Abstract
Schema Therapy has shown promising results for personality disorders but there is a limited evidence base for group schema therapy (ST-g) with mixed personality disorders. The aim of this study was to explore the feasibility, acceptability, and preliminary effectiveness of ST-g in a sample of eight participants with mixed personality disorders (with a predominant diagnosis of avoidant personality disorder) and high levels of comorbidity. Treatment was comprised of 20 sessions which included cognitive, behavioral, and experiential techniques. Specific schema-based strategies were chosen for a diagnostically mixed group of personality disorder clients. Six participants attended until end of treatment and two dropped-out before mid-treatment. All outcome measures showed changes with large effect sizes in avoidant personality disorder symptom severity, depression and anxiety levels between pre-therapy and follow-up. Four participants achieved a loss of personality disorder diagnosis at the end of therapy. By follow-up, five participants had achieved a loss of diagnosis, suggesting that participants derived ongoing benefits from the group even after treatment ended. Six participants no longer met criteria for depression at the end of treatment and this was maintained for all participants at 6-month follow-up. At follow-up, the majority of participants showed clinically significant change on the Global Symptom Index (GSI). For the Schema Mode Inventory (SMI) maladaptive modes, the majority of participants showed improvement at follow-up. At follow-up, 40% of participants showed clinically significant change on the SMI adaptive modes. Qualitative feedback indicates that the group helps to normalize participants' psychological experiences and difficulties and promotes self-expression and self-disclosure, while reducing inhibition. Preliminary results suggest that short-term ST-g may benefit those with mixed personality disorders, but generalizability is limited by the small sample size and lack of control group.
Highlights
Personality disorders are highly prevalent in clinical settings
The first participant dropped out of the group at session three. Feedback provided by this participant suggested that this was due to high levels of shame related to returning to the group after missing a session, and difficulty tolerating the distress associated with working on schemas and maladaptive coping strategies whilst moving house and working full-time
The participant indicated that this was due to strong feelings of guilt associated with having missed multiple group sessions which triggered a sense of shame and self-criticism for “not putting in enough effort.”
Summary
Personality disorders are highly prevalent in clinical settings. One-third of clients in outpatient clinical settings are diagnosed with a personality disorder (Zimmerman et al, 2005). The majority of individuals diagnosed with a personality disorder meet criteria for more than one. Borderline, and obsessive-compulsive personality disorders are among the most frequently specified diagnoses (Zimmerman et al, 2005). Personality disorders are notoriously difficult to treat and often require long-term treatment with psychotherapy (National Institute of Clinical Excellence, 2009). One psychotherapy that shows promise for effectively treating a range of personality disorders is Schema Therapy
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