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Browsing by Author "Malogiannis, Ioannis A."
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Item Correction to: Design of an international multicentre RCT on group schema therapy for borderline personality disorder(BMC, 2022-03-25) Wetzelaer, Pim; Farrell, Joan; Evers, Silvia M.A.A.; Jacob, Gitta A.; Lee, Christopher W.; Brand, Odette; van Breukelen, Gerard; Fassbinder, Eva; Fretwell, Heather; Harper, R. Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A.; Schweiger, Ulrich; Startup, Helen; Stevenson, Teresa; Zarbock, Gerhard; Arntz, Arnoud; Psychology, School of ScienceCorrection to: BMC Psychiatry 14, 319 (2014) https://doi.org/10.1186/s12888-014-0319-3 Following publication of the original article [1], the authors identified errors in the numbers of the below sentences. The updated numbers are given below and the changes have been highlighted in bold typeface. The sentences currently read: In format A (GST-A), two-year GST consists of 124 groups sessions with a duration of 90 minutes. In addition, in GST-A a total of up to 18 individual sessions can be used at the patients discretion or in times of crisis. In total, patients in this condition receive 74 group sessions and 62 individual sessions. The sentences should read: In format A (GST-A), two-year GST consists of 118 groups sessions with a duration of 90 minutes. In addition, in GST-A a total of up to 17 individual sessions can be used at the patients discretion or in times of crisis. In total, patients in this condition receive 63 group sessions and 61 individual sessions. The original article [1] has been corrected.Item Design of an international multicentre RCT on group schema therapy for borderline personality disorder(BioMed Central, 2014-11) Wetzelaer, Pim; Farrell, Joan; Evers, Silvia M. A. A.; Jacob, Gitta A.; Lee, Christopher W.; Brand, Odette; van Breukelen, Gerard; Fassbinder, Eva; Fretwell, Heather; Harper, R. Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A.; Schweiger, Ulrich; Startup, Helen; Stevenson, Teresa; Zarbock, Gerhard; Arntz, Arnoud; Department of Psychology, IU School of ScienceBackground Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. Methods/Design An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients¿ and therapists¿ experiences with GST, and studies on variables that might influence the effectiveness of GST. Discussion This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation and additional investigations, it will contribute to an evidence-based understanding of which treatment should be offered to patients with BPD from clinical, economic, and stakeholders¿ perspectives.Item Effectiveness of Predominantly Group Schema Therapy and Combined Individual and Group Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial(American Medical Association, 2022) Arntz, Arnoud; Jacob, Gitta A.; Lee, Christopher W.; Brand-de Wilde, Odette Manon; Fassbinder, Eva; Harper, R. Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A.; Ruths, Florian A.; Schweiger, Ulrich; Shaw, Ida A.; Zarbock, Gerhard; Farrell, Joan M.; Psychology, School of ScienceImportance: Schema therapy (ST), delivered either in an individual or group format, has been compared with other active treatments for borderline personality disorder (BPD). To our knowledge, the 2 formats have not been compared with treatment as usual (TAU) or with each other. Such comparisons help determine best treatment practices. Objective: To evaluate whether ST is more effectively delivered in a predominantly group or combined individual and group format and whether ST is more effective than optimal TAU for BPD. Design, setting, and participants: In this multicenter, 3-arm randomized clinical trial conducted at 15 sites in 5 countries (Australia, Germany, Greece, the Netherlands, and the UK), outpatients aged 18 to 65 years who had BPD were recruited between June 29, 2010, and May 18, 2016, to receive either predominantly group ST (PGST), combined individual and group ST (IGST), or optimal TAU. Data were analyzed from June 4, 2019, to December 29, 2021. Interventions: At each site, cohorts of 16 to 18 participants were randomized 1:1 to PGST vs TAU or IGST vs TAU. Both ST formats were delivered over 2 years, with 2 sessions per week in year 1 and the frequency gradually decreasing during year 2. Assessments were collected by blinded assessors. Main outcomes and measures: The primary outcome was the change in BPD severity over time, assessed with the Borderline Personality Disorder Severity Index (BPDSI) total score. Treatment retention was analyzed as a secondary outcome using generalized linear mixed model survival analysis. Results: Of 495 participants (mean [SD] age, 33.6 [9.4] years; 426 [86.2%] female), 246 (49.7%) received TAU, 125 (25.2%) received PGST, and 124 (25.0%) received IGST (1 of whom later withdrew consent). PGST and IGST combined were superior to TAU with regard to reduced BPD severity (Cohen d, 0.73; 95% CI, 0.29-1.18; P < .001). For this outcome, IGST was superior to TAU (Cohen d, 1.14; 95% CI, 0.57-1.71; P < .001) and PGST (Cohen d, 0.84; 95% CI, 0.09-1.59; P = .03), whereas PGST did not differ significantly from TAU (Cohen d, 0.30; 95% CI, -0.29 to 0.89; P = .32). Treatment retention was greater in the IGST arm than in the PGST (1 year: 0.82 vs 0.72; 2 years: 0.74 vs. 0.62) and TAU (1 year: 0.82 vs 0.73; 2 years: 0.74 vs 0.64) arms, and there was no significant difference between the TAU and PGST arms (1 year: 0.73 vs 0.72; 2 years: 0.64 vs 0.62). Conclusions and relevance: In this randomized clinical trial, IGST was more effective and had greater treatment retention compared with TAU and PGST. These findings suggest that IGST is the preferred ST format, with high retention and continuation of improvement in BPD severity after the completion of treatment.