Psychological symptoms, early maladaptive schemas and schema modes: predictors of the outcome of group schema therapy in patients with personality disorders

Abstract

Objective: This naturalistic study examined the outcomes of group schema therapy for patients with personality disorders (PD) and the effect of psychological symptoms, early maladaptive schemas (EMS) and schema modes on outcome.

Method: Assessments were made of 194 patients at baseline, during treatment, at treatment termination and at three-month follow-up. We used the Symptom Checklist-General Severity Index (SCL-GSI) to measure the remission-rate of global psychological distress and as a dependent variable in a multilevel model to conduct univariate and multiple variate analyses.

Results: The research sample achieved medium symptom reduction (pre–post d = 0.65, 95% CI [0.39–0.91]) and the remission rate was about 30% after 60 sessions. These results remained stable at three-month follow-up (pre-follow-up d = 0.61, 95% CI [0.29–0.94]; 28.9%). Higher baseline scores on the SCL scale interpersonal sensitivity, the EMS defectiveness/shame and all the maladaptive schema modes together predicted improvements in global psychological distress after treatment.

Conclusions: A long-term form of group schema therapy proved effective for a broad group of patients with PD. Internalizing symptoms seems predictive for improvement at outcome. Almost a third of the patients achieved remission. There is therefore room for improvement, possibly by increasing dose or intensity in combination with individual sessions.

Keywords:

• personality disorders
• prediction
• outcome research
• group psychotherapy
• long-term psychotherapy

Notes

1 The clinical assessment procedure included at least two interviews, the first to make a general evaluation of the patient’s psychopathology, the “clinical anamnesis”, and the second to establish a semi-structured biographical interview (i.e., covering standardised topics such as family, education and interpersonal history etc).

2 A strategy in which the patient and therapist decide on the patient’s treatment plan in consultation (Elwyn et al., 2017).