A Mixture of Individual and Group Schema Therapy Superior for the Treatment of Borderline Personality Disorder

Depressed young woman sharing while sitting with friends and mental health instructor in group meeting at classroom
Patients with borderline personality disorder were recruited at 15 sites in 5 countries between 2010 and 2016 for this CONSORT trial.

For borderline personality disorder (BPD), a multicenter randomized clinical trial found individual and group schema therapy (IGST) was more effective than predominately group schema therapy (PGST) or treatment as usual (TAU). These findings were published in JAMA Psychiatry.

Patients (N=495) with BPD were recruited at 15 sites in 5 countries between 2010 and 2016 for the CONSORT (Consolidated Standards of Reporting Trial) trial. Participants were randomized to receive TAU (n=246), PGST (n=125), or IGST (n=124). PGST comprised 2 group sessions per week for 1 year with a maximum of 12 individual sessions and in year 2, group sessions occurred weekly in months 13-18, every other week in months 19-21, and monthly in months 22-24 with a maximum of 5 individual sessions.

IGST comprised 1 individual and 1 group session per week for 1 year and in year 2, bi-weekly individual and group sessions in months 13-18, biweekly group and monthly individual sessions in months 19-21, and monthly group and individual sessions in months 22-24. The primary outcome was BPD severity through year 3 as measured by the BPD Severity Index (BPDSI).

Patients in the TAU, PGST, and IGST cohorts were aged mean 33.89 (standard deviation [SD], 9.55), 33.20 (SD, 9.33), and 33.46 (SD, 9.17) years; 86.2%, 87.2%, and 85.4% were women; and BPDSI scores were 31.63 (SD, 8.60), 30.95 (SD, 8.75), and 30.44 (SD, 8.74) points, respectively.

The combined intervention recipients exhibited more significant differences to BPD severity than the TAU recipients (Cohen d, 0.73; P =.001), reaching significance at year 1.5 (mean difference, 2.38; 95% CI, 0.27-4.49; P =.03).

Stratified by intervention, IGST was superior to TAU (Cohen d, 1.14; P <.001) and PGST (Cohen d, 0.84; P =.03). IGST became more effective at year 1 compared with TAU (difference, 2.59; P =.048) and year 2.5 compared with PGST (difference, 2.68; P =.04). PGST did not differ from TAU (Cohen d, 0.30; P =.32).

IGST was superior with regards to treatment retention at years 1 and 2 compared with either treatment arms.

Stratified by BPD traits, IGST was superior to TAU for 7 subscales (all P <.001) and trended to be superior to PGST for 2 subscales (P =.07). No subscales differed between PGST and TAU (all P >.99).

More TAU recipients (2.1%) exhibited a ≥11.70-point increase in BPSDI scores compared with PGST (1.25%) or IGST (0.88%).

This study was limited by the consequences of the 2007-2008 worldwide financial crisis, in which some study sites withdrew participation due to financial cutbacks.

The study authors concluded, “In this randomized clinical trial, IGST was more effective in reducing the severity of BPD compared with TAU and PGST. However, PGST was not more effective than TAU. The international multicenter design, the size of the study population, and the execution of the study in regular mental health services that were treating BPD support the generalizability of the results.”

Disclosure: Multiple authors declared industry affiliations. Please refer to the original article for a full list of disclosures.


Arntz A, Jacob GA, Lee CW, et al. Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: a randomized clinical trial.JAMA Psychiatry. Published online March 2, 2022. doi:10.1001/jamapsychiatry.2022.0010