Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy

BMC Psychiatry

Odile M. C. Bremer¹  Michiel Boog²  Carlijn J. M. Wibbelink³  Raoul P. P. P. Grasman³  Arnoud Arntz³  Jan H. Kamphuis³  Roland Sinnaeve⁴  Chrissy James⁵  Linda Kramer⁶  Faye I. Smits⁷  Maria Ploegmakers⁸  Arita Schaling⁹  Annemieke M. Koppeschaar^1,10  Eliane C. P. Dek^1,11  Sevinç Göral Alkan^1,12 

[1] Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, 1093 MB, Amsterdam, the Netherlands;Department of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, 3062 MA, Rotterdam, the Netherlands;Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands;Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands;Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium;Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, 1082 JC, Amsterdam, the Netherlands;GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC, Heerhugowaard, the Netherlands;GGZ Rivierduinen, Sandifortdreef 19, 2333 ZZ, Leiden, the Netherlands;Pro Persona, Siependaallaan 3, 4003 LE, Tiel, the Netherlands;Pro Persona, Willy Brandtlaan 20, 6716 RR, Ede, the Netherlands;PsyQ Amsterdam, Overschiestraat 57, 1062 XD, Amsterdam, the Netherlands;PsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, 3062 MA, Rotterdam, the Netherlands;i-psy Amsterdam, Overschiestraat 61, 1062 XD, Amsterdam, the Netherlands;

关键词: Borderline personality disorder;    Schema therapy;    Dialectical behavior therapy;    Randomized clinical trial;    Treatment selection;    Personalized medicine;    Mechanisms of change;    Mediators;    Effectiveness;   

DOI  :  10.1186/s12888-021-03670-9

来源: Springer

【 摘 要 】

BackgroundSpecialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated.MethodsThe BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being.DiscussionThe current study contributes to the optimization of treatments for BPD patients by extending our knowledge on “Which treatment – DBT or ST – works the best for which BPD patient, and why?”, which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments).Trial registrationNetherlands Trial Register, NL7699, registered 25/04/2019 - retrospectively registered.

【 授权许可】

CC BY