General Abstract:

In this symposium we will share our knowledge about schema therapy with cluster C patients from different perspectives, presented by scientists and experienced clinicians.
From the scientific perspective, we will present the research designs of three running RCT’s on the effectiveness of schema therapy for cluster C. From a clinical perspective, the cluster C treatment protocols will be introduced in an interactive way with exercises and examples of case-studies.

Cluster C personality disorders (avoidant, dependant, and obsessive-compulsive personality disorder) are highly prevalent and related to unfavourable outcome and chronicity of all common mental health disorders. Even though schema therapy is frequently offered in clinical practice for patients with cluster C personality disorders, evidence for the optimal treatment for these patients is scarce.

Detailed protocols for the treatment of Cluster C personality disorders are recently developed. Regarding group therapy two protocols are developed: Group Schema Therapy for cluster C (GST-C, Tjoa & Muste, 2021) and schema-focused dynamic group therapy (SFGT, Aalders). For individual schema therapy, a 50-sessions specific for cluster C patients is developed (Bamelis, 2014). The effectiveness of these protocols is studied in three large RCT’s that are currently running in the Netherlands (Quest-CLC, I-FORCE, G-FORCE).

In this symposium, we will share the results of a large pilot study on the GST-C protocol and present the designs of the running RCTs. Also, we will focus on clinical practice by giving you the opportunity to get to know the different schema therapy protocols by a vivid presentation with exercises and case studies.

With this symposium we hope to focus the attention on the treatment of patients with cluster C personality disorders, a patient group that has been highly neglected in scientific research and show you the rich possibilities of schema therapy.

Presentation 1: 

Title: Group-ST for cluster-C personality disorders: results of a large pilot study.

Presenter's Name: Prof. dr. Arnoud Arntz, PhD

General Abstract for Presentation 1:

In this study we piloted a group-ST protocol for cluster-C personality disorders in a multi-centre collaboration of 8 sites. The protocol consisted of 30 90-minutes groups sessions with max 9 participants led by 2 therapists, and a max. of 300 minutes individual ST, followed by 5 60-minutes booster sessions in smaller groups. The group-ST followed the Farrell & Shaw model and had every 10 sessions a moment when 2-3 participants left, after which the next session 2-4 entered the group. We had N=140 participants, the majority having Avoidant PD as primary diagnosis. The primary outcome was a severity index based on a semi-structured interview assessing frequency and burden of manifestations of the primary PD. Results will be presented, including effects up to 2 years follow-up, treatment retention, and effects on secondary outcomes such as functioning (WHODAS). In general, the findings were positive, leading to a next stage of testing the protocol. Experiences of therapists with the model gave rise to some adjustments, after which the group model is now investigated in an RCT comparing it to individual ST and treatment as usual.

Presentation 2:

Title: I-FORCE: design of a RCT on the effectiveness of individual therapy for cluster C personality disorders.

Presenter's Name: Martine Daniels, MSc, PhD candidate

General Abstract for Presentation 2:

The study design of this large pragmatic RCT will be outlined, comparing the differential (cost)- effectiveness of two individual psychodynamic therapies (short-term psychodynamic supportive psychotherapy (SPSP), affect phobia therapy (APT)) and individual schema therapy (ST). The ST protocol was based on Cluster-C protocol from Arntz (2012).

To get a better idea of what works for whom, this RCT will also study different predictive factors, non-specific and therapy specific mediators. In this presentation, our hypothesis on potential predictors and mediators will be shared. Also, the current evidence of individual (schema therapy) treatment of cluster C PD will be outlined.

Presentation 3

Title: Individual schema therapy for cluster C patients: a closer look at the protocol.

Presenter's Name: Jet Alberts, MSc & Katinka de Boer, MSc

General Abstract for Presentation 3:

Following the previous presentation about individual schema therapy for Cluster C personality disorders we will show some experiential work and give the attendees the opportunity to experience and try these techniques. The focus will be on working with the Coping Modes. We all have Coping modes, but people with Cluster C PD are captured by their Coping modes and experiences a lot of limitations because of these modes. As therapists we make them aware of their Coping modes and how they affect them in daily life. Experiential work is a strong and powerful way to work with your patient, which you can experience hands on during this presentation.

Presentation 4

Title: G-FORCE: design of a RCT on the effectiveness of group therapy for cluster C personality disorders

Presenter's Name: Birre van den Heuvel, MSc, PhD candidate

General Abstract for Presentation 3:

In this presentation the study design of G-FORCE will be presented. G-FORCE is a pragmatic RCT, comparing two forms of group schema therapy and psychodynamic therapy.

The two forms of group schema therapy in this research are the group schema therapy for cluster C (GST-C, Tjoa & Muste, 2021) and schema-focused group therapy (SFGT, Aalders & Van Dijk, 2012).

With G-FORCE we will also try to answer the question: which type of group therapy works for whom, and why? Potential predictors and working mechanisms will be discussed in this light.

Presentation 5

Title: Group schema therapy for cluster C patients: a closer look at the protocol.

Presenter's Name: Jet Alberts, MSc & Katinka de Boer, MSc

General Abstract for Presentation 3:

Following the presentation of Birre van den Heuvel about group schema therapy for cluster C personality disorders we will include the attendees in experiential groupwork for people with Cluster C PD. The focus will be on exterminating the parental modes through experiential techniques. This will give you the opportunity to learn and experience the strength of experiential work, which can either be through chair-work, imaginations, or other experiential techniques. The idea is that the attendees will be actively working, emotionally experiencing, and getting new input for future (group) therapies.

About the Presenters:

Prof. dr. Arnoud Arntz, PhD

Arnoud Arntz is professor of Clinical Psychology and chair of the Department of Psychology at the University of Amsterdam, the Netherlands. His main research interests lie in the fields of PTSD and personality disorders, both applied and fundamental. He is perhaps best known for his contributions to the development of and research into Schema Therapy and Imagery Rescripting. He also practices as a therapist at PsyQ in Amsterdam, where he treats patients with trauma and personality disorders. He is a former editor of the Journal of Behavior Therapy and Experimental Psychiatry.

Martine Daniels, MSc, PhD Candidate

Martine Daniëls is Clinical psychologist, PhD candidate and senior schema therapist at NPI/Arkin Mental Health Care in Amsterdam. As schema therapist and cognitive behavior therapist she is specialized in treatment of patients with Personality Disorders.

She is the executive investigator of the I-FORCE study on the effectiveness of individual treatment for Cluster-C PDs. Before, she was connected as researcher to the IREM study (Imagery Rescripting vs. Eye Movement Desensitization and Reprocessing as treatment of childhood-trauma related PTSD in adults).

Jet Alberts, MSc

Jet Alberts is Healthcare Psychologist and Supervisor-Trainer Schema Therapy VST & ISST. She works at NPI/Arkin Mental Health Care in Amsterdam. As a schema therapist she has extensive experience in the treatment of patients with Personality Disorders (individual and group).

She participates in the BOOTS and FORCE studies as therapist. Together with Katinka de Boer, she offers schema therapy training throughout the Netherlands. They are the authors of a chapter about the treatment of a client with Avoidant PD and depression in the Casebook Schema Therapy.

Katinka de Boer, MSc

Katinka de Boer is Healthcare Psychologist and Psychotherapist and Supervisor-Trainer Schema therapy VST & ISST. She works at NPI/Arkin Mental Health Care in Amsterdam. As a schema therapist she has extensive experience in the treatment of patients with Personality Disorders (individual and group).

She participates in the BOOTS and FORCE studies as therapist. Together with Jet Alberts, she offers schema therapy training throughout the Netherlands. They are the authors of a chapter about the treatment of a client with Avoidant PD and depression in the Casebook Schema Therapy.

Birre van den Heuvel, MSc, PhD Candidate

Birre van den Heuvel works as a clinical psychologist at the NPI/Arkin Mental Health Care in Amsterdam, a specialized center for personality disorders. She is specialized in psychodynamic therapy, couple therapy and group therapy. She combines clinical work with scientific research, which gives her the opportunity to contribute to gain more knowledge about effective treatments for personality disorders. She is executive investigator of the G-FORCE study.