The Evidence Base

A Closer Look at the Research on Schema Therapy

Schema Therapy has a strong and growing evidence base for borderline personality disorder and other complex, longstanding presentations. The summary on our homepage states the headline findings plainly. This page adds the context a clinician evaluating the literature will want, including where the evidence is strongest and where it is still developing.

Network meta-analysis (Setkowski et al., 2023)

A 2023 network meta-analysis of the leading psychotherapies for borderline personality disorder ranked Schema Therapy highest both for reducing symptom severity and for retaining patients in treatment. It is a genuinely encouraging result. The appropriate caveat is that Schema Therapy’s ranking rests on relatively few trial arms compared with the larger evidence base behind DBT, so the ranking should be read as promising rather than settled. More trials will sharpen the picture.

The landmark randomized trial (Giesen-Bloo et al., 2006)

In a three-year randomized controlled trial, roughly half of the patients treated with Schema Therapy no longer met criteria for borderline personality disorder, with lower dropout than the comparison treatment. This remains one of the most cited results in the field. Questions have since been raised about the fidelity of the comparison treatment as delivered, which is worth knowing when weighing the size of the between-group difference. The within-group change, the proportion of patients who recovered, is less sensitive to that concern.

Head-to-head with DBT (Assmann et al., 2024)

The PRO*BPD trial compared Schema Therapy directly with DBT. Both treatments were effective, and neither showed global superiority over the other. The differences were in profile rather than in overall win or loss. DBT tended to reduce anger more quickly, while Schema Therapy showed advantages in quality of life and overall functioning across follow-up. For a clinician, the practical reading is that both are strong options, and the choice can be guided by presentation and treatment goals rather than by a single ranking.

How to read all of this together

Taken as a whole, the literature supports Schema Therapy as a serious, effective treatment for borderline personality disorder, with the strongest single result being the recovery proportion in the 2006 trial and the broadest being its top ranking in the 2023 network meta-analysis. It is not the only effective treatment, and it does not need to be. The honest summary is that it performs at least as well as the other leading specialized treatments, with a distinctive strength in the outcomes clinicians care about after symptoms stabilize.

References

Giesen-Bloo, J., et al. (2006). Outpatient psychotherapy for borderline personality disorder. Archives of General Psychiatry, 63(6), 649–658.
Setkowski, K., et al. (2023). Which psychotherapy is most effective and acceptable in the treatment of borderline personality disorder? A network meta-analysis. Psychological Medicine.
Assmann, N., et al. (2024). Schema therapy versus dialectical behavior therapy for borderline personality disorder (PRO*BPD).