Mental health consists of the absence of mental disorders and the presence of mental well-being. However; mental health care currently focuses mainly on mental disorders and less on promoting mental well-being. And yet people with personality problems often score very low on well-being. In order to work on sustainable mental health, attention is needed for both mental complaints and well-being and this is achieved through promoting psychological adaptation.

Psychological adaptation is the process in which a person deals in a healthy way with their own needs, emotions and inner signals (such as stress) as well as the smaller or larger challenges in life. For people with personality problems psychological adaptation is also low, they mainly react in rigid patterns.

Creative arts and psychomotor therapies (CAPTS) are a non-verbal form of therapy in which various creative methods, such as theater, sports, dance, music and sports methods, are used to make contact with emotions and to practice healthier ways of dealing with them. This is very suitable for working on promoting psychological adaptivity, within a safe and playful context. It's about doing and experiencing, and discovering what works for you personally, more than talking and understanding.

That this is effective is endorsed by professionals and clients in mental health care, but scientific evidence is still scarce. That is why a specially developed, CAPTS module for people with personality problems will be investigated in a mixed methods design. We focus on both effectiveness and working mechanisms in a Multiple Baseline Single Case Experimental Design and a qualitative approach.

Personality disorders are common psychiatric disorders. 5%-10% of all Dutch people have a personality disorder. The best-known personality disorders are borderline, narcissistic and avoidant personality disorders. Personality disorders often arise in adolescence. Deep-seated limitations in behavior, thoughts, feelings, connection and intimacy lead to long-term dysregulation in dealing with oneself and others. This causes problems in several areas of life that patients can no longer solve themselves, including difficulties in intimate relationships and incapacity for work. Specialist treatment can turn the tide.

Creative arts and psychomotor therapies (CAPTS) are often a permanent part of the treatment for personality disorders, in addition to psychotherapy and psychotropic drugs. The treatment tradition of the CAPTS spans approximately a century and includes the disciplines: art, drama, dance, music and psychomotor therapy. For professional therapists, the patients' request for help is the starting point. The treatments for the various personality disorders therefore often overlap. The CAPTS focus on experiencing and doing. Feelings, thoughts and behavioral patterns emerge through making art, play, music or physical sensation. Awareness and (self) reflection are stimulated and new roles and skills are practiced in a safe manner.

With CAPTS, patients with a personality disorder can develop more appropriate ways of relating to themselves and others. To date, little practice-oriented research has been conducted into the treatment of personality disorders with occupational therapy. However, the Dutch Healthcare Institute insists on substantiation of the effectiveness of the CAPTS to justify its reimbursement. There is also an increasing demand for this from the professional organizations of professional therapists and patient organizations.

Existing treatments for personality disorders are aimed at reducing complaints. However, mental health also consists of the presence of well-being. Well-being is about whether someone feels good psychologically, emotionally and socially. Even if patients have physical and psychological complaints. Patients with a personality disorder often have low well-being. Promoting well-being is an important step towards their recovery, which is an important treatment goal according to the treatment guideline. Working on better psychological adaptation is how this can be achieved, one will get more adaptive to their own emotional needs within the context of daily life. Wellbeing will be improved accordingly.

CAPTS professionals indicate that no specific treatment module with CAPTS interventions has yet been developed to promote the psychological adaptation and well-being of patients with a personality disorder. From a professional point of view, they feel the need for this, because that is precisely where their strength lies. Patient organizations confirm the importance of this from the patient perspective.

When developing and evaluating CAPTS interventions, it is therefore important to promote psychological adaptation and well-being of patients with a personality disorder, in addition to reducing complaints.

In summary, personality disorders are common and serious psychiatric disorders that impair psychological and social functioning. CAPTS treatment is promising for promoting psychological adaptation and well-being of patients with personality disorders. However, treatment specifically aimed at this is not yet available in practice. Practical research into the development and evaluation of CAPTS interventions meets an important and immediate need in the professional field and is in line with the treatment guidelines for personality disorders and various national research agendas. From a social perspective, the proper treatment of people with serious psychological suffering is an important issue.

Research Question:

How can the various CAPTS disciplines promote psychological adaptivity in patients with a personality disorder and what is the effect of this approach on complaint reduction and well-being?

Aim of this research:

Designing and testing a practical and broadly applicable module with CAPTS interventions and a practical manual that promote psychological adaptation and well-being of people with personality disorders.

Inclusion Criteria:

• being diagnosed with one or more PD according to the DSM-V criteria
• being motivated for CAPTs
• able to participate in group therapy

Exclusion Criteria:

• acute psychosis or crisis
• prominent PTSD symptoms which require specialised trauma treatment
• a suspected eating disorder defined as a BMI lower than 18,
• an IQ below 85,
• insufficient command of the Dutch language.

We will make IPD available, but personal data will not be shared at all. Using a doi for the processed data giving a description of the meta-data and then data can be requested at the principal investigator, to whom data requests can be sent.

After publication of the main paper until 10 years after this publication.

The principal investigator will investigate whether requests are reasonable and feasible and adhere to ethical considerations.