A multi-site randomized controlled trial comparing Schema Therapy and Mentalization-Based Treatment for borderline personality disorder: A framework for the study of (differential) change processes and the empirical search for treatment selection criteria.

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The primary aim of the study is to investigate patient characteristics that predict (differential) treatment response across MBT and ST. In addition, mechanisms of change in MBT and ST will be examined. Furthermore, the (cost-)effectiveness of MBT and ST will be investigated. Finally, therapeutic and organizational characteristics that may influence the effectiveness of MBT and ST will be examined.

The first assessment will occur after inclusion and before randomization. The subsequent five assessments will occur at 7.5, 13.5, 19.5, 25.5, 31 and 36 months after the start of the treatment.

Mentalization-Based Treatment (MBT):

MBT is a psychodynamic-oriented treatment that focuses on increasing mentalization in borderline patients. Mentalization refers to the process of implicitly and explicitly interpreting behaviors of oneself and others in term of mental states (e.g., feelings, desires, needs, beliefs, and intentions; Bateman & Fonagy, 2010). Bateman and Fonagy (2010) defined the unstable capacity for mentalization as the core feature of BPD. The mentalizing capacity of patients with BPD typically fails in the context of intimate relationships and high arousal. Consequently, patients with BPD are unable to make sense of actions and internal experiences of oneself and others, which results in impulsive behavior, emotional instability, and difficulties in interpersonal functioning.



Schema Therapy (ST):

ST is based on an integrative cognitive therapy, combining cognitive behavior therapy with attachment theory, psychodynamic concepts, and experiential therapies (Jacob & Arntz, 2013). Central concepts are early maladaptive schemas and schema modes. Early maladaptive schemas can be defined as broad, pervasive patterns of thoughts, emotions, memories, and cognitions regarding oneself and relationships with others, developed during childhood (Young et al., 2003). A schema mode refers to an activated set of schemas and the associated coping response (i.e., overcompensation, avoidance, and surrender), and describes the momentary emotional, cognitive, and behavioral state of the patient. ST aims to replace the maladaptive schemas of patients with BPD by more healthy schemas.