An open clinical trial of an adapted inpatient addiction treatment with group Schema Therapy and milieu therapy

In this study, we will do further research of Schema Therapy (ST) and SafePath, a milieu-therapeutic form of ST, for double-diagnosed (substance abuse plus personality disorder) patients in a clinical setting at de Hoop. De Hoop has already implemented this therapeutic approach for several years under the supervision of D. Bernstein. All enrolled patients will receive the same treatment as not enrolled patients. This proposal represents an open trial in which we will test the already implemented treatment model on a clinical ward, involving a case series design (Kazdin, 2010) in which each patient forms its own individual control based on their own natural waiting list baseline.

In terms of effectiveness, we hypothesized that for each patient during treatment:
1 Compared to a waiting list baseline, the intensive inpatient treatment with adapted ST interventions together with ST milieu therapy during 12 weeks results in larger improvements in core PD cognitions over time (interaction effects condition*time; primary outcome).

2 Compared to a waiting list baseline the treatment phase results in larger improvements in healthy schema modes (Healthy Adult and Happy Child) and larger decreases Schema Modes, especially ‘the Detached Protector’, ‘the Detached Self-soother’, ‘impulsive child’ and EMSs in the DR domain and ‘Insufficient Self-control’, over time (interaction effect condition*time on observed behavior problems; secondary outcomes).

3 Compared to a waiting list baseline, the treatment phase result in larger improvements in craving and general complaints. (interaction effect condition*time on observed behavior problems; secondary outcomes).

4 Compared to a waiting list baseline, the treatment phase, results in larger decreases in negatively valued cognitive and affective aspects of God representations and larger increases in supportively valued cognitive and affective aspects of God representations in patients with a Christian religious affiliation over time (interaction effect condition*time on observed behavior problems; secondary outcomes).

5 Visual inspection of slopes and effect sizes during different measurements time points, shows that increases in healthy schema modes (Healthy Adult and Happy Child) and supportive religious representations and decreases in problematic schema coping, especially avoidant coping, problematic Schema Modes, especially ‘the Detached Protector’, ‘the Detached Self-soother’, and EMSs, in the DR domain and ‘Insufficient Self-control’, and negative religious representations go together with decreases in reported PD-cognitions, PD pathology, general complaints, and craving (SUD pathology) within patients.

Weekly measurements start from inclusion (dysfunctional core belief strength; PACS; God cognition strength). For remaining variables, three measurement points (after inclusion, at start of treatment, and at end of treatment).

A therapeutic approach, including a group Schema Therapy as well as SafePath (a milieu-form of ST) aimed at substance use disorder and personality disorder provided in a clinical setting during 12 weeks.