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.

MMPI-II personality profiles of patients with psychogenic nonepileptic seizures.

This comparative study explored whether psychogenic nonepileptic seizures (PNES) are a unique disorder with distinctive personality characteristics or (seen from the personality profile) PNES are allied with the domain of a general functional somatic symptom and syndrome (FSSS). We compared the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) results for 41 patients with newly diagnosed PNES and 43 patients with newly diagnosed insomnia. There were no statistically significant quantitative scoring differences on the main clinical scales, indicating that there is no substantial difference in "personality makeup" between the two groups with a FSSS. Additional subscale analysis indicated that patients with PNES reported significantly more somatic complaints (Hysteria 4) and bizarre sensory experiences (Schizophrenia 6). Further profile analysis revealed that the personality pattern of patients with PNES was characterized by a strong tendency toward "conversion V, a lack of control pattern and less excessive worries" as compared with patients with insomnia. Patients with PNES are characterized by a stronger tendency toward somatization and externalization, which has treatment implications.