Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T07:20:16.516Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychotherapy for personality disorders: Short-term day hospital psychotherapy versus outpatient individual therapy – a randomized controlled study

Published online by Cambridge University Press:  16 April 2020

Espen Arnevik ,
Theresa Wilberg ,
Øyvind Urnes ,
Merete Johansen ,
Jon T. Monsen  and
Sigmund Karterud
Espen Arnevik*
Affiliation:
Department for Personality Psychiatry, Ullevål University Hospital, 0407Oslo, Norway
Theresa Wilberg
Affiliation:
Department for Personality Psychiatry, Ullevål University Hospital, 0407Oslo, Norway
Øyvind Urnes
Affiliation:
Department for Personality Psychiatry, Ullevål University Hospital, 0407Oslo, Norway
Merete Johansen
Affiliation:
Department for Personality Psychiatry, Ullevål University Hospital, 0407Oslo, Norway
Jon T. Monsen
Affiliation:
Department of Psychology, University of Oslo, PB 1094 Blindern, 0317Oslo, Norway
Sigmund Karterud
Affiliation:
Department for Personality Psychiatry, Ullevål University Hospital, 0407Oslo, Norway
*
*Corresponding author. Tel.: +47 22117832. E-mail address: espenarn@ulrik.uio.no (E. Arnevik).
Get access

Abstract

This article describes the results of an eight-month follow-up investigation from a randomized controlled trial of day hospital psychotherapy (DHP) compared with outpatient individual psychotherapy (OIP) for patients with personality disorders (N = 114). The patients were randomly assigned to either 18 weeks of day hospital treatment followed by long-term conjoint group and individual therapy (DHP), or outpatient individual psychotherapy (OIP). The main outcome measures were attrition rate, suicide attempts, suicidal thoughts, self-injury, psychosocial functioning, symptom distress, and interpersonal and personality problems. The study showed a low dropout rate and a moderate improvement on a broad range of clinical measures for both treatments. However, there was no indication of the superiority of one treatment over the other. Neither was there any indication that day hospital treatment was better for the most poorly functioning patients. Further studies will follow this group of patients for the next few years, the results of which may have implications for resource allocation and the organization of mental health services for patients with personality disorders.

Keywords

Personality disorderRTCDay hospital treatment
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 2 , March 2009 , pp. 71 - 78
Copyright
Copyright © Elsevier Masson SAS 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alden, L.E., Wiggins, J.S., Pincus, A.L.Construction of circumplex scales for the Inventory of Interpersonal Problems. J Pers Assess 1990;55:521–536CrossRefGoogle ScholarPubMed
Bateman, A., Fonagy, P.Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999 Oct;156(10):1563–1569Google Scholar
Bateman, A., Fonagy, P.Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 2001 Jan;158(1):36–42CrossRefGoogle Scholar
Beck, A.T., Steer, R.A.Manual for the Beck Hopelessness Scale San Antonio, Texas:Psychological Corporation 1988Google Scholar
Chiesa, M., Fonagy, P., Holmes, J., Drahorad, C.Residential versus community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2004;161(8):1463–1470CrossRefGoogle ScholarPubMed
Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., Kernberg, O.F.Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007 Jun 1;164(6):922–928Google Scholar
Derogatis, L.R.SCL-90-R manual: administration, scoring & procedures USAClinical Psychometric Research 1983Google Scholar
Faul, F., Erfdfelder, E., Lang, A.G., Buchner, A.G*Power 3: a flexible statistical power analysis program for the social, behavioural, and biomedical sciences. Behav Res Methods 2007;39:175–191CrossRefGoogle Scholar
First, M.B.Structural clinical interview for DSM-IV axis II personality disorders (version 2.0) New YorkNew York State Psychiatric Institute 1994Google Scholar
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T.et al.Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006 Jun 1;63(6):649–658CrossRefGoogle Scholar
Gråwe, R.W., Hagen, H., Husum, T.L., Pedersen, P.B., Ruud, T.Pasienter som mottar poliklinisk behandling i psykisk helsevern for voksne – September 2004 Available at: http://www.sintef.no/content/page1____6304.aspx SINTEF Helse; 2005. Report No.: STF778 A055013 [accessed 03.03.08]Google Scholar
Groth-Marnat, G.The handbook of psychological assessment 2nd ed.New YorkJohn Wiley & Sons 1990Google Scholar
Hummelen, B., Wilberg, T., Karterud, S.Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy. Int J Group Psychother 2007 Jan;57(1):67–91Google Scholar
Jacobson, N.S., Truax, P.Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991 Feb;59(1):12–19CrossRefGoogle Scholar
Kallert, T.W., Glockner, M., Priebe, S., Briscoe, J., Rymaszewska, J., Adamowski, T.et al.A comparison of psychiatric day hospitals in five European countries: implications of their diversity for day hospital research. Soc Psychiatry Psychiatr Epidemiol 2004 Oct;39(10):777–788CrossRefGoogle Scholar
Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friis, S., Haaseth, O.et al.Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network. J Personal Disord 2003 Jun;17(3):243–262CrossRefGoogle Scholar
Karterud, S., Urnes, O.Short-term day treatment programmes for patients with personality disorders. What is the optimal composition?. Nord J Psychiatry 2004;58(3):243–249CrossRefGoogle ScholarPubMed
Karterud, S., Vaglum, S., Friis, S., Irion, T., Johns, S., Vaglum, P.Day hospital therapeutic community treatment for patients with personality disorders. An empirical evaluation of the containment function. J Nerv Ment Dis 1992 Apr;180(4):238–243CrossRefGoogle ScholarPubMed
Krawitz, R.A prospective psychotherapy outcome study. Aust N Z J Psychiatry 1997 Aug;31(4):465–473CrossRefGoogle ScholarPubMed
Leichsenring, F., Leibing, E.The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003;160(7):1223–1232CrossRefGoogle ScholarPubMed
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L.et al.Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006 Jul;63(7):757–766CrossRefGoogle Scholar
Marshall, M., Crowther, R., Almaraz-Serrano, A.M., Tyrer, P.Day hospital versus out-patient care for psychiatric disorders. Cochrane Database Syst Rev 2001;3:CD003240CrossRefGoogle Scholar
McGlashan, T.H., Grilo, C.M., Sanislow, C.A., Ralevski, E., Morey, L.C., Gunderson, J.G.et al.Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive–compulsive personality disorders: toward a hybrid model of axis II disorders. Am J Psychiatry 2005 May;162(5):883–889CrossRefGoogle Scholar
Ogrodniczuk, J.S., Piper, W.E.Day treatment for personality disorders: a review of research findings. Harv Rev Psychiatry 2001 May;9(3):105–117CrossRefGoogle Scholar
Pedersen, G.Circumplex of Interpersonal Problems (CIP): Norsk revidert versjon av Inventory of Interpersonal Problems-Circumplex (IIP-C). J Norwegian Psychol Assoc 2000;39:25–34Google Scholar
Perry, J.C., Banon, E., Ianni, F.Effectiveness of psychotherapy for personality disorders. Am J Psychiatry 1999;156(9):1312–1321Google ScholarPubMed
Piper, W.E., Rosie, J.S., Azim, H.F., Joyce, A.S.A randomized trial of psychiatric day treatment for patients with affective and personality disorders. Hosp Community Psychiatry 1993 Aug;44(8):757–763Google Scholar
Bonora, L.I., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M.F., Dunbar, G.C.Reliability and Validity of the MINI International Neuropsychiatric Interview (M.I.N.I.): According to the SCID-P. Eur Psychiatry 1997;12:232–241Google Scholar
Svartberg, M., Stiles, T.C., Seltzer, M.H.Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Am J Psychiatry 2004;161(5):810–817CrossRefGoogle ScholarPubMed
Verheul, R., Andrea, H., Berghout, C.C., Dolan, C., Busschbach, J.J., van der Kroft, P.J.et al.Severity Indices of Personality Problems (SIPP-118): development, factor structure, reliability, and validity. Psychol Assess 2008 Mar;20(1):23–34CrossRefGoogle Scholar
Verheul, R., Herbrink, M.The efficacy of various modalities of psychotherapy for personality disorders: a systematic review of the evidence and clinical recommendations. Int Rev Psychiatry 2007 Feb;19(1):25–38CrossRefGoogle Scholar
Wilberg, T., Urnes, O., Friis, S., Irion, T., Pedersen, G., Karterud, S.One-year follow-up of day treatment for poorly functioning patients with personality disorders. Psychiatr Serv 1999 Oct;50(10):1326–1330CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.