Open Access Highly Accessed Study protocol

Implementation of outpatient schema therapy for borderline personality disorder: study design

Marjon Nadort1*, Arnoud Arntz2, Johannes H Smit1, Josephine Giesen-Bloo2, Merijn Eikelenboom1, Philip Spinhoven4, Thea van Asselt5, Michel Wensing3 and Richard van Dyck1

Author Affiliations

1 GGZinGeest, Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, The Netherlands

2 Maastricht University, Department of Clinical Psychological Science, The Netherlands

3 Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, The Netherlands

4 Leiden University, Institute of Psychology and Department of Psychiatry, The Netherlands

5 Maastricht University Medical Center, Department of Clinical Epidemiology and Medical Technology Assessment, The Netherlands

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BMC Psychiatry 2009, 9:64  doi:10.1186/1471-244X-9-64

Published: 6 October 2009



Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD) in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis.


Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%.


The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value.

Trial Registration

The Dutch Cochrane Center, NTR (TC = 1781).