title: Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy.
abstract: Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, The Netherlands; Department of Clinical Psychological Science, Maastricht University, The Netherlands. Electronic address: A.R.Arntz@UvA.nl.
authors.forename: Arnoud
authors.initials: A
authors.lastname: Arntz
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, The Netherlands; International Media and Entertainment Management Academy for Digital Entertainment NHTV University of Applied Sciences, Breda, The Netherlands.
authors.forename: Snežana
authors.initials: S
authors.lastname: Stupar-Rutenfrans
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, The Netherlands; Community Mental Health Center Virenze RIAGG, Vaals, The Netherlands.
authors.forename: Josephine
authors.initials: J
authors.lastname: Bloo
authors.affiliation: VU Medical Centre Amsterdam, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: van Dyck
authors.affiliation: Institute of Psychology, Leiden University, Leiden, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010352:Patient Dropouts / Q000523:psychology*; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Borderline Personality Disorder; Dissociation; Outcome prediction; Schema Therapy; Transference Focused Psychotherapy; Treatment discontinuation