Horn et al., 201588. Horn EK, Bartak A, Meerman AMMA, Rossum BV, Ziegler UM, Thunnissen M, et al. Effectiveness of psychotherapy in personality disorders not otherwise specified: a comparison of different treatment modalities. Clin Psychol Psychother. 2015;22(5):426-42.
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The Netherlands; Multicenter quasiexperimental |
PDNOS N = 205 (100% of the sample): - PD mixed only (65%); - Appendix PD only (17%); - PD mixed and appendix PD (18%) Mean age 35.1 (SD = 10.3) years 72% female. |
Short-term (< 6 months) and long-term (> 6 months) outpatient, day hospital and inpatient psychotherapy Psychodynamic (27%), cognitive- behavioural (21%) or integrative orientation (52%) 60 months follow-up. |
Symptom severity; Psychosocial functioning; Quality of life Patients in all treatment modalities showed positive outcomes at short-term and long-term follow-ups, especially in terms of improvements of symptom severity and social role functioning. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior at 12-month followup. At 60-month after baseline, effectiveness remained but observed differences between modalities mostly diminished. |
Not a randomized controlled trial. Difference of loss to follow-up. Did not take into acount other treatment attributes - potential impact of theoretical orientation and medication use, or patient attributes - axis I comorbidity. Effectiveness is determined by self-report, without information if whether patients still meet criteria for a PD diagnosis after 5 years. Sites overlapped only partially in terms of the (equal) availability of the six modalities. |
Horn et al, 20151717. Horn EK, Verheul R, Thunnissen M, Delimon J, Soons M, Meerman AMMA, et al. Effectiveness of short-term inpatient psychotherapy based on transactional analysis with patients with personality disorders: a matched control study using propensity score. J Pers Disord. 2015;29(5):663-83.
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The Netherlands; Matched-control study |
PDNOS N = 61 (42% of the STIP-TA patients and 49% of the OP patients) Mean age 39.4 (SD 9.8) years in STIP-TA patients, and 39.3 (SD 10.2) in OP patients 70% female. |
Short-term (3-month) inpatient Psychotherapy based on transactional analysis (STIPTA) and other psychotherapies (OP) varying widely in terms of setting, duration, and theoretical orientation 36 months follow-up. |
General psychiatric symptomatology; Psychosocial functioning; Quality of life At 36 months, 68% of STIP-TA patients were symptomatically recovered compared to 48% of OP patients. STIP-TA outperformed OP in terms of improvements in general psychiatric symptomatology and quality of life. Superiority of STIP-TA was most pronounced at 12-month followup, but remained intact over the course of the 3-year follow-up. A very promising and effective treatment option in mainly PDNOS patients. |
Not a randomized controlled trial. Only self-report instruments used as outcome measures. Information about the treatment fidelity and adherence was not collected. The interpretation of the results is limited by the variation of treatment modalities in the OP condition. |
Kvarstein et al., 20171818. Kvarstein EH, Nordviste O, Dragland L, Wilberg T. Outpatient psychodynamic group psychotherapy - outcomes related to personality disorder, severity, age and gender. Personal Ment Health. 2017;11(1):37-50.
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Norway; Naturalistic study |
PDNOS N = 18 (17.4% of the sample) Mean age 38.5 (SD 10) years 60% female. |
Outpatient Psychodynamic groups, mean treatment duration 1.5 (SD 0.9) years 3-year follow-up. |
Symptom distress; Interpersonal problems; Occupational functioning; Psychiatric health service use. PDNOS benefits across all outcomes. The most favourable outcomes were found for patients with PDNOS. PDNOS patients may be well managed within outpatient group therapy. |
Naturalistic designs limits inferences on outcome as an effect of the treatment. Dual roles of clinicians and researches may also limit validity of patient reported ratings. Diagnostic procedures held a high standard, but reliability was not investigated. |
Chakhssi et al., 201519 |
The Netherlands; Nonrandomized exploratory study |
PDNOS N = 38 (48.3% of the ACT patients and 42.9% of the CBT- TAU patients) Mean age 32.88 (SD 10.13) years in ACT patients, and 33.26 (SD 9.63) in CBT- TAU patients 82.7% female. |
Specialized day hospital setting for patients with personality disorders that did not respond to previous treatments 26-week group-based acceptance and commitment therapy (ACT). Same duration group-based treatment-as-usual based on cognitive behaviour therapy (CBT-TAU) Both supplemented by arts therapy, including creative and drama therapy, and rehabilitation counselling. |
Change in personality pathology; General psychological functioning; Experimental avoidance; Coping skills; Positive outcomes; Quality of life Group-based interventions for treatment-resistant patients with personality disorders led to significant improvements in personality pathology, general psychological functioning, coping skills and quality of life, regardless of whether participants received ACT or CBT-TAU. In group analysis, no main effect of therapy condition was observed on the outcome measures. Assessment of change on an individual level showed that a significantly higher percentage of participants receiving ACT improved on personality pathology. |
Patients were not randomized. Treatment fidelity was not assessed. The unequal sample size across groups may have affect the results. The patients were not only provided with ACT or CBT-TAU but also with other treatments, and the effect of these treatments on the outcomes remains unknown. Medication use during the study was not measured. No independent data was available on the type and quality of previous outpatient treatment interventions. Do not report results for the PDNOS group separately. |
Schaap et al., 20162020. Schaap GM, Chakhssi F, Westerhof GJ. Inpatient schema therapy for nonresponsive patients with personality pathology: Changes in symptomatic distress, schemas, schema modes, coping styles, experienced parenting styles, and mental well-being. Psychotherapy (Chic). 2016;53(4):402-412.
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The Netherlands; Naturalistic prospective study |
PDNOS N = 24 (42.9% of treatment completers and 26.1% of dropouts) Mean age 26.94 (SD 6.45) years 72.3% female. |
12 months group schema therapy (ST) inpatient for patients with PDs who did not respond to previous psychotherapy Specific ST techniques, psychodrama, art, movement and music therapies, social services, pharmacotherapy, education about medication 6 months follow-up. |
Maladaptive schemas; Schema modes; Maladaptive coping styles; Mental well-being; Psychological distress after treatment Over participants improved significantly on all outcome measures from pretreatment to posttreatment, and these improvements were maintained at follow-up. Experienced parenting styles was the one area that showed no improvement. These findings are comparable with treatment results for patients without such a nonresponsive treatment history. |
Lack of a control-group. Treatment fidelity was not assessed. The patients were not only provided with ST, but also with additional therapies. Diagnosis were based on the clinical judgement and not by structured interviews. The relationship between the YSQ (Young schema questionnaire) and SMI (Short schema mode inventory) was large. Do not report results for the PDNOS group separately. |
Cyranka et al., 201621
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Poland; Naturalistic study |
Mixed features PDs N = 34: - Other PDs (24% of the sample); - Mixed and other PDs (15% of the sample); - PDs unspecified (2% of the sample) Mean age 31.5 (SD 6.9) years 74% female |
10-14 weeks intensive short-term group psychotherapy in a day ward with elements of individual therapy Integrated the elements of psychodynamic, cognitive and behavioural theories |
Personality functioning using MMPI-2 clinical scales. Having undergone the psychotherapy treatment, the majority of the examined were observed to demonstrate positive changes in personality functioning which were classified as severe or moderate pathology. |
Lack of a control-group. Not carrying out a follow-up study. Not extending the analysis with other questionnaire scales. Do not report results for the mixed features PDs group separately. |
Hoglend et al., 201122 |
Norway; Randomized controlled clinical trial |
PDNOS N = 19 (35% of transference group and 49% of comparison group) Mean age 34.9 (SD 8.7) years in transference patients, and 32.7 (SD 9.5) in comparison patients 63% female. |
1 year of dynamic psychotherapy with low to moderate use of transference interpretations (transference group). Dynamic psychotherapy without this component (comparison group). Both with other treatments components such as clarifications, confrontations and extratransference interpretations. |
Remission from personality disorder; Improvement in interpersonal functioning; Use of mental health resources in the 3-year period after treatment termination. After therapy with transference interpretation, PD-patients improved significantly more in core psychopathology and interpersonal functioning, the drop-out rate was reduced to zero, and use of health services was reduced to 50%, compared to therapy without this ingredient. Three years after treatment termination, 73% no longer met diagnostic criteria for any PD in the transference group, compared to 44% in the comparison group. |
Only clinician-rated outcome measures were used. No longer meeting full criteria for any PD may be seen as a problematic measure of recovery, since it also may include patients who just drop one criterion below the cut-off scores for a definite diagnosis. Primary outcome (recovery from PD) was based on non-blind ratings. Do not report results for the PDNOS group separately. |