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Group Schema Therapy for Cluster-C Personality Disorders

Projectomschrijving

Schematherapie

Cluster C-persoonlijkheidsstoornissen (Cl-C PS) vormen een grote groep ggz-cliënten (20%). Er is echter erg weinig onderzoek gedaan naar Cluster C-behandelingen. Er is bekend dat individuele schematherapie (ST) kosteneffectief is. Omdat groepsbehandeling efficiënter lijkt, wordt er veel groeps-ST (GST) gegeven. Of dit werkelijk goedkoper en minstens zo effectief is, is onbekend. Het is ook onbekend of GST geschikt is voor alle cliënten. Wellicht dat introverte cliënten, of cliënten met veel traumatische ervaringen, meer baat hebben bij individuele ST.

Doel

In deze studie wordt daarom bij 378 cliënten met Cl-C PS de effectiviteit en de kosten van GST vergeleken met die van individuele ST en gebruikelijke behandeling. Ook wordt onderzocht wie bij welke behandeling het meeste baat zal hebben. In een kwalitatieve studie worden de ervaringen van cliënten bevraagd om na te gaan wat hen heeft geholpen te herstellen en een waardevol leven te leiden. Ervaringsdeskundigen zijn betrokken als lid van de study board .

Producten

Titel: Group schema therapy for cluster-C personality disorders: results of a multicenter open pilot study
Auteur: Anne-Sophie Venhuizen
Link: https://eabct2022.org/images/EABCTProgramme5-9.pdf
Titel: Webinar ‘Herkennen en omgaan met Cluster-C Persoonlijkheidsstoornissen voor POH-GGZ’
Auteur: Anne-Sophie Venhuizen, Iuno Groot, Joska van Houten, Brian de Lint
Link: https://www.quest-clc.socsci.uva.nl/nieuws/
Titel: QUEST-CLC: QUalitative & Effectiveness study to Select optimal Treatment – for CLuster-C personality disorders
Auteur: Iuno Groot & Anne-Sophie Venhuizen
Link: https://www.quest-clc.socsci.uva.nl/
Titel: Design of an RCT on cost-effectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder: the QUEST-CLC study protocol
Auteur: Groot, I. Z., Venhuizen, A. S. S., Bachrach, N., Walhout, S., de Moor, B., Nikkels, K., ... & Arntz, A.
Magazine: BMC Psychiatry
Link: https://link.springer.com/article/10.1186/s12888-022-04248-9

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Samenvatting van de aanvraag

BACKGROUND Given the high prevalence of Cluster-C Personality Disorders (Cl-C PDs) in clinical populations (>20%), disease burden, societal costs (48000–79000 € per year per person) and the consequences for the prognosis of comorbid mental disorders, a major efficiency gain in health care can be achieved if Cl-C PDs are recognized and treated in time[1,2]. Cost-effectiveness research of their treatment is scarce. The only controlled cost-effectiveness study published so far found Individual Schema Therapy (IST) superior to Treatment as Usual (TAU)[1]. Group treatment is an attractive solution for improving quality and efficiency of health care as larger numbers can be treated in (>50%) less time compared to individual therapy. Group schema therapy (GST) is delivered in a protocolled manner, which facilitates training and implementation, making GST easily accessible for large patients groups. GST might deliver a cost-effective solution for unnecessary long treatments and chronicity of Cl-C PDs. However, up to date there is no RCT supporting its (cost-)effectiveness. Costs other than related to direct application are unknown. Documenting the (cost-)effectiveness of GST is therefore an urgent issue. Moreover, it is unlikely that GST fits all – some might do better with IST, for instance clients with specific diversity characteristics, introverted, sleep disordered or highly traumatized clients. AIMS The overall aim of the project is to assess the evidence for GST for Cl-C PDs and to improve treatment allocation for individual clients. Three main questions are addressed: 1. Is GST for Cl-C PDs (cost-)effective compared to TAU? 2. How does GST compare to IST as treatment for Cl-C PDs in (cost-)effectiveness? 3. What client-characteristics predict better response to GST, IST, or TAU? In addition, we aim to improve our understanding of what is essential in treatment to further ameliorate treatment protocols and meet clients’ needs better. METHOD In a multicenter Randomized Controlled Trial (RCT) GST, IST and TAU are compared in 378 Cl-C PD clients in effectiveness and cost-effectiveness. Ten sites are planned to participate. GST and IST are based on protocols and completed within 1 year. TAU is the optimal treatment available at the site for the particular patient according to regular procedures, ST excluded. GST is based on a protocol that has been piloted in N=140 clients of 6 sites, and found to have high treatment retention and a large pre-post effect size. In collaboration with experience experts, the protocol has been further improved. Severity of the primary Cl-C PD is the primary outcome, assessed with clinical interviews by independent raters blind for treatment. Functioning (including social & societal) and wellbeing are important secondary outcomes. For the economic evaluation, a societal perspective is used. Assessments take place at week 0 (baseline), week 17 (mid GST), week 34 (post GST), week 51 (post booster sessions of GST), and 2 years (FU). The 2-year follow-up is important as assessment of long-term effects is essential to study whether effects are maintained or lost, or further increase. This follow-up is also important for the cost-effectiveness, as it will clarify what the (societal and health-care) costs are after treatment. Client characteristics predicting better response to a specific treatment are studied, e.g. childhood trauma, autistic features, and introversion. A tool supporting clients and clinicians in matching treatment to client will be developed. A qualitative study explores experiences of participants: what is helpful for recovery and creating a fulfilling life; how can treatments be improved. EXPECTED RESULTS Superiority of GST vs TAU is expected given a study in which IST for Cl-C was superior to TAU in effectiveness[3] and cost-effectiveness[1], and GST for Borderline PD was superior to TAU[4]. The effects of a recent pilot study further support this expectation. However, we also expect that for some clients GST is suboptimal. Therefore we will create a tool that informs client and clinician which treatment is presumed to be optimal (personalized care). Results will be disseminated by publications, presentations and trainings. If GST is found to be (cost-)effective for many patients, supply of effective treatment can be easily increased. The allocation tool will help to improve treatment outcomes and efficiency. Results of the qualitative study will help to improve the studied treatments. REFERENCES [1] Bamelis LLM et al. Economic evaluation of ST and COP for personality disorders. J CLIN PSYCHIAT 2015; 76:1432-40 [2] Hutsebaut J et al. Time for cluster C personality disorders: state of the art. TIJDSCHR PSYCHIAT 2018; 60:306-14 [3] Bamelis LLM et al. Results of a multicentered RCT of the clinical effectiveness of ST for personality disorders. AM J PSYCHIAT 2014; 171:305–22. [4] Arntz A. Group Schema Therapy for Borderline PD. Report to ZONMW. University of Amsterdam 2017

Onderwerpen

Kenmerken

Projectnummer:
636310019
Looptijd: 65%
Looptijd: 65 %
2020
2025
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
prof. dr. A.R. Arntz PhD
Verantwoordelijke organisatie:
Universiteit van Amsterdam