Schema Therapy for Forensic Patients with Personality Disorders: Design and Preliminary Findings of a Multicenter Randomized Clinical Trial in the Netherlands

Abstract

According to Dutch Law, patients committing severe crimes justifying imprisonment of four years or more who cannot be held (fully) accountable for these acts can be sentenced to compulsory hospitalization in a specialized TBS hospital in the Netherlands. In the current paper, the effects of TBS treatment will be addressed in terms of recidivism numbers after termination of TBS treatment, as well as in behavioral changes that are observed during admission to TBS hospitals. Although these results offer some indirect support suggesting that TBS is effective, no randomized controlled trials had been conducted up until now that could confirm this. In the current study, preliminary results are reported from a multicenter randomized clinical trial on the effectiveness of Schema Therapy (ST) for hospitalized TBS patients with Antisocial, Borderline, Narcissistic, or Paranoid Personality Disorders, including those with high levels of psychopathy. Patients at seven TBS clinics were randomly assigned to receive three years of either ST or Treatment As Usual (TAU), and are being assessed on several outcome variables, such as recidivism risk (HCR-20, START), personality disorder symptoms (SIDP-IV, SNAP), and successful re-integration into the community. A three-year follow-up study will examine actual recidivism. One hundred and two patients are participating in the study. The preliminary findings from the first 30 patients to complete the three-year study suggest that ST is yielding better outcomes than TAU with regard to reducing recidivism risk and promoting re-entry into the community. These findings are not yet statistically significant, and thus need to be interpreted with caution until confirmed in our complete sample and follow up. However, they suggest that ST may be a promising treatment for offenders with personality disorders, including some psychopathic ones.

Acknowledgments

The authors would like to express their appreciation to the management, staff, therapists, and patients at the seven forensic hospitals that are participating in this research: de Rooyse Wissel (Venray and Maastricht), van der Hoeven (Utrecht), Oostvaarders (Almere), Mesdag (Groningen), Veldzicht (Balkbrug), Assen (Assen), and Kijvelanden (Portugaal). This project is supported financially by the Netherlands Ministry of Justice, the Expertise Center for Forensic Psychiatry, Maastricht University's Faculty of Psychology and Neuroscience, and the participating forensic hospitals. We gratefully acknowledge their support. We thank present and former project coodinators, Lieke Bouts and Annette Löbbes, database manager, Lotte de Geus, and research assistants, Marije Keulen-de Vos, Kai Karos, Silke Vanstipelen, Eva de Spa, Ellen de Jonge, Merel van Vliet, Antoine Sint Fiet, Mariët Slaats, Thijs Kanters, and Marloes Hartkoorn, for their help with data collection. Thanks also to Gerard van Breukelen for his statistical consultation.