Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy.

BACKGROUND: Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS: The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION: The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION: Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.

The Effectiveness of Aftercare for Juvenile and Young Adult Offenders.

This study examined the New Perspectives Aftercare Program (NPAP) for serious juvenile and young adult offenders in The Netherlands. Participants (n = 127) were randomly assigned to NPAP (n = 66) or existing aftercare services ("treatment as usual" [TAU], n = 61). The aim was to determine whether NPAP was effective in decreasing cognitive distortions and criminal thinking patterns and increasing prosocial skills of the juveniles compared with TAU. No direct intervention effects were found on any of the outcome measures. Moderator analyses, however, showed several interaction effects of ethnicity and coping skills for both NPAP and TAU youths. Furthermore, NPAP dropouts displayed significantly more indirect aggression at posttest compared with youths dropping out from TAU. Possible explanations for the mostly null effects are discussed, including implications for further research, policy, and practice.

Aftercare programs for reducing recidivism among juvenile and young adult offenders: a meta-analytic review.

The aim of this meta-analytic study, including 22 studies and 5764 participants, was to examine the effects of aftercare programs on recidivism in juvenile and young adult offenders released from correctional institutions. The studies had to be (quasi-)experimental, with the control group receiving 'care as usual' or no treatment. Recidivism was measured by re-arrests and/or reconvictions and was based on official reports. Although the overall effect size for aftercare programs was generally small (d=.12), moderator analyses indicated more substantial effects and showed that aftercare is most effective if it is well-implemented and consists of individual instead of group treatment, and if it is aimed at older and high-risk youth. Whereas the treatment duration and moment of starting the aftercare program were not related to the program's effectiveness, more intensive aftercare programs were associated with lower recidivism rates.