy cheaper than individual schema therapy but it is also more effective, because the group processes catalyze the recovery process. More people can also be treated with this type of therapy.

The study subsidised by ZonMw, will determine cost effectiveness compared to the ’treatment as usual’ (TUA). 192 patients with Borderline Personality Disorder will be divided into three groups and treated in six Dutch centres (RIAGG Maastricht, Mondriaan Zorggroep Heerlen, G-kracht Delft, GGZ Oost Brabant Helmond, Symfora Hilversum and the Vincent van Gogh Instituut Venray). The project is embedded within an international study in five countries (the Netherlands, Great Britain, the United States and Australia) with a total participation of 448 patients in 14 centres.

Two types of Group Schema Therapy (solely group therapy or group therapy combined with individual sessions) will be compared against a control group receiving the treatment as usual (as there is no single standard therapy for borderline patients in the Netherlands, participating centers decide in their usual manner about the treatment). During and after the treatment, which will last two years, the effect of treatment will be measured (disorder severity, suicidality, social functioning, general psychiatric symptoms and quality of life). Patients and therapists will also be asked to share their experiences in in-depth interviews and focus groups.

In parallel with this study, Maastricht University and the University of Freiburg will also be launching a research project within the same patient population, investigating specific brain responses and brain networks at start, halfway and end of treatment, using neuroimaging techniques (fMRI). This study will be conducted using a European 'Open Research Area' subsidy. Borderline Personality Disorder is characterized by emotional dysregulation and ‘threat bias’ (biased information processing towards threat-signs). This study will investigate how the emotional and impulsive brain response and information processing in the brain during ‘threat bias’ changes during the treatment, compared to psychopathology controls and nonpatients.

Borderline Personality Disorder occurs among between 1 and 2.5% of the population. Characteristics are chronic instability, emotional dysregulation, self-injury, impulsive and suicidal behaviour, separation anxiety, major stress sensitivity and identity problems. The medical and societal costs are considerable, particularly because full participation in the employment process is often impossible for these patients.

Caroline Roulaux | idw
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