TY - JOUR
T1 - Schema therapy for violent PD offenders
T2 - A randomized clinical trial
AU - Bernstein, David P.
AU - Keulen-De Vos, Marije
AU - Clercx, Maartje
AU - De Vogel, Vivienne
AU - Kersten, Gertruda C.M.
AU - Lancel, Marike
AU - Jonkers, Philip P.
AU - Bogaerts, Stefan
AU - Slaats, Mariëtte
AU - Broers, Nick J.
AU - Deenen, Thomas A.M.
AU - Arntz, Arnoud
N1 - We gratefully acknowledge the financial and other support of the Expertise Center for Forensic Psychiatry (EFP) and grant support (D. Bernstein, Principal Investigator) from the Netherlands Ministry of Security and Justice, the ‘Scientific Research and Documentation Center’ ‘Wetenschappelijk Onderzoek en Documentatiecentrum’; WODC), and Maastricht University’s Faculty of Psychology and Neuroscience.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Antisocial Personality Disorder
KW - BEHAVIOR
KW - METAANALYSIS
KW - PERSONALITY-DISORDER
KW - PREDICTIVE-VALIDITY
KW - PSYCHOPATHY
KW - RECIDIVISM
KW - RISK-ASSESSMENT SCHEME
KW - Schema Therapy
KW - aggression
KW - forensic
KW - personality disorders
KW - psychopathy
KW - psychotherapy
KW - randomized clinical trial
KW - recidivism
KW - rehabilitation
KW - treatment
KW - treatment outcomes
KW - violence
UR - http://www.scopus.com/inward/record.url?scp=85108063707&partnerID=8YFLogxK
U2 - 10.1017/S0033291721001161
DO - 10.1017/S0033291721001161
M3 - Article
C2 - 34127158
AN - SCOPUS:85108063707
VL - 53
SP - 88
EP - 102
JO - Psychological Medicine
JF - Psychological Medicine
SN - 0033-2917
IS - 1
ER -