The (Cost-)Effectiveness of Generalist Versus Specialist Treatment for Severe Personality Disorders'

NCT ID: NCT06789380

Last Updated: 2025-02-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

358 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-21

Study Completion Date

2028-12-31

Brief Summary

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The goal of this clinical trial is to investigate if generalist treatment (GIT-PD) is non-inferior in improving level op personality functioning compared to specialist treatment (MBT/ST) in patients with severe personality disorders. The main questions it aims to answer are:

1. Is generalist treatment (GIT-PD) non-inferior in improving level of personality functioning compared to specialist treatment (MBT/ST) in patients suffering from severe personality disorders (PD)?
2. What patient characteristics predict which patients will benefit more from specialist or generalist treatment?

Participants will be randomized to either specialist or generalist treatment. Interventions included in specialist treatment are Mentalization-Based Treatment (MBT) and Schema Therapy (ST). Generalist treatment will be offererd following the principles of the Guideline-Informed Treatment for Personality Disorders (GIT-PD), a principle-driven treatment framework based upon common factors and allowing personalized treatment according to patients' needs. All participating institutions offer GIT-PD and MBT and/or ST. Before, during and after following this treatment participants will complete measurements at 8 distinct time points.

Participants will be asked to:

* complete a range of instruments at baseline to enable the construction of a personalized advantage index to predict treatment response based on patient characteristics
* complete questionnaires at all 7 post-randomization time points
* undergo a semi-structured interview at 3 time points
* follow treatment for personality disorders (either GIT-PD or MBT/ST)

Detailed Description

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Conditions

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Severe Personality Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomly assigned to either group A or B.

Group A will receive the guideline-infomred treastment for personality disorders (GIT-PD).

Group B receives either mentalization-based treatment (MBT) or schema therapy (ST), depending on local availbility, treatment history and shared-decision making.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Specialist Treatment for Severe Personality Disorders

Participants will receive specialist treatment for severe personality disorders. Specifically, the type of treatment will be either mentalization-based treatment (MBT) or schema therapy (ST), depending on local availbility, treatment history and shared-decision making. Both MBT and ST must adhere to the protocol and minimum dosage described in respective effect studies published on MBT or ST.

Group Type ACTIVE_COMPARATOR

Schema therapy

Intervention Type BEHAVIORAL

Schema therapy (ST) is an evidence-based, fully manualized, specialist form of psychotherapy for personality disorders (Bamelis et al., 2014; Sempértegui et al., 2013; Arntz et al., 2022). Eligible programs must adhere to the minimum standards described in the evidence-based literature. ST is an integrative treatment method, originally rooted in cognitive theory, but with additional influences from Gestalt, psychodynamic, and experiential methods. Schema therapy programs may differ in intensity and duration, even at the same site, but must include a minimum of either 40 sessions and/or a duration of 12 to 24 months. In addition, in order to be eligible, a schema therapy program must be of higher intensity or longer duration than the generalist treatment (GIT-PD) offered at the same site.

Mentalization-based treatment

Intervention Type BEHAVIORAL

Mentalization-based treatment (MBT) is an evidence-based, fully manualized, specialist form of psychotherapy for personality disorders (Bateman \& Fonagy, 2008; Bateman \& Fonagy, 2009; Laurenssen et al., 2018; Juul et al., 2023). MBT is rooted in psychodynamic and attachment theory and aims to alter personality pathology by improving mentalizing and enhancing epistemic trust. Eligible programs must adhere to the minimum standards described in the evidence-based literature. MBT programs may differ in intensity and duration, even at the same site, but must include a minimum of either 40 sessions or a duration of 12 to 24 months. In additon, in order to be eligible, an MBT program must be of higher intensity or longer duration than the generalist treatment (GIT-PD) offered at the same site.

Generalist Treatment for Severe Personality Disorders

Participants will receive a generalist treatment for severe personality disorders. Specificially, the Guideline-Informed Treatment for Personality Disorders (GIT-PD). Sites can only participate in this study, if they offer a GIT-PD programme of lower dosage than the specialist intervention offered at the same site.

Group Type EXPERIMENTAL

Guideline-informed treatment for personality disorders

Intervention Type BEHAVIORAL

GIT-PD is a non-theoretical and non-methodological approach, based upon principles derived from common factors across evidence-based treatments for PD. GIT-PD has a flexible approach, enabling tailoring treatment to clinical needs of different types of patients. The treatment duration (start-end) is 12- 18 months. The treatment consists of three distinct phases. First, an assessment phase. Second, a modular treatment phase that offers either group or individual interventions. Third, a follow-up phase with limited treatment and focus on relapse prevention. In order to be eligible, GIT-PD should be less intensive than specialist psychotherapies offered in the control arm at the same location (i.e. MBT or ST). GIT-PD will not include evidence-based psychotherapy for personality disorders as described in previous RCTs.

Interventions

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Schema therapy

Schema therapy (ST) is an evidence-based, fully manualized, specialist form of psychotherapy for personality disorders (Bamelis et al., 2014; Sempértegui et al., 2013; Arntz et al., 2022). Eligible programs must adhere to the minimum standards described in the evidence-based literature. ST is an integrative treatment method, originally rooted in cognitive theory, but with additional influences from Gestalt, psychodynamic, and experiential methods. Schema therapy programs may differ in intensity and duration, even at the same site, but must include a minimum of either 40 sessions and/or a duration of 12 to 24 months. In addition, in order to be eligible, a schema therapy program must be of higher intensity or longer duration than the generalist treatment (GIT-PD) offered at the same site.

Intervention Type BEHAVIORAL

Mentalization-based treatment

Mentalization-based treatment (MBT) is an evidence-based, fully manualized, specialist form of psychotherapy for personality disorders (Bateman \& Fonagy, 2008; Bateman \& Fonagy, 2009; Laurenssen et al., 2018; Juul et al., 2023). MBT is rooted in psychodynamic and attachment theory and aims to alter personality pathology by improving mentalizing and enhancing epistemic trust. Eligible programs must adhere to the minimum standards described in the evidence-based literature. MBT programs may differ in intensity and duration, even at the same site, but must include a minimum of either 40 sessions or a duration of 12 to 24 months. In additon, in order to be eligible, an MBT program must be of higher intensity or longer duration than the generalist treatment (GIT-PD) offered at the same site.

Intervention Type BEHAVIORAL

Guideline-informed treatment for personality disorders

GIT-PD is a non-theoretical and non-methodological approach, based upon principles derived from common factors across evidence-based treatments for PD. GIT-PD has a flexible approach, enabling tailoring treatment to clinical needs of different types of patients. The treatment duration (start-end) is 12- 18 months. The treatment consists of three distinct phases. First, an assessment phase. Second, a modular treatment phase that offers either group or individual interventions. Third, a follow-up phase with limited treatment and focus on relapse prevention. In order to be eligible, GIT-PD should be less intensive than specialist psychotherapies offered in the control arm at the same location (i.e. MBT or ST). GIT-PD will not include evidence-based psychotherapy for personality disorders as described in previous RCTs.

Intervention Type BEHAVIORAL

Other Intervention Names

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Schema-focused therapy SFT

Eligibility Criteria

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Inclusion Criteria

* 'severe' or 'extreme' personality disorder (PD) according to the alternative model for PDs

Exclusion Criteria

* IQ \< 75
* legal incapacity
* Any mental state disorder that requires prior treatment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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GGZ de Viersprong

UNKNOWN

Sponsor Role collaborator

Ggz Oost Brabant

OTHER

Sponsor Role collaborator

Stichting Altrecht GGZ

UNKNOWN

Sponsor Role collaborator

Stichting Dimence Group

UNKNOWN

Sponsor Role collaborator

Tilburg University

OTHER

Sponsor Role collaborator

Arkin

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Henricus L. Van, Dr.

Role: PRINCIPAL_INVESTIGATOR

Arkin NPI

Joost Hutsebaut, Prof. dr.

Role: STUDY_DIRECTOR

Tilburg University; GGZ de Viersprong

Nathan Bachrach, Dr.

Role: STUDY_CHAIR

Tilburg University; GGZ Oost-Brabant

Locations

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GGZ de Viersprong

Halsteren, North Brabant, Netherlands

Site Status RECRUITING

GGZ Oost-Brabant

Helmond, North Brabant, Netherlands

Site Status RECRUITING

Arkin NPI

Amsterdam, North Holland, Netherlands

Site Status RECRUITING

Dimence Group

Almelo, Overijssel, Netherlands

Site Status RECRUITING

Altrecht

Zeist, Utrecht, Netherlands

Site Status NOT_YET_RECRUITING

Countries

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Netherlands

Central Contacts

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Jan Philipp Löffler, MSc

Role: CONTACT

+31-020-590-4700

Facility Contacts

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Joost Hutsebaut, Prof. dr.

Role: primary

+31-088-656-216

Nathan Bachrach, Dr.

Role: primary

+31-088-846-04-60

Jan Philipp Löffler, MSc

Role: primary

+31-020-590-4700

Maarten van Dijk, Dr.

Role: primary

+31-0570-639-600

Maarten van Westen, Dr.

Role: primary

+31-030-696-5100

Related Links

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https://p-daet.nl/

Study website aimed at a broad audience.

Other Identifiers

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P-DAET NL86263.028.24 / P2409

Identifier Type: -

Identifier Source: org_study_id

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