Reiss Neele, Lieb Klaus, Arntz Arnoud, Shaw Ida A, Farrell Joan
University Medical Center Mainz, Germany.
Maastricht University, The Netherlands.
Behav Cogn Psychother. 2014 May;42(3):355-67. doi: 10.1017/S1352465813000027. Epub 2013 Mar 5.
Schema Therapy (ST), a psychotherapy model integrating cognitive, experiential and behavioural interventions, was initially developed and evaluated as an outpatient treatment for patients with severe and chronic disorders, among them Borderline Personality Disorder (BPD). Two randomized controlled trials have demonstrated the effectiveness of ST for BPD, delivered in an individual or group format, in the outpatient setting. However, the most severely impaired BPD patients are referred to inpatient treatment due to suicidality and severe self-harm. Specialized inpatient treatment programs are limited, with little evaluative research.
The pilot studies are designed to be first steps in naturalistic clinical settings to evaluate the effects of an intensive inpatient ST treatment program.
This report presents the results of three independent uncontrolled pilot studies with a total of 92 BPD patients. The programs combine individual and group modalities and are consistent theoretically with the ST model for BPD patients.
RESULTS show that inpatient ST can significantly reduce symptoms of severe BPD and global severity of psychopathology with effect sizes ranging from Cohen's d = 2.84 to Cohen's d = .43.
Differences in the effect sizes across the three pilot studies could be explained by length of treatment, number of group psychotherapists and their training. Although there are limitations to the presented pilot studies such as differences in the samples, treatment settings, variations in the treatment itself and the use of different measures, which may have influenced outcome, they are a starting point for describing and evaluating inpatient treatment for BPD in naturalistic settings.
图式疗法（ST）是一种整合了认知、体验和行为干预的心理治疗模式，最初是作为针对严重慢性疾病患者（包括边缘型人格障碍（BPD）患者）的门诊治疗方法而开发和评估的。两项随机对照试验已证明，在门诊环境中，以个体或团体形式提供的ST对BPD有效。然而，由于存在自杀倾向和严重的自我伤害行为，最严重受损的BPD患者会被转诊至住院治疗。专门的住院治疗项目有限，且评估研究较少。
这些试点研究旨在自然主义临床环境中迈出第一步，以评估强化住院ST治疗项目的效果。
本报告呈现了三项独立的非对照试点研究的结果，共有92名BPD患者参与。这些项目结合了个体和团体治疗方式，在理论上与针对BPD患者的ST模型一致。
结果显示，住院ST可显著减轻严重BPD的症状和精神病理学的整体严重程度，效应大小范围从科恩d值 = 2.84至科恩d值 = 0.43。
三项试点研究中效应大小的差异可通过治疗时长、团体心理治疗师的数量及其培训来解释。尽管所呈现的试点研究存在局限性，如样本差异、治疗环境、治疗本身的变化以及使用不同的测量方法，这些可能影响了结果，但它们是在自然主义环境中描述和评估BPD住院治疗的起点。
