We have come a long way since the anecdotal finding in the clinical literature that inpatient treatment may be harmful for patients with BPD. In this brief summary, Neele Reiss (lead author of the recent report on three pilot studies testing inpatient schema therapy) tells us about the development, and empirical status, of this exciting mode of delivering schema therapy to patients with BPD.

Neele Reiss

Institute for Psychotherapy in Mainz (ipsti-mz)
Kaiserstr. 18
55116 Mainz
Germany
www.ipsti-mz.de
Contact Neele: EMAIL

Reiss, N., Lieb, K., Arntz, A., Shaw, I. A., & Farrell, J. (2014). Responding to the treatment challenge of patients with severe BPD: results of three pilot studies of inpatient schema therapy. Behavioural and cognitive psychotherapy,42(03), 355-367.

Schema Therapy can be delivered in an individual or group format and both formats have demonstrated effectiveness in treating Borderline Personality Disorder (BPD) in the outpatient setting. However, the most severely impaired BPD patients are often referred to inpatient treatment due to suicidality and severe self-harm. Few specialized inpatient Schema Therapy treatment programs, combining elements of individual and group Schema Therapy, exist, and these need to be evaluated to determine their effectiveness.

As a first step in examining the effectiveness of new treatment programs in these naturalistic clinical settings, three independent uncontrolled pilot studies of intensive inpatient ST treatment programs (each with 9.5 hours of Schema Therapy per week) with a total of 92 BPD patients were conducted. We found that inpatient ST can significantly reduce symptoms of severe BPD and global severity of psychopathology.

Interestingly, the amount of symptom reduction achieved differed significantly between the three pilot studies. This could be explained by variations in length of treatment (ranging from an average of 10 weeks to 18 weeks), number of group psychotherapists (1 vs 2 group therapists) and their training (experts vs beginners). Although there are limitations to our pilot studies such as differences in the samples, treatment settings, variations in the treatment itself and the use of different measures, which may have influenced outcome, they are a starting point for describing and evaluating inpatient treatment for BPD in naturalistic settings.

What could this mean? If you are treating severely impaired BPD patients, who suffer from symptoms that make outpatient treatment dangerous to you as a therapist or your patient, referring your patient to an intensive inpatient Schema Therapy treatment program is an option to consider. However, it looks like several factors influence how effective the inpatient ST program would be for your patient, so watch out for the dosage of therapy your patient is getting (how many hours per week for how long?) and how the group schema therapy component is administered (how many therapists in the group, training of therapists).

Neele Reiss

For further reading, please see:

Peer-reviewed papers

1.    Reiss, N. & Jacob, G. A. (2010). Schematherapie bei Borderline Persönlichkeitsstörung (Schema Therapy for Borderline Personality Disorder). URL: http://www.afp-info.de/N-Reiss-und-G-A-Jacob-2010.219.0.html (07.05.2010).

2.    Reiss, N., Mobascher, A. & Lieb, K. (2011). Schematherapie in Gruppen für Patienten mit Borderline Persönlichkeitsstörung (Schema Therapy in group for patients with Borderline Personality Disorder). Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 59 (3), 187-194. doi: 10.1024/1661-4747/a000070

3.    Reiss, N., Dominiak, P., Harris, D., Knörnschild, C., Schouten, E., Jacob, G.A. (2012). Reliability and Validity of the German Version of the revised Schema Mode Inventory (SMI). European Journal of Psychological Assessment, 4, 297-304. doi: 10.1027/1015-5759/a000110

4.    Reiss, N., Lieb, K., Arntz, A., Shaw, I.A., Farrell, J. (2014). Responding to the treatment challenge of patients with severe BPD: results of three pilot studies of inpatient schema therapy. Behavioural and Cognitive Psychotherapy, 42, 355–367. doi:10.1017/S1352465813000027

5.    Reiss, N., Vogel, F., Nill, M., Graf-Morgenstern, M., Finkelmeier, B. & Lieb, K. (2013). Behandlungszufriedenheit von Patientinnen mit Borderline Persönlichkeitsstörung bei stationärer Schematherapie (Treatment satisfaction of patients with Borderline Personality Disorder in inpatient Schema Therapy. Psychotherapie - Psychosomatik - Medizinische Psychologie, 63, 93-100.

Book Chapters and Books

1.    Reiss, N. & Vogel, F. (2010). Stationäre Schematherapie bei Borderline-Persönlichkeitsstörung (inpatient Schema Therapy for Borderline Personality Disorder). In E. Roediger & G. Jacob (Eds.), Fortschritte der Schematherapie. Konzepte und Anwendungen (New Developments in Schema Therapy. Concepts and Applications), pp. 217-226. Göttingen: Hogrefe.

2.    Farrell, J., Shaw, I. & Reiss, N. (2012). Schema Therapy Groups for Borderline Personality Disorder Patients: the Best of Both Worlds of Group Psychotherapy. In M. Van Vreeswick, J. Broersen M. & Nadort (Eds.), Handbook of Schematherapy: Theory, Research and Practice, pp. 341-358.  NY: Wiley-Blackwell.

3.    Reiss, N., Jacob, G. & Farrell, J. (2012). Inpatient Schema Therapy for Patients with Borderline Personality Disorder - a case study. In M. Van Vreeswick, J. Broersen M. & Nadort (Eds.), Handbook of Schematherapy: Theory, Research and Practice, pp. 301-310. NY: Wiley-Blackwell.

4.    Farrell, J.M., Fretwell, H. & Reiss, N. (2012). Group Schema Therapy. In N. Seel (Ed.), Encyclopedia of Learning Sciences, pp.1395-1399. Berlin: Springer.

5.    Farrell, J.M., Fretwell, H. & Reiss, N. (2012). Schema Therapy. In N. Seel (Ed.) Encyclopedia of Learning Sciences, pp. 2939-2949. Berlin: Springer.

6.    Reiss, N., Arntz, A. & Young, J. (2012). Conclusions and Future Directions for Group Schema Therapy.  In J.M. Farrell & I.A. Shaw (Eds.), Group Schema Therapy for Borderline Personality Disorder: A Step-by-Step Treatment Manual With Patient Workbook, pp 295-301. NY: Wiley-Blackwell.

7.    Reiss, N. (2013). Die denken doch alle, dass ich gestört bin – Soziale Phobie (They all think I am crazy – social phobia). In L. Seebauer & G. Jacob (Eds.), Fallbuch Schematherapie (casebook Schema Therapy), pp 68-74. Weinheim: Beltz.

8.    Jacob, G. & Reiss, N. (2013). Gewalt und Drogen als einzige Überlebensstrategien – schwere Cluster B-Persönlichkeitsstörung (Violence and drugs as survival strategies – a severe Cluster B- Personality Disorder). In L. Seebauer & G. Jacob (Eds.), Fallbuch Schematherapie (casebook Schema Therapy), pp 68-74. Weinheim: Beltz.

9.    Reiss, N. (2013). Rückzug ins Gewächshaus – Ängstlich-vermeidende Persönlichkeitsstörung (Withdrawal to the greenhouse – avoidant personality disorder). In L. Seebauer & G. Jacob (Eds.), Fallbuch Schematherapie (cassebook Schema Therapy), pp 213-218. Weinheim: Beltz.

10.  Reiss, N. & Rohrmann, S. (2014). Schema Therapy – an innovative emotion-focused psychotherapy model. In C. Mohiyeddini (Ed.), Health Behaviour, NY: Nova Science Publishers.

11.  Reiss, N., Farrell, J.M. & Shaw, I.A. (2014). The Schema Therapy Clinican’s Guide. NY: Wiley-Blackwell.

12.  Reiss, N. & Vogel, F. (2014). Empathische Konfrontation in der Schematherapie (Empathic confrontation in Schema Therapy). Weinheim: Beltz.