Warnsveld

Eating disorders EDs are challenging psychiatric conditions with high mortality and often become chronic, lasting an average of six years. Comorbid personality issues like negative core beliefs and early maladaptive schemas EMS are strongly linked to the severity and persistence of EDs. While cognitive-behavioral therapy enhanced CBT-E is the standard first-line treatment focusing on symptoms, it does not address these underlying personality factors. This study aims to evaluate the clinical and cost-effectiveness of group schema therapy GST for ED patients with comorbid personality pathology who do not respond significantly to the initial phase of CBT-E, addressing a crucial gap in treatment options. Participants who have completed the first two phases of CBT-E but show limited improvement will be randomized to either continue CBT-E or start GST. GST begins with five individual sessions introducing the schema therapy model and organizing coping modes, followed by 26 weekly group sessions and up to eight optional individual sessions. A psycho-education webinar for relatives is also included. GST focuses on changing personal coping modes and early maladaptive schemas while supporting healthy adult mode development. CBT-E involves 20 to 40 weekly individual therapy sessions across four phases, targeting eating behavior patterns and relapse prevention. Throughout the study, participants will be assessed at multiple time points before, during, and after treatment, including up to 12 months post-treatment. Evaluations include questionnaires measuring eating disorder symptoms, schema-related beliefs, symptom inventories, quality of life, and treatment costs. These assessments aim to track changes in ED severity, personality pathology, and overall well-being. The study intends to provide evidence on whether GST offers better clinical outcomes and cost benefits compared to continued CBT-E, potentially influencing future standard care for chronic eating disorders.