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Dineke Feenstra & Joost Hutsebaut September 2009, Ghent

TRAP: A long term outcome and process study of a residential treatment for treatment refractory adolescents with personality disorders. Dineke Feenstra & Joost Hutsebaut September 2009, Ghent. PTC De Viersprong.

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Dineke Feenstra & Joost Hutsebaut September 2009, Ghent

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  1. TRAP:A long term outcome and process study of a residential treatment for treatment refractory adolescents with personality disorders Dineke Feenstra & Joost Hutsebaut September 2009, Ghent

  2. PTC De Viersprong • PTC De Viersprong is a third line mental health setting. It offers specialized assessment and treatment programs (outpatient, day hospital and inpatient) for adolescents and adults with personality disorders • De Viersprong has its own research department, the VISPD: Viersprong Institute for Studies on Personality Disorders

  3. Research group • Joost Hutsebaut • Dineke Feenstra • Annelies Laurenssen • Jan van Busschbach • Roel Verheul • Els Havermans

  4. Background:Outcome research in adolescents • Progress in child- and adolescent psychotherapy outcome research: • Psychotherapy is an effective treatment for children and adolescents (mood-, anxiety-, eating-, and conduct disorders) (Kazdin & Weisz, 2004). • Improvement in methodological qualities of research (more controlled studies, treatment protocols etc.) (Kazdin, 2002).

  5. Background:Outcome research in adolescents • Limitations in child- and adolescent psychotherapy outcome research: • Uncovered area: personality disorders (PD) in adolescents • Lack of developmental sensitivity: treatment models as well as outcome instruments are little developmentally sensitive • Review of 25 empirically supported psychotherapies in adolescents (Weisz & Hawley, 2002) • 14 effective treatments • 7 adult models, 6 child models, 1 adolescent model (MST)

  6. Background: Treatment of PD in adolescents • Adolescents are left out of multidisciplinary guidelines for the treatment of PD’s • No evidence based models for the treatment of adolescent PD • Few handbooks: Kernberg, 2000 (psychodynamic approach); Bleiberg, 2001 (relational approach rooted in attachment theory); Miller et al., 2007 (DBT); Freeman & Reinecke, 2007

  7. Background:Outcome studies adolescents with PD • Chanen et al., 2008: • RCT Cognitive Analytic Therapy (CAT) versus manualised good clinical care • Rathus & Miller, 2002: • Quasi experimental investigation of an adaptation of Dialectical Behavior Therapy (DBT)

  8. TRAP-study: Rationale • Rationale: • First: little is known about severe personality disorders in adolescents • Second: little is known about intensive inpatient treatment (for personality disturbed adolescents) • Third: we know little about developmental sensitive outcomes of psychotherapy for adolescents

  9. TRAP-study:Objectives • Objective 1: treatment outcome • Objective 2: prediction of treatment outcome • Objective 3: relation between relational changes and relapse

  10. TRAP-study:Design • Naturalistic study • Include 130 adolescents with personality pathology who are admitted to the inpatient unit of the youth department of De Viersprong (duration of treatment is 1 year) • Measurements at start of treatment, 6, 12 and 24 months after the start of treatment

  11. TRAP-study:Instruments

  12. TRAP-study:Sample charachteristics • Sample characteristics (baseline): • N = 133 • Gender = 113 female (85%); 20 male (15%) • Mean age = 16.55 (range 14-19) • Mean IQ = 104 (range 78-137)

  13. TRAP-study:Sample characteristics • Sample characteristics (baseline): • Axis I: 100 adolescents (75.19%) had at least 1 Axis I disorder * Other axis I disorders were diagnosed in less than 10% of the adolescents.

  14. TRAP-study:Sample characteristics • Sample characteristics (baseline): • Axis II: 63 adolescents (47.37%) had at least 1 Axis II personality disorder

  15. TRAP-study:Drop out • Dropping out of the treatment:

  16. TRAP-study:Results symptom level (BSI) • Brief symptom inventory (BSI)

  17. TRAP-study:Results personality functioning (SIPP)

  18. TRAP-study:Results other outcome measures (self report)

  19. TRAP-study:Strengths & limitations • Strengths: • Use of developmentally sensitive (and positive) outcome instruments • Several measuring points • Including severely personality disturbed adolescents • Use of semi structured interviews to assess both Axis I and Axis II disorders • Limitations: • No control group • High level of drop-out • Underrepresentation of boys • No treatment manual

  20. TRAP-study • Conclusion: • A group of severely disturbed adolescents underwent an intensive inpatient treatment program. A large group of these adolescents dropped out of treatment. The adolescents that stayed in treatment showed improvement in symptom level, personality functioning and developmental tasks (f.e. school). • This is a first step (pilot study) in investigating the uncovered area of adolescents with severe personality disorders. Further research is needed, investigating manualized treatment programs with methodologically stronger research designs.

  21. Contact • Website: • www.deviersprong.nl • www.vispd.nl • Email: • dineke.feenstra@deviersprong.nl • joost.hutsebaut@deviersprong.nl

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