Schema therapy for adults with autism and personality disorder

Rationale: Research indicates significantly more personality pathology and personality disorders in adults with autism spectrum disorder (ASD) than in controls. To our knowledge treatment of personality disorder comorbidity in adults with ASD is understudied and is still in its infancy: we do not know if treatment of personality disorders may be applicable to adults with ASD. In particular, it is unknown whether patients with ASD benefit from experiential techniques that are part of schema therapy developed for the treatment of personality disorders,.


Objective: The aim of the study is to investigate the efficacy of a schema mode focused treatment with adult clients with ASD and comorbid personality pathology (i.e. at least one personality disorder). Specifically, we investigate if they can benefit from both cognitive-behavioral, and experiential interventions.


Study design: A multiple baseline case series study


Study population: Adult individuals (age > 21 years) with ASD and at least one personality disorder. Participants will be recruited from Sarr expertise center for autism in Rotterdam. The study requires 12 participants.


Intervention: The treatment protocol consists of 35 weekly offered sessions, followed by 10 monthly booster sessions. A multiple baseline design will be used with baseline varying from 5 to 10 weeks, with weekly supportive sessions. After baseline, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, schema modes are explored, and information about the treatment will be given. Then 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions will be given. Finally, there will be a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and respond weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs (by VAS), and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after baseline, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II will be administered during screening procedure (i.e. before baseline), at 5- and at 10-month follow-up.


Main study parameters: The primary study parameter is negative core beliefs. Secondary study parameters include: schema modes, personality disorder manifestations, psychological symptoms, and social interaction and communication.

The aim of the study is to investigate if a schema mode treatment with cognitive-behavioral, and experiential interventions will be effective for adult patients with autism spectrum disorder (ASD) and at least one personality disorder (PD). The research question is ‘Can patients with comorbid ASD-PD benefit from schema therapy, more specifically its cognitive-behavioral, and experiential interventions?
The first objective is to study in detail the effects of the major technique groups of schema therapy, that is cognitive-behavioral techniques and experiential techniques, on belief strength of negative core beliefs in comorbid ASD-PD patients. The research question is ‘Will schema therapy lead to less belief strenght of negative core beliefs in comorbid ASD-PD patients?’. We hypothesize that schema therapy leads to less belief strenght of negative core beliefs.

A secondary objective is dysfunctional schema modes (i.e. personality pathology) being less frequently present. The research question is ‘Will schema therapy lead to dysfunctional schema modes (i.e. personality pathology) being less frequently present and functional modes more often present in comorbid ASD-PD patients?’. We hypothesize that schema therapy leads to dysfunctional schema modes (i.e. personality pathology) being less frequently present, and functional modes more often present.

A third objective is remission of diagnostic criteria of a personality disorder. The research question is ‘Will diagnostic criteria of the comorbid personality disorder in comorbid ASD-PD patients be in remission after schema therapy?’ We hypothesize that schema therapy leads to personality traits being less frequently present.

A fourth objective is a change in severity of psychopathological symptoms, related to syndromal disorders like depression and anxiety disorders. The research question is ‘Will psychopathological symptoms in comorbid ASD-PD patients diminish by schema therapy?’ We hypothesize that psychopathological symptoms will be diminished by the given treatment.

Lastly, we hypothesize that schema therapy will lead to improvement in social interaction and communication. The research question is ‘Will social interaction and communication in comorbid ASD-PD patients improve by schema therapy?’ Our hypothesis is that more insight into one owns functioning by the given treatment will lead to improvement in social interaction and communication.

Participants will rate idiosyncratic negative core beliefs (Belief Strenght) every week.

Before baseline (in screening procedure) SMI, SCID-II, Belief Strength, SCL-90, SRS-A are assessed.



After baseline SMI, Belief Strength, SCL-90 and SRS-A are assessed.

After exploration SMI, Belief Strength, SCL-90 and SRS-A are assessed.

After cognitive-behavioral interventions: SMI, SCL-90, SRS-A are assessed.



After experiential interventions: SMI, SCL-90 and SRS-A are assessed.

During 10 monthly follow-up idiosyncratic negative core beliefs (Belief Strenght) are monthly assessed.



At 5-month follow-up SMI, SCID-II, Belief Strength, SCL-90, SRS-A are assessed.



At 10-month follow-up SMI, SCID-II, Belief Strength, SCL-90, SRS-A are assessed.

The treatment protocol consists of 35 sessions, offered weekly, followed by 10 monthly booster sessions. A multiple baseline design will be used with baseline varying from 5 to 10 weeks, with weekly supportive sessions. After baseline, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, schema modes are explored, and information about the treatment will be given. Then 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions will be given. Finally, there will be a 10-month follow-up with monthly booster sessions. Participants are randomly assigned to baseline length, and 6 of them are first assigned to cognitive-behavioral interventions and then followed by experiential interventions, whereas the other 6 participants start with experiential interventions followed by cognitive-behavioral interventions.