A small randomised controlled trial on ST-MBCT + TAU versus COMET + TAU for patients with a personality disorder

INTERVENTION: For this pilot study, a parallel‐groups randomized single‐blind trial was used. Randomization to the condition SMT or COMET was performed by GraphPad software (http://www.graphpad.com/quickcalcs/randomize1.cfm). Signed informed consent was obtained after full explanation of the procedures and of both therapies before the first assessment and randomization. Each patient was screened by means of the Mini‐International Psychiatric Interview‐Plus (M.I.N.I.‐Plus, Sheehan, & Lecrubier et al., 1997, 1998; Bohnen, de Winter & Hoenkamp, 2011) and the Structured Clinical Interview of DSM‐IV Disorders II (SCID‐II, First, Spitzer, Gibbon, Williams, & Benjamin, 1997; Weertman, Arntz, & Kerkhofs, 2000). After inclusion, the patients filled in five self‐report questionnaires before the start of the group training, directly after the last session of the group training of two months and one month after finishing the group training. Schema Mindfulness Training (SMT) The used SMT‐protocol, written by van Vreeswijk et al. (2014), consists of eight group sessions of 90 minutes, once a week. The structure of the training is as follows: session one: psycho‐education on schemas, modes and basic mindfulness exercises; session two: more mindfulness for the environment; session three: mindfulness for respiration and painful memories; session four: mindfulness to schema coping; session five: mindful allowing and accepting what is; session six: mindfulness to schemas facts or fiction; session seven: mindful taking care of yourself by the Healthy adult and the Happy child (Young et al., 2011); session eight: schema mindfulness and the future. COMET A negative self‐image is a problem common to many psychiatric disorders (Appelo & Korrelboom, 2005) and to various types of personality disorders as well (Beck, Freeman & Associates, 1990). Korrelboom (2011) has written a protocol to positively correct a dysfunctional self‐image using counter‐conditioning by positive verbalisations (Lange et al., 19 CONDITION: Outpatients with personality disorder(s) ; Mental and Behavioural Disorders INCLUSION CRITERIA: 1. Patients (male or female) with a main diagnosis on Axis II, meaning one or more cluster A, B, C personality disorders or a personality disorder NOS 2. Aged 18 to 65 years 3. Patients were allowed to have a diagnosis on Axis I other than the exclusion criteria PRIMARY OUTCOME: General psychological distress assessed using the Symptom Checklist‐90 (SCL‐90; Dutch version by Arrindell & Ettema, 1986). The SCL‐90 is a 90‐item self‐report questionnaire which measures the following complaints: Agoraphobia, Anxiety, Depression, Somatic complaints, Insufficiency of thinking and doing, Interpersonal sensitivity, Hostility, Sleeping problems. The sum score represents a Global Severity Index. The Dutch version is reliable (Cronbach’s alpha 0.97 by total score) and valid (Arrindell & Ettema, 1986). In this study the Cronbach’s alpha for the total score was 0.88. We used the Global severity index (GSI) as primary outcome.; ; Method of measurement:; Questionnaire (self‐assessment); ; Timepoints:; T1: Before the start of the therapy; T2: Directly after the last therapy session; T3: One month after T2 SECONDARY OUTCOME: 1. Mindfulness assessed with the Mindfulness Attention Awareness Scale (MAAS, Brown & Ryan, 2003; Dutch version by Schroevers, Nyklícek, & Topman, 2008). The MAAS is a 15‐item self‐report questionnaire which represents the frequency of everyday mindfulness experiences. Previous studies found a one‐factor structure. Cronbach’s alpha ranged between .82 ‐ .87 (Carlson & Brown, 2005; Brown & Ryan, 2003). The Dutch version is reliable (Cronbach’s alpha 0.81) and valid (Schroevers, Nyklícek, & Topman, 2008). In this study the Cronbach’s alpha was 0.86. This study used the sum score of the MAAS as an index of mindfulness ; ; 2. Self‐esteem assessed using the Rosenberg Self‐Esteem Scale (RSES, Rosenberg, 1965; Dutch version by Franck, de Raedt, Barbez, & Rosseel, 2008). The RSES is a 10‐item self‐report questionnaire assessing the degree of self‐esteem. The Dutch version of the RSES is reliable (Cronbach’s alpha 0.86) and valid (Franck, de Raedt, Barbez, & Rosseel, 2008). The Cronbach’s alpha in this study was 0.87. This study used the sum score of RSES as a measure of self‐esteem. ; ; 3. Schemas assessed with the Young Schema Questionnaire, (YSQ; Young & Brown, 1994; Dutch version by Rijkeboer, 2005). The YSQ is a 205‐item self‐report questionnaire which represents sixteen dysfunctional schema’s: Abandonment/ Instability, Mistrust/Abuse, Emotional Deprivation and Social Isolation/Alienation (schema domain 1: Disconnection and Rejection); Dependence/Incompetence, Enmeshment/ Undeveloped Self and Failure (schema domain 2: Impaired Autonomy and Performance); Entitlement/ Grandiosity and Insufficient Self‐control/Self‐discipline (schema domain 3: Impaired Limits); Subjugation and Selfsacrifice/ Approval Seeking/Recognition Seeking (schema domain 4: Other Directedness); and Emotional Inhibition and Unrelenting Standards/Hypercriticalness (schema domain 5: Overvigilance and Inhibition). The Dutch version of the YSQ is reliable (Cronbach’s alpha ranging .76 ‐ .95) and valid (Rijkeboer & van den Bergh, 2006). For the purpose of this study the trialists used the five schema domains. ; ; 4. Schema modes assessed with the Schema Mode Inventory‐I (SMI‐I; Young et al., 2007). The SMI‐I is a 118‐item self‐report questionnaire which represents fourteen modes divided over four domains: Vulnerable child, Angry child, Enraged child, Impulsive child, Undisciplined child (child mode domain), Compliant surrenderer, Detached protector, Detached self‐soother, Self‐aggrendizer, Bully/Attack mode (coping mode domain), Punitive parent, Demanding parent (parent mode domain), Happy child and Healthy adult (healthy mode domain). The Dutch version of the SMI‐I is reliable (Cronbach’s alpha ranging between .79 ‐ .96) and valid (Lobbestael, van Vreeswijk, Spinhoven, Schouten, & Arntz, 2010). For the purpose of this study the trialists used the four mode domains.; ; Method of measurement:; Questionnaire (self‐assessment); ; Timepoints:; T1: Before the start of the therapy; T2: Directly after the last therapy session; T3: One month after T2