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Effectiveness of different forms of psychotherapy for patients with cluster C personality disorder

Effectiveness of different forms of psychotherapy for patients with cluster C personality disorder. Anna Bartak Marieke D. Spreeuwenberg, Helene Andrea, Jan J.V. Busschbach, Roel Verheul, Theo Stijnen, Paul M.G. Emmelkamp Study on Cost-Effectiveness of Personality Disorder Treatment (SCEPTRE)

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Effectiveness of different forms of psychotherapy for patients with cluster C personality disorder

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  1. Effectiveness of different forms of psychotherapy for patients with cluster C personality disorder Anna Bartak Marieke D. Spreeuwenberg, Helene Andrea, Jan J.V. Busschbach, Roel Verheul, Theo Stijnen, Paul M.G. Emmelkamp Study on Cost-Effectiveness of Personality Disorder Treatment (SCEPTRE) Xth International ISSPD Congress, The Hague, September 2007

  2. Background • Few effectiveness studies cluster C • Focus on theoretical orientations • Mostly no differences found • Few comparisons of “dosage” • Ethical problems with randomisation  SCEPTRE: Dosage comparison using a quasi- experimental design

  3. Sample • N = 361 • Mean age = 33.5 (SD=9.5) • 70.1 % women • 29.9 % men • 67.3 % pure cluster C • 23.3 % cluster C & cluster B • 3.9 % cluster C & cluster A • 5.5 % cluster C & cluster A & B

  4. Treatment • Psychotherapy • Different “dosage” groups: • Outpatient up to 6 months (not incl.) • Outpatient more than 6 months (n=63) • Day hospital up to 6 months (n=83) • Day hospital more than 6 months (n=66) • Inpatient up to 6 months (n=75) • Inpatient more than 6 months (n=74)

  5. Outcome measures • GSI (SCL-90) • Psychological symptom distress • OQ-45 • Social role functioning • Interpersonal functioning • EQ-5D • Quality of Life

  6. Times of measurement • Variable • Effect modelling for outcome at 12 months after baseline

  7. Raw change in symptom distressUnpublished – Do not quote

  8. Raw change in social functioningUnpublished – Do not quote

  9. Raw change in interpersonal functioningUnpublished – Do not quote

  10. Raw change in quality of lifeUnpublished – Do not quote

  11. Recovered?Raw recovery ratesUnpublished – Do not quote To compare: in Dutch mental health services, 60% of patients remain ‘unchanged’ after treatment (GAF, data from 2006)

  12. Unbiased effects of different treatment dosages • Comparison of five different dosages • But: pre-treatment differences of patients • Propensity score (PS) “the conditional probability of assignment to a certain treatment group, given the set of observed pre-treatment characteristics”

  13. Propensity Score • Dimensional Assessment of Personality Pathology (DAPP-BQ) • Motivation • Quality of Life (EQ-5D) • Functioning (OQ-45) • Symptom Distress (GSI) • Severity Indices of Personality Problems (SIPP) • Diagnosis (SIDP-IV) • Age

  14. Comparison • Difference scores: Diff = Diff 1 – Diff 2 Diff 2 Diff 1 Treatment 1 Treatment 2

  15. Symptom distressUnpublished – Do not quote

  16. FunctioningUnpublished – Do not quote

  17. Quality of lifeUnpublished – Do not quote

  18. Conclusion • Patients with cluster C personality pathology improve during psychotherapy • Short inpatient therapy (up to 6 months) shows the highest improvement at 12 months after baseline, in terms of symptom distress, social and interpersonal functioning, and quality of life anna.bartak@deviersprong.nl

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