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Schema therapy is an effective treatment for avoidant, dependent and obsessive–compulsive personality disorders
  1. Christopher J Hopwood,
  2. Katherine M Thomas
  1. Department of Psychology, Michigan State University, East Lansing, Michigan, USA
  1. Correspondence to Christopher J Hopwood, hopwood2{at}

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What is already known on this topic?

It is difficult to evaluate the effectiveness of personality disorder (PD) assessment and treatment because of unclear boundaries between PDs as conceptualised in the current taxonomy1 and similarly unclear boundaries between concepts of treatments across orientations and manuals.2 Nevertheless, there has been consistent evidence that focused psychosocial interventions lead to symptom reductions in borderline PD.3 Considerably, less is known about how to best treat non-borderline PDs.

What does this paper add?

  • In a large, multisite study, Bamelis and colleagues showed that schema therapy is more effective than clarification-based therapy or treatment as usual in terms of reducing dropout and interview-based PD symptoms and increasing interview-rated functioning for a sample of individuals with a range of primary PDs.

  • This study also highlights how different therapy training protocols can lead to differences in patient dropout and outcome. Specifically, experiential training was generally more effective than lecture-based training in reducing patient distress and dropout.


  • There was little evidence that schema therapy was more useful for improving self-reported functioning or longer term outcomes, suggesting that patients in the study did not experience differential effects of treatments from their perspective.

  • The study is based on a taxonomic system for classifying PDs that is known to be psychometrically problematic.1

  • Ostensible …

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  • Competing interests None.