interventions for personality pathology

what are empirically supported treatments (evidence based treatments)

treatments identified by the APA found to be efficacious and effective for one or more psychological conditions

which personality disorder has the most empirically supported treatments

borderline

why are there not alot of empirically supported treatments

people feel like they don’t need psychotherapy

pathology might interfere with seeking treatment

PD’s are ‘life-long’ disorders = little incentive to create treatments for something ‘incurable’

many current treatments are ineffective

therapy for paranoid - Psychodynamic approach

object relations- focus on relationships

goal is to resolve anger that was developed from the past and improve views on desiring satisfying relationships

therapy for paranoid - Cognitive Behavioral approach

use anxiety-reduction techniques to reduce distress associated with paranoia

improve skills at solving interpersonal problems

develop more realistic interpretations of other’s intentions

therapy for schizoid

many people seek treatment for other disorders (alcohol, depression)

attempt to help them engage and experience positive experiences

provide social skills training to engage in more satisfying social interactions

therapy for schizotypal

goals to help people ‘reconnect’ with the world

• recognize limits of their thinking and powers

increase positive social contacts

connect with feelings

use CBT to teach skills to recognize, evaluate, and challenge unusual thoughts/perceptions

why are there not many therapy options for antisocial pd

lack of conscience, desire to change, or respect for therapy interfere with treatment

potential antisocial therapy

CBT: guide individuals towards thinking more about moral issues and the needs of others - unsupported by research

early intervention with conduct disorder

why are there not many therapy options for histrionic pd

difficult to treat due to demands, tantrums, and seductiveness of patients

patients may pretend to have important insights or pretend to change during treatment to appease therapist’s demands

potential histrionic therapy

CBT: help change beliefs about helplessness and develop skills for problem solving

Psychodynamic: resolve unconscious disputes leading to histrionic presentations

why are there not many therapy options for narcissistic pd

patients inability to recognize, acknowledge, or confront ‘weakness’

seek treatment for other disorders

patients may try to manipulate therapist and project grandiose attitudes onto therapistp

potential therapy for narcissistic

psychodynamic work in digging into underlying insecurities

CBT to redirect patient to challenge their thoughts and interpret criticism more rationally

schema-focused therapy for narcissism

combination of CBT strats with object relations to change maladaptive schhemas

dialectical behavioral therapy for narcissism

target behaviors and symptoms related to emotion intolerance and dysregulation relating to self-criticism, shame, anger, and insecurity

therapy options for avoidant - psychodynamic

resolve unconscious feelings of inferority

therapy options for avoidant - cognitive-behavioral

changes distressing beliefs and thoughts

persevere when experiencing negative emotions

provide social skill training

engage in social exposure

what is a difficulty in therapy with avoidant

avoidance of the therapist

therapy option for dependent overall

teach patients to accept responsibility for themselves and feel empowered to do so

therapy option for avoidant overall

individuals generally are seeking acceptance and affection from others

therapy option for dependent - psychodynamic

work out dependency needs through transference

therapy option for dependent - cognitive-behavioral

provide assertiveness training

challenge and change assumptions of incompetence and helplessness

therapy option for OCPD overall

often do not see that their rigidity is causing problems

therapy options for OCPD - psychodynamic

recognize how underlying feelings of insecurities are impacting relationships

therapy options for OCPD - cognitive-behavioral

change dichotomous thinking

reduce perfectionism, intolerance to uncertainty, indecisiveness, procrastination, and chronic worrying

therapy option for OCPD - newer developments

radically open DBT

mentalization-based treatment for BPD - overall

focus on mentalizing

• process of making sense of oneself and others by recognizing mental states

• being able to ‘read,’ access, and reflect on internal states of being

attachment

• acknowledging the role of early attachment relationships in the development of mentalizing abilities

focus on the ‘here-and-now’

modest research support

mentalization-based treatment BPD - target symptoms

emotion dysregulation

interpersonal difficulties

identity disturbances

mentalization-based treatment BPD - goals

reduce self-harming behaviors

improve interpersonal functioning

enhance emotion regulation skills

build resilience

schema-focused therapy for BPD

founded on CBT

help patients change their self-defeating symptoms (life patterns) using CBT and emotion-focused techniques

focus on relationships of individual and traumatic childhood experiences

schema-focused therapy - schema modes (BPD)

momentary emotional states and coping mechanisms triggered by underlying schemas

• vulnerable child mode: loneliness, sad, fear

• angry/impulsive child mode

• punitive parent mode: internalized criticism

• healthy adult mode: goal for therapy - nurtured vulnerable child, control of impulsive child, and counteracting punitive parent mode

schema-focused cognitive therapy

challenge and reframe maladaptive beliefs

schema-focused behavioral therapy

practice healthier behaviors and coping strats

schema-focused experiential therapy

use imagery exercises or dialogues to connect with vulnerable aspects of the self

transference-focused therapy for BPD - overall

focus on revealing the underlying causes of symptoms and develop healthier ways of engaging with the self, others, and world

transference-focused therapy - psychodynamic

individuals sense of self and others split into unrealistic extremes of good and bad

• conflicting dyads are expressed through self-destructive symptoms

goal to work through these processes through transference

what is transference

allows the patient to project their thoughts, feelings, and behaviors from past relationships onto the therapist

work through these projections to resolve unconscious disputes

what is integration

brings together fragmented views of oneself (positive & negative) to form more cohesive and realistic sense of self

target dichotomous thinking, all aspects of one’s identity

research support for transference-focused therapy

its mixed evidence

• good outcomes from one randomized controlled trial

• performed similarly to DBT and supportive therapy in another RTC

  • less well than schema-focused therapy in another RTC

what is the gold standard for BPD

DBT - dialectical behavior therapy