Schema therapy for borderline personality disorder: A comprehensive review of its empirical foundations, effectiveness and implementation possibilities

Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences.
Highlights
► Offers both theoretical description and empirical review of the schema model for BPD.
► Evidence exists for a number of schema constructs and mechanisms.
► The extant efficacy studies show positive outcomes of schema therapy for BPD.
► Schema therapy seems a societal cost-effective approach.
► Further work is required to achieve full empirical support of the model and therapy.
Keywords: Borderline personality disorder, Schema therapy, Young's schema model, Early maladaptive schema, Schema mode, Effectiveness