title: Psycho-education with problem solving (PEPS) therapy for adults with personality disorder: a pragmatic multi-site community-based randomised clinical trial.
abstract: BACKGROUND
  Impairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorder
  
  
  METHODS
  This is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress.
  
  
  CONCLUSIONS
  PEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users.
  
  
  BACKGROUND
  International Standard Randomised Controlled Trial Number - ISRCTN70660936.
authors.affiliation: Institute of Mental Health, University of Nottingham, Sir Colin Campbell Building, Nottingham NG7 2TU, UK. Mary.McMurran@nottingham.ac.uk
authors.forename: Mary
authors.initials: M
authors.lastname: McMurran
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Crawford
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Reilly
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Paul
authors.initials: P
authors.lastname: Moran
authors.forename: Hywel
authors.initials: H
authors.lastname: Williams
authors.forename: Clive E
authors.initials: CE
authors.lastname: Adams
authors.forename: Conor
authors.initials: C
authors.lastname: Duggan
authors.forename: Juan
authors.initials: J
authors.lastname: Delport
authors.forename: Diane
authors.initials: D
authors.lastname: Whitham
authors.forename: Florence
authors.initials: F
authors.lastname: Day
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012107:Research Design; D016037:Single-Blind Method; D012919:Social Behavior; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult