Effectiveness of brief schema group therapy for borderline personality disorder symptoms: a randomized pilot study

Abstract

Background and objectives

Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242).

Methods

Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions.

Results

Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures.

Limitations

Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes.

Conclusions

Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.

Keywords:

• Schema group therapy
• borderline personality disorder
• randomized clinical trial

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This study was supported by a grant for the first author from Helsinki University Hospital.

Notes on contributors

Hanna-Mari Hilden

Hanna-Mari Hilden, MD, PhD, is Associate Chief Physician in Helsinki University Hospital, Psychiatry, Mood Disorders Department. Her research mainly focuses on medical ethics and social medicine. She has piloted the first schema therapy groups in Finland in 2017.

Tom Rosenström

Tom Rosenström, PhD (psychology), MSc (applied mathematics), docent, LP, is an Academy of Finland Research Fellow at the Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland. He has worked on academic questions of mental health research for more than 10 years.

Irma Karila

Irma Karila, LP, PhD, is a licensed psychotherapist (advanced). Her 40-year career has focused on psychotherapy training and supervision, specialized in the treatment of depression and personality disorders. She has co-authored Guide to Schema therapy and the Handbook of Cognitive psychotherapy (in Finnish).

Aila Elokorpi

Aila Elokorpi, BN, RN, is a psychiatric nurse in Helsinki University Hospital, Psychiatry, Mood Disorders Department. She works mainly with patients with borderline disorder, anxiety disorder, depression and bipolar disorders.

Mirka Torpo

Mirka Torpo, LP, works as a psychologist in Helsinki University Hospital, Psychiatry, Mood Disorders Department. She is a licensed psychotherapist.

Ritva Arajärvi

Ritva Arajärvi, MD, PhD, is Chief Physician in Helsinki University Hospital, Psychiatry, Mood Disorders Department. Her research mainly focuses on schizophrenia. She is a licensed psychotherapist.

Erkki Isometsä

Erkki Isometsä, MD, PhD, is Professor of Psychiatry at the University of Helsinki, Chair of the Finnish Task Force for Current Care Guidelines for Depression, and President of The Finnish Psychiatric Association. His research mainly focuses on clinical epidemiology, risk factors, pathogenesis and treatment of mood disorders and suicidal behaviour.