1. Schema therapy for violent PD offenders: a randomized clinical trial
- Author
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Gertruda C.M. Kersten, Marije Keulen-de Vos, David P. Bernstein, Arnoud Arntz, Philip P. Jonkers, Marike Lancel, Stefan Bogaerts, Maartje Clercx, Vivienne de Vogel, Thomas A M Deenen, Mariëtte Slaats, Nick J. Broers, RS: FPN CPS III, Section Clinical Psychology, FPN Methodologie & Statistiek, RS: FPN M&S I, Developmental Psychology, and Clinical Psychology and Experimental Psychopathology
- Subjects
050103 clinical psychology ,medicine.medical_specialty ,medicine.medical_treatment ,Psychopathy ,RISK-ASSESSMENT SCHEME ,Learning and Plasticity ,treatment outcomes ,PREDICTIVE-VALIDITY ,psychopathy ,rehabilitation ,law.invention ,Experimental Psychopathology and Treatment ,violence ,Randomized controlled trial ,law ,medicine ,personality disorders ,0501 psychology and cognitive sciences ,Psychiatry ,METAANALYSIS ,Applied Psychology ,Schema Therapy ,0505 law ,Schema therapy ,recidivism ,Rehabilitation ,treatment ,Recidivism ,business.industry ,Aggression ,Antisocial personality disorder ,aggression ,05 social sciences ,Antisocial Personality Disorder ,forensic ,randomized clinical trial ,medicine.disease ,Personality disorders ,PERSONALITY-DISORDER ,psychotherapy ,Psychiatry and Mental health ,050501 criminology ,medicine.symptom ,business ,BEHAVIOR - Abstract
BackgroundViolent 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.MethodsWe 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.ResultsPatients 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).ConclusionsThese 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.
- Published
- 2021