Schema therapy effectiveness in borderline personality disorder

Studies summarized:

Giesen-Bloo J, van Dyck R, Spinhoven P, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63(6):649-658. doi:10.1001/archpsyc.63.6.649

Nadort M, Arntz A, Smit JH, et al. Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: a randomized trial. Behav Res Ther. 2009;47(11):961-973. doi:10.1016/j.brat.2009.07.013

Objective

This page summarizes two studies of schema therapy for borderline personality disorder (BPD): how it compared with transference-focused psychotherapy (TFP), and how it worked in regular mental health care.

Main part

Schema therapy versus TFP (Giesen-Bloo et al., 2006). In this multicenter trial, 88 people with BPD were randomly assigned to three years of either schema therapy or TFP, with sessions twice a week. (The paper calls it "schema-focused therapy.") Data on 86 of them were analyzed: 44 in schema therapy and 42 in TFP. Both treatments reduced BPD symptoms and improved quality of life. After three years, more people in the schema therapy group had recovered on the Borderline Personality Disorder Severity Index (BPDSI): 45.5% (20 of 44), compared with 23.8% (10 of 42) in the TFP group. Reliable clinical improvement was also more common with schema therapy (65.9% versus 42.9%). The schema therapy group improved more on general psychological symptoms and quality of life as well.

People were more likely to leave TFP than schema therapy. About 27% (12 of 44) of the schema therapy group left treatment, compared with about 52% (22 of 42) of the TFP group. Among those who stayed in treatment, the schema therapy group had fewer sessions (median 189.5 versus 231).

Schema therapy in regular mental health care (Nadort et al., 2009). This study looked at 62 people with BPD treated with schema therapy in regular mental health care, using a somewhat shorter version of the original protocol. After 1.5 years, 42% had recovered from BPD. Having the therapist available by phone outside office hours in a crisis made no added difference.

Conclusion

In the first trial, schema therapy did better than TFP on all measures after three years, and fewer people left treatment. The second study found that schema therapy could be delivered in regular mental health care, with results and drop-out comparable to the earlier trial. Together, they suggest that schema therapy can help people with BPD.

If this brings up something difficult, you don't have to deal with it alone. Talk to your therapist, or open the Crisis tab in the CopingCard app.