Am J Psychiatry. 2014 Mar;171(3):305-22. doi: 10.1176/appi.ajp.2013.12040518.
The authors compared the effectiveness of 50 sessions of schema therapy with clarification-oriented psychotherapy and with treatment as usual among patients with cluster C, paranoid, histrionic, or narcissistic personality disorder.
A multicenter randomized controlled trial, with a single-blind parallel design, was conducted between 2006 and 2011 in 12 Dutch mental health institutes. A total of 323 patients with personality disorders were randomly assigned (schema therapy, N=147; treatment as usual, N=135; clarification-oriented psychotherapy, N=41). There were two cohorts of schema therapy therapists, with the first trained primarily with lectures and the second primarily with exercises. The primary outcome was recovery from personality disorder 3 years after treatment started (assessed by blinded interviewers). Secondary outcomes were dropout rates and measures of personality disorder traits, depressive and anxiety disorders, general psychological complaints, general and social functioning, self-ideal discrepancy, and quality of life.
A significantly greater proportion of patients recovered in schema therapy compared with treatment as usual and clarification-oriented psychotherapy. Second-cohort schema therapists had better results than first-cohort therapists. Clarification-oriented psychotherapy and treatment as usual did not differ. Findings did not vary with specific personality disorder diagnosis. Dropout was lower in the schema therapy and clarification-oriented psychotherapy conditions. All treatments showed improvements on secondary outcomes. Schema therapy patients had less depressive disorder and higher general and social functioning at follow-up. While interview-based measures demonstrated significant differences between treatments, differences were not found with self-report measures.
Schema therapy was superior to treatment as usual on recovery, other interview-based outcomes, and dropout. Exercise-based schema therapy training was superior to lecture-based training.
作者比较了 50 次图式治疗、澄清导向心理治疗和常规治疗对 C 群、偏执型、表演型或自恋型人格障碍患者的疗效。
一项多中心随机对照试验，采用单盲平行设计，于 2006 年至 2011 年在 12 家荷兰精神卫生机构进行。共有 323 名人格障碍患者被随机分配（图式治疗组，n=147；常规治疗组，n=135；澄清导向心理治疗组，n=41）。图式治疗师有两批，第一批主要通过讲座培训，第二批主要通过练习培训。主要结局是治疗开始 3 年后人格障碍的恢复情况（由盲法评估者评估）。次要结局是脱落率和人格障碍特征、抑郁和焦虑障碍、一般心理困扰、一般和社会功能、自我理想差距以及生活质量的测量。
与常规治疗和澄清导向心理治疗相比，图式治疗组有更多的患者恢复。第二批图式治疗师的结果优于第一批治疗师。澄清导向心理治疗和常规治疗没有差异。研究结果不因特定人格障碍诊断而有所不同。图式治疗和澄清导向心理治疗组的脱落率较低。所有治疗方法在次要结局上都有所改善。图式治疗组患者在随访时抑郁障碍较少，一般和社会功能较高。虽然基于访谈的测量方法显示治疗之间存在显著差异，但自我报告测量方法未发现差异。
图式治疗在恢复、其他基于访谈的结局和脱落方面优于常规治疗。基于练习的图式治疗培训优于基于讲座的培训。
