Giovanni Fassone
Introduction: aim of the study was to compare an integrated treatment model of cognitive-evolutionary therapy (double-setting TCE: individual and group psychotherapy) with individual cognitive-evolutionary therapy (individual TCE) in outpatients subjects with personality disorders and/or Axis I comorbidity. The testing hypothesis is that patients treated with double setting-TCE may show lower drop-out rates and better improvement in symptoms pre-post treatment if compared with those treated with control condition. Methods Patients with 18-60 years, with personality disorders (mainly borderline disorder) and/or Axis I comorbidity, that were allocated by preference to one of the treatment conditions. Double setting-TCE consisted in two group sessions (2 hours each) and two individual sessions per month (6 hours treatment per month) presented to the patient as one treatment package; individual-TCE consisted in one weekly session of individual therapy (4 hours treatment per month). Pharmacotherapy was administered in both groups as needed. GAF, BASIS-32 and QoL-I were used to estimate symptoms and social adjustment. Information about previous treatment, drugs, admissions, drop-out from therapy, as well as motivation towards treatment program, impulsive behavior (self harming behavior and substance abuse) were systematically collected for all patients. Evaluations were made at baseline, and after 12, 18 and 24 months of treatment. Treatment in both groups was supposed to last 24 months.
Results A total of 109 subjects were included in the study, the majority of them (83%) being treated in private practice setting. Double setting-TCE (n=85) showed lower drop-out rate if compared to control treatment (19 vs. 65%). This result is confirmed also in BPD patients subgroups (23 vs. 60%). Furthermore, double setting-TCE group showed significant pre-post treatment improvement (baseline vs end of treatment) in all evaluation (VGF, BASIS-32, QoL-I), as well as a significant reduction in the number of self harming behavior and substance abuse behavior. Discussion: a limitation of the study consisted in clinical and diagnostic differences between two groups, individual TCE control group being more severe in terms of symptoms and global functioning, previous admissions, higher drop-out rates. BPD patients were significantly more frequent in this group. This difference may explain all the others. In fact, when only BPD subjects were compared in both groups, no difference was observed. Other limitations and further consideration on internal and external validity are discussed. In conclusion, double setting TCE seem to be more effective than simple individual TCE, in terms of drop-out reduction, symptoms relief and global functioning. In order to stimulate discussion on the role of multiple treatment settings, further investigation is needed to compare double setting TCE, other forms of integrated TCE co-therapy and simple individual TCE.
