Schema therapy for violent PD offenders: A randomized clinical trial

David P. Bernstein*, Marije Keulen-De Vos, Maartje Clercx, Vivienne De Vogel, Gertruda C.M. Kersten, Marike Lancel, Philip P. Jonkers, Stefan Bogaerts, Mariëtte Slaats, Nick J. Broers, Thomas A.M. Deenen, Arnoud Arntz

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

3 Citations (Scopus)

Abstract

Background 

Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. 

Methods 

We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. 

Results 

Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes - rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms - and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment∗time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment∗time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment∗time: t(1387) = -2.85, p = 0.005). 

Conclusions 

These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Original languageEnglish
Number of pages15
JournalPsychological Medicine
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • aggression
  • Antisocial Personality Disorder
  • forensic
  • personality disorders
  • psychopathy
  • psychotherapy
  • randomized clinical trial
  • recidivism
  • rehabilitation
  • Schema Therapy
  • treatment
  • treatment outcomes
  • violence

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