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. Methods. We 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. Results. Patients 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). Conclusions. These 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
Abstract: The Problem-Solution Chain (PSC) models proposed in this exploratory paper are conceived as describing chains of problem-solution links, thereby modelling specific multi-link ‘problem-solving’ paths, typically (but not exclusively) from a high-level business problem to lower-level functional solution components. The main elements are ‘Problems’ and ‘Solutions’. These may be selected from purpose-made, domain-specific collections of elements. Single ‘Problem-Solution links’ are comparable to compact, high-level descriptions of design patterns and can be directly related to design problem templates as used in Design Science. Coherent collections of such links would resemble boiled-down representations of pattern languages. Instantiations of PSCs for specific situations aim to help conceptualise and discuss pre-architectural, high-level overviews, for example, of (options for) functionalities or applications representing ‘solutions’ for ‘solving’ some business need or capability ‘problem’. A useful metaphor is that PSCs help describe and discuss basic ingredients (related problems and solutions) for some specific situation, which can later (out of scope here) be developed into a recipe (e.g. an enterprise or process architecture and roadmap) and eventually into an actual dish (realisation of the architecture/solution). Thus, PSCs can, for example, be conceptualisations and conversation aids in the early stages of business-IT alignment efforts and system design. This explorative, practice-oriented paper presents our initial conceptualisation of PSCs. We also present a syntax and notation for problem-solution chains as specified for the Simplified Modelling Platform (SMP), and we briefly discuss the possibility of supporting PSC modelling with guided conversations for PSC modelling. We demonstrate and evaluate our proposed concepts by applying them in a single real case. Much work lies ahead.
We review over 10 years of research at Elsevier and various Dutch academic institutions on establishing a new format for the scientific research article. Our work rests on two main theoretical principles: the concept of modular documents, consisting of content elements that can exist and be published independently and are linked by meaningful relations, and the use of semantic data standards allowing access to heterogeneous data. We discuss the application of these concepts in five different projects: a modular format for physics articles, an XML encyclopedia in pharmacology, a semantic data integration project, a modular format for computer science proceedings papers, and our current work on research articles in cell biology.
