The Effects of Schema Therapy in Outpatient Forensic Mental Health Care: a Single Case Multiple-baseline Study.

Forensic psychiatry aims at reducing recidivism risk by treating mental or psychiatric problems. In forensic psychiatry approximately between 42 and 84% of the patients have PDs. Individuals with PDs have an increased risk of violence and a higher recidivism risk than offenders without PDs. Consequently, in outpatient forensic mental health settings, PDs are both assessed and treated. Treatment of PDs with ST was demonstrated to be effective in regular mental health care. For forensic patients, ST was adjusted by adding specific modes. This adjustment showed promising results. However, this study was limited to closed forensic psychiatric hospitals where patients were admitted mandatorily. In recent years, there has been a development in the field of personality and PDs with more attention for personality functioning (PF) as the core of personality pathology. This is described in Criterion A of the Alternative Model for Personality Disorders (AMPD) in the DSM-5 section III. Some instruments that measure PF, for instance the SIPP-118 are applicable to measure the change in PF as an effect of treatment. In forensic outpatient mental health, as far as we know, no specific instrument has been identified as a routine outcome monitoring during PD treatment. This study will examine the outcome of ST for PDs in forensic outpatient mental health. To our knowledge this has not been studied before. We will examine three primary outcomes. A first outcome is measured in terms of changes towards more adaptive schemas and modes. A second outcome is defined in terms of reducing recidivism risk. Thirdly, we will investigate whether the concept of severity of PF as described in Criterion A of the AMPD in the DSM-5 is useful to monitor the effect of ST treatment for these patients. Because having a PD is known to correlate with experiencing a lesser quality of life and having other psychological problems, these concepts are secondary outcome variables for the effect of treatment.