Schema Therapy for Forensic Patients with Personality Disorders: Design and Preliminary Findings of a Multicenter Randomized Clinical Trial in the Netherlands

Abstract

According to Dutch Law, patients committing severe crimes justifying imprisonment of four years or more who cannot be held (fully) accountable for these acts can be sentenced to compulsory hospitalization in a specialized TBS hospital in the Netherlands. In the current paper, the effects of TBS treatment will be addressed in terms of recidivism numbers after termination of TBS treatment, as well as in behavioral changes that are observed during admission to TBS hospitals. Although these results offer some indirect support suggesting that TBS is effective, no randomized controlled trials had been conducted up until now thatThe authors would like to express their appreciation to the management, staff, therapists, and patients at the seven forensic hospitals that are participating in this research: de Rooyse Wissel (Venray and Maastricht), van der Hoeven (Utrecht), Oostvaarders (Almere), Mesdag (Groningen), Veldzicht (Balkbrug), Assen (Assen), and Kijvelanden (Portugaal). This project is supported financially by the Netherlands Ministry of Justice, the Expertise Center for Forensic Psychiatry, Maastricht University's Faculty of Psychology and Neuroscience, and the participating forensic hospitals. We gratefully acknowledge their support. We thank present and former project coodinators, Lieke Bouts and Annette Löbbes, database manager,

Examining the influence of psychopathy, hostility biases, and automatic processing on criminal offenders' Theory of Mind

“…Thirty-six of these participants were participating in a randomized clinical trial (RCT) on the effectiveness of Schema Therapy versus Treatment as Usual in forensic patients with Cluster B PDs (Bernstein et al, 2012). The inclusion and exclusion criteria for this RCT aimed to select a group of patients whose personality pathology was the primary focus of treatment.…”

Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

“…Tarrier et al [45] suffers from being small, having a high attrition rate and of the control group receiving additional treatment, and has been criticised for the quality of therapy delivered [46]. Over a broad range of outcomes there were no differences in pro-violent attitudes between groups.…”

“…Bernstein et al [46] report on the first cohort of a larger study. Final outcomes for the complete group, including three year follow up, are due by 2018.…”

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets, violence risk and aggressive behaviour in a sample of mentally disordered offenders

“…Other studies in forensic mental health settings have explored Schema Focussed Therapy; these have revealed positive but non-significant impacts on risk for recidivism (Bernstein, Nijman, Karos, Keulen-de Vos, de Vogel, & Lucker, 2012), another had no impact (Doyle, Tarrier, Shaw, Dunn, & Dolan, 2016). Evaluations of Aggression Replacement Training have produced positive impacts on aggression and self-reported anger (Zwets, Hornsveld, Muris, Kanters, Langstraat, & van Marle, 2016), as have evaluations of the cognitive skills programme Reasoning and Rehabilitation, in terms of improvement in attitudes towards violence (Young, Gudjonsson, & Chick, 2010), and reduction in violent behaviour (Cullen, Clarke, Kuipers, Hodgins, Dean & Fahy, 2012).…”

“…These studies are limited because most comprise small participant populations and is unclear whether all participants have a history of violent offending, most participants in these studies were noted to be diagnosed with PD rather than SMI (e.g., Bernstein et al, 2012;Davidson et al, 2009;Doyle et al, 2016) or the participants were predominantly diagnosed with PD (Zwets et al, 2016). Finally, as noted above, none have evaluated the sort of multi-modal interventions that are now (relatively) common in criminal justice services and seen as necessary for high-risk violent offenders with multiple needs and internal responsivity issues (Polaschek, 2011).…”