Abstract
BackgroundImpairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorderMethodsThis is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress.DiscussionPEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users.Trial RegistrationInternational Standard Randomised Controlled Trial Number - ISRCTN70660936
Highlights
Impairment in social functioning is a key component of personality disorder
If a relatively brief and effective treatment can be offered to a broad spectrum of people with Personality disorder (PD) dwelling in the community, this will have the potential to improve the lives of people with PD, improve access to services, and reduce health and non-health service costs
Using the Social Problem Solving Inventory-Revised (SPSI-R) [13], we have found that people with PD, both community adults presenting for treatment and detained offenders with PD, report greater impairment on all SPSI-R scales compared to a sample of mature students [9]
Summary
Psychoeducation and problem solving (PEPS) therapy may benefit people with this disorder. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. A definitive evaluation is being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorder. People with PD place considerable demands upon a range of services, including emergency departments, social services, and the criminal justice system. For those who enter outpatient specialist mental health services, treatment costs are around £135 per treatment session [3], and treatment for people with PD is often of long duration. If a relatively brief and effective treatment can be offered to a broad spectrum of people with PD dwelling in the community, this will have the potential to improve the lives of people with PD, improve access to services, and reduce health and non-health service costs
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