T beyond the effects of TAU, which may be attributed to the fact that 40 of patients failed to attend a single session (i.e., the intervention consisted of the Zebularine site treatment manual alone). In sum, MACT appears to have clinical utility for individuals with BPD when delivered in conjunction with treatment as usual; however, in mixed-diagnosis samples, its effects may be negligible and treatment retention may be problematic.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptSchema-Focused Therapy (SFT)Critics of traditional CBT have observed that the demands and assumptions of CBT are at odds with the needs of patients with PDs (45). Specifically, CBT’s structured, instructive, problem-focused approach may be ill-suited to patients who present with vague or diffuse problems, cognitive rigidity, poor emotional awareness or an interpersonal style that undermines collaborative relationships (46, 47). Schema-focused therapy (SFT) retains a cognitive theoretical framework, and suggests that PDs result from early maladaptive schemas that interfere with the individual’s ability to meet his or her core needs. The individual develops patterns of avoidance and compensation to avoid triggering the schema, but these patterns become over-generalized and rigid. To modify early maladaptive schemas, SFT employs a broad range of techniques, including behavioral, psychodynamic, experiential and interpersonal strategies. As a result, the treatment is more flexible, elaborative and emotion-focused than traditional cognitive approaches (45). SFT treatments also tend to be longer, ranging from one to four years in duration (48). The first systematic investigation of SFT as a treatment for BPD was published as a series of six case reports (29). Outpatients received SFT based on Young’s (1996) treatment guidelines. They were assessed periodically over the course of 18?6 months of SFT, and again a year after treatment termination. All six patients showed progressive improvements in symptoms of depression, social functioning and global functioning. At follow-up, five had maintained treatment gains and three no longer met diagnostic criteria for BPD at the end of treatment. As a group, the patients remained mildly impaired at follow-up, however, improvements in symptoms, social and overall functioning were equivalent to a large effect size. These findings have been replicated and broadened in two RCTs. Giesen-Bloo and colleagues (50) evaluated outcomes of patients who participated in either SFT (n = 45), or transference-focused psychotherapy (TFP; n = 43), a psychodynamic intervention. Patients received biweekly individual psychotherapy for up to three years. T0901317MedChemExpress T0901317 Relative to those in TFP, patients in SFT showed greater improvement across BPD symptom domains, including abandonment fears, relationships, identity disturbance, dissociation and paranoia, impulsivity and parasuicidal behavior. A symptomatic behavior composite, consisting of measures of general symptoms, defense style, PD-related beliefs, favored SFT over TFP throughout the course of treatment. At treatment termination, the treatment groups did not differ in terms of quality of life, however, patients in SFT made more rapid gains in this domain. Overall, a greater proportion of patients in SFT compared to TFP made clinically significant gains (66 vs. 43 ) and met the BPD recovery criterion (46 vs. 24 ),Psychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewi.T beyond the effects of TAU, which may be attributed to the fact that 40 of patients failed to attend a single session (i.e., the intervention consisted of the treatment manual alone). In sum, MACT appears to have clinical utility for individuals with BPD when delivered in conjunction with treatment as usual; however, in mixed-diagnosis samples, its effects may be negligible and treatment retention may be problematic.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptSchema-Focused Therapy (SFT)Critics of traditional CBT have observed that the demands and assumptions of CBT are at odds with the needs of patients with PDs (45). Specifically, CBT’s structured, instructive, problem-focused approach may be ill-suited to patients who present with vague or diffuse problems, cognitive rigidity, poor emotional awareness or an interpersonal style that undermines collaborative relationships (46, 47). Schema-focused therapy (SFT) retains a cognitive theoretical framework, and suggests that PDs result from early maladaptive schemas that interfere with the individual’s ability to meet his or her core needs. The individual develops patterns of avoidance and compensation to avoid triggering the schema, but these patterns become over-generalized and rigid. To modify early maladaptive schemas, SFT employs a broad range of techniques, including behavioral, psychodynamic, experiential and interpersonal strategies. As a result, the treatment is more flexible, elaborative and emotion-focused than traditional cognitive approaches (45). SFT treatments also tend to be longer, ranging from one to four years in duration (48). The first systematic investigation of SFT as a treatment for BPD was published as a series of six case reports (29). Outpatients received SFT based on Young’s (1996) treatment guidelines. They were assessed periodically over the course of 18?6 months of SFT, and again a year after treatment termination. All six patients showed progressive improvements in symptoms of depression, social functioning and global functioning. At follow-up, five had maintained treatment gains and three no longer met diagnostic criteria for BPD at the end of treatment. As a group, the patients remained mildly impaired at follow-up, however, improvements in symptoms, social and overall functioning were equivalent to a large effect size. These findings have been replicated and broadened in two RCTs. Giesen-Bloo and colleagues (50) evaluated outcomes of patients who participated in either SFT (n = 45), or transference-focused psychotherapy (TFP; n = 43), a psychodynamic intervention. Patients received biweekly individual psychotherapy for up to three years. Relative to those in TFP, patients in SFT showed greater improvement across BPD symptom domains, including abandonment fears, relationships, identity disturbance, dissociation and paranoia, impulsivity and parasuicidal behavior. A symptomatic behavior composite, consisting of measures of general symptoms, defense style, PD-related beliefs, favored SFT over TFP throughout the course of treatment. At treatment termination, the treatment groups did not differ in terms of quality of life, however, patients in SFT made more rapid gains in this domain. Overall, a greater proportion of patients in SFT compared to TFP made clinically significant gains (66 vs. 43 ) and met the BPD recovery criterion (46 vs. 24 ),Psychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewi.
