Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial

Arne van den End, Jack Dekker, Aartjan T F Beekman, Inga Aarts, Aishah Snoek, Matthijs Blankers, Chris Vriend, Odile A van den Heuvel, Kathleen Thomaes, Arne van den End, Jack Dekker, Aartjan T F Beekman, Inga Aarts, Aishah Snoek, Matthijs Blankers, Chris Vriend, Odile A van den Heuvel, Kathleen Thomaes

Abstract

Background: Posttraumatic stress disorder (PTSD) is a serious and relatively common mental disorder causing a high burden of suffering. Whereas evidence-based treatments are available, dropout and non-response rates remain high. PTSD and Cluster C personality disorders (avoidant, dependent or obsessive-compulsive personality disorder; CPD) are highly comorbid and there is evidence for suboptimal treatment effects in this subgroup of patients. An integrated PTSD and CPD treatment may be needed to increase treatment efficacy. However, no studies directly comparing the efficacy of regular PTSD treatment and treatment tailored to PTSD and comorbid CPD are available. Whether integrated treatment is more effective than treatment focused on PTSD alone is important, since (1) no evidence-based guideline for PTSD and comorbid CPD treatment exists, and (2) treatment approaches to CPD are costly and time consuming. Present study design describes a randomized controlled trial (RCT) directly comparing trauma focused treatment with integrated trauma focused and personality focused treatment. Methods: An RCT with two parallel groups design will be used to compare the clinical efficacy and cost-effectiveness of "standalone" imagery rescripting (n = 63) with integrated imagery rescripting and schema therapy (n = 63). This trial is part of a larger research project on PTSD and personality disorders. Predictors, mediators and outcome variables are measured at regular intervals over the course of 18 months. The main outcome is PTSD severity at 12 months. Additionally, machine-learning techniques will be used to predict treatment outcome using biopsychosocial variables. Discussion: This study protocol outlines the first RCT aimed at directly comparing the clinical efficacy and cost-effectiveness of imagery rescripting and integrated imagery rescripting and schema therapy for treatment seeking adult patients with PTSD and comorbid cluster C personality pathology. Additionally, biopsychosocial variables will be used to predict treatment outcome. As such, the trial adds to the development of an empirically informed and individualized treatment indication process. Clinical Trial registration: ClinicalTrials.gov, NCT03833531.

Keywords: PTSD; avoidant; cluster C; dependent; imagery rescripting; obsessive-compulsive; personality disorder; schema therapy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 van den End, Dekker, Beekman, Aarts, Snoek, Blankers, Vriend, van den Heuvel and Thomaes.

Figures

Figure 1
Figure 1
Patient flow diagram displaying the participant selection process and expected number of patients.
Figure 2
Figure 2
Overview of the trial procedure for ImRs only and integrated ImRs and ST including treatment and measurement timing. ImRs, imagery rescripting; ST, Schema therapy; SF-PMT, Schema focused psychomotor therapy; IC, Informed consent; FU, follow-up.

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