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Schema therapy for violent PD offenders: A randomized clinical trial
Bernstein,David P. Keulen-De Vos,Marije Clercx,Maartje De Vogel,Vivienne Kersten,Gertruda C.M. Lancel,Marike Jonkers,Philip P. Bogaerts,Stefan Slaats,Mariëtte Broers,Nick J.
Bernstein,David P.
Keulen-De Vos,Marije
Clercx,Maartje
De Vogel,Vivienne
Kersten,Gertruda C.M.
Lancel,Marike
Jonkers,Philip P.
Bogaerts,Stefan
Slaats,Mariëtte
Broers,Nick J.
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.
Description
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.
Date
2023
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Research Projects
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Keywords
Antisocial Personality Disorder, BEHAVIOR, METAANALYSIS, PERSONALITY-DISORDER, PREDICTIVE-VALIDITY, PSYCHOPATHY, RECIDIVISM, RISK-ASSESSMENT SCHEME, Schema Therapy, aggression, forensic, personality disorders, psychopathy, psychotherapy, randomized clinical trial, recidivism, rehabilitation, treatment, treatment outcomes, violence, SDG 16 - Peace, Justice and Strong Institutions
Citation
Bernstein, D P, Keulen-De Vos, M, Clercx, M, De Vogel, V, Kersten, G C M, Lancel, M, Jonkers, P P, Bogaerts, S, Slaats, M, Broers, N J, Deenen, T A M & Arntz, A 2023, 'Schema therapy for violent PD offenders : A randomized clinical trial', Psychological Medicine, vol. 53, no. 1, pp. 88-102. https://doi.org/10.1017/S0033291721001161
License
info:eu-repo/semantics/openAccess