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Schema therapy for violent PD offenders: a randomized clinical trial
- David P. Bernstein, Marije Keulen-de Vos, Maartje Clercx, Vivienne de Vogel, Gertruda C. M. Kersten, Marike Lancel, Philip P. Jonkers, Stefan Bogaerts, Mariëtte Slaats, Nick J. Broers, Thomas A. M. Deenen, Arnoud Arntz
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- Journal:
- Psychological Medicine / Volume 53 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 15 June 2021, pp. 88-102
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Background
Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.
MethodsWe compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.
ResultsPatients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).
ConclusionsThese findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. 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Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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An ocean-ridge type magma chamber at a passive volcanic, continental margin: the Kap Edvard Holm layered gabbro complex, East Greenland
- Stefan Bernstein, Minik T. Rosing, C. Kent Brooks, Dennis K. Bird
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- Geological Magazine / Volume 129 / Issue 4 / July 1992
- Published online by Cambridge University Press:
- 01 May 2009, pp. 437-456
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The gabbros of the Tertiary Kap Edvard Holm Layered Serieshave a stratigraphic thickness of more than 5000 m. Earlier work has shown that the range in cumulus mineral compositions is restricted (plagioclase An81—An51; olivine Fo85—Fo66; pyroxenes Ca43Mg46Fe11 to Ca43Mg37Fe20). Field evidence of magma injections is common, which together with the restricted range in mineral chemistry suggests that the magma chamber was frequently replenished by a less fractionated magma. A detailed study of a 600 m section (900–1500 m) in the Lower Layered Series reveals a period of crystallization when the magma chamber behaved as a closed system (900–1300 m). The rocks formed during this periodare well-laminated olivine–gabbros (900–110 m), which evolved to well-laminated oxide-gabbros (1100–1300 m). Compositional trends in the cumulusminerals are towards more evolved compositions (plagioclase An64—An58, pyroxene Mg# from 80 to 76) with stratigraphic height. From 1300 m to 1500 m, granular olivine-gabbros dominate, with moreprimitive mineral compositions (plagioclase An67—An76, pyroxene Mg# from 78 to 82). The transition olivine–gabbro to oxide-gabbro at 1100m is a consequence of fractional crystallization, and it is shown how changes in activities of FeO and Fe203 in the magma are reflected in the total iron content of plagioclases.The transition from oxide-gabbro to olivine-gabbro at 1300 m results from replenishment by less evolved basaltic magma. On the basis of calcic pyroxene chemistry and the mineral crystallization sequence it is concluded that the Kap Edvard Holm Layered Series crystallized from a tholeiitic magma similar to MORB. Melanogabbroic units occur throughout the intrusion as discordant to subconcordant sill-like bodies 0.2–2.0 m thick. The melanogabbroic units consist of Cr-rich augite-olivine-plagioclase heteradcumulates and contain deformed mica crystals of pre-emplacement origin. These units crystallized from a wet, MgO-rich magma which was injected into the layered host gabbros after the formation of the cumulus pile, but before the magma was completely solidified.
The Kap Edvard Holm Layered Series has several parallels with the plutonic part of ophiolite sequences. These include: cumulus mineral assemblage, compositions of the minerals and the restricted range in compositions with stratigraphic height; field evidence of repeated replenishment of basaltic magma; dyke swarms overlying the roof zone of the magma chamber; and the existence of a late intrusive suite of wet, MgO-rich magma. These parallels suggest that the processes involved in the formation of the Kap Edvard Holm Layered Series were similar to those involved in the formation of the crustalpart of many ophiolites and beneath present-day spreading ridges. The Kap Edvard Holm Layered Series is therefore believed to represent a shallow-level magma chamber which acted as a reservoir for basaltic flows at the continental margin during the opening of the North Atlantic Ocean.
Formation of wehrlites through dehydration of metabasalt xenoliths in layered gabbros of the Noe-Nygaard Intrusion, Southeast Greenland
- STEFAN BERNSTEIN, DENNIS K. BIRD
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- Geological Magazine / Volume 137 / Issue 2 / March 2000
- Published online by Cambridge University Press:
- 01 March 2000, pp. 109-128
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The Noe-Nygaard Intrusion is a 4 × 2.5 km stock composed of layered gabbros and wehrlites within the Precambrian basement of the coastal mountains west of the Kialineq Plutonic Complex. Transgressive relationships to Tertiary mafic dykes and the occurrence of abundant metabasaltic xenoliths signify a Tertiary age for the intrusion. The intrusion is characterized by alternating zones of gabbro and wehrlite; gabbro is both intruded and replaced by wehrlite, and the wehrlite zones are characterized by abundant metabasaltic xenoliths. Based on 87Sr/86Sr ratios, mica, olivine and oxide gabbros are all cumulates, crystallized at different differentiation stages from a common parental magma. Field relations, together with similarities in strontium isotope ratios, and in the major and rare earth element (REE) mineral chemistry between gabbros and wehrlites, indicate that the wehrlite bodies were formed by the dissolution of plagioclase from a gabbro cumulate mush by H2O derived from dehydration and the partial assimilation of metabasaltic xenoliths. In terms of their REE characteristics, melts from which the Noe-Nygaard Intrusion crystallized are within the compositional range of melts for other early Tertiary mafic/ultramafic complexes of East Greenland. However, they were generated at a greater mean melting pressure, and have less radiogenic strontium isotope ratios than the nearby Imilik mafic/ultramafic complex, supporting existing models for mantle heterogeneity at the time of continental break-up. The abundance of metabasaltic xenoliths in the Noe-Nygaard Intrusion provides further evidence for the lateral extent of the North Atlantic flood basalt province, which onshore has been mostly removed by glacial erosion south of 68° N in Greenland.
Petrology and geochemistry of the Kruuse Fjord Gabbro Complex, East Greenland
- JOHN G. ARNASON, DENNIS K. BIRD, STEFAN BERNSTEIN, NICHOLAS M. ROSE, CRAIG E. MANNING
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- Geological Magazine / Volume 134 / Issue 1 / January 1997
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- 01 January 1997, pp. 67-89
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The Kruuse Fjord Gabbro Complex is a composite intrusion of layered gabbro and troctolite with subordinate ultramafic rocks and minor trondhjemitic bodies. It was emplaced into Archaean continental crust of East Greenland during early Tertiary rifting of Greenland from Eurasia. The work to date has identified an outer gabbro series and an inner troctolite series, and these are separated by a narrow zone of trondhjemitic intrusions. In the southeast, the partially crystallized cumulates of the gabbro series were intruded by a lenticular, ultramafic pluton 800 m in thickness. Volumetrically minor, syenite–trachyandesite net-veined dykes and later, diabase dykes cross-cut the plutonic rocks. Structural and topographic features suggest that the layered rocks were affected by synmagmatic subsidence and deformation but not by monoclinal coastal flexure.
The gabbro series is composed of a marginal gabbro unit, about 20 m wide, bordering more than a 2 km thickness of layered olivine and magnetite gabbro cumulates. The marginal gabbro is interpreted to be chilled magma. The layered cumulates are the product of repeated injections of magma that fractionated in an open-system magma chamber. Anorthositic and troctolitic layers in the lower part of the sequence may represent inputs of magma and suggest that the order of cumulus mineral crystallization was (1) plagioclase (An39–85), (2) olivine (Fo46–82), (3) augite (Wo28–47En39–58Fs8–18 ) and (4) magnetite. The disappearance of cumulus magnetite and a reversal in mineral compositions at 1.5 km from the base of the succession suggests a major input of magma occurred at this height. In the troctolite series, the composition of cumulus minerals, mineral crystallization sequence and style of emplacement are similar to those in the gabbro series. The ultramafic pluton is composed of coarse-grained wehrlite, olivine melagabbro and troctolite that were formed by at least three injections of magma. The typical mineral crystallization sequence was (1) cumulus chromite and olivine (Fo84–88); (2) poikilitic chrome diopside (Wo29–51En43–63Fs3–13 ); and (3) intercumulus plagioclase (An75–90), phlogopite, apatite and localized disseminated sulphides containing Au and platinum-group elements.
Comparison of crystallization sequences and the major and trace element compositions of clinopyroxene suggests that the gabbroic and troctolitic rocks formed from a magma represented by the chilled marginal gabbro, a tholeiitic basalt magma similar to E-MORB, whereas the ultramafic rocks formed from a magma that was relatively enriched in incompatible trace elements and volatiles. The association of these two magma types is an example of bimodal mafic–ultramafic magmatism in a rifting environment.
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