Treating Personality Disorders PDF

Treating Personality Disorders Research How do we know if a treatment works? Randomized clinical (controlled) trial (RCT) Goal of RCT: maximize internal validity Confidence that treatment effects are due to the treatment, and not to other things (confounding vari...

Treating Personality Disorders Research How do we know if a treatment works? Randomized clinical (controlled) trial (RCT) Goal of RCT: maximize internal validity Confidence that treatment effects are due to the treatment, and not to other things (confounding variables) RCTs Types: No treatment/waitlist control group Compares a treatment to what would happen if a client received no care Attention control group Compares a treatment to what would happen if a client received attention, but no actual treatment from a clinician Treatment as usual (TAU) Compares a treatment to whatever is already being done in the community Another treatment Compares a treatment to another treatment RCTs Pros: Can provide excellent info about what really works for which types of clients Cons: Clients often carefully selected, may not be representative of “real world” clients Treatment is more rigid than in “real world” (meant to be comparable for all participants to maximize internal validity) Clients don’t choose their therapist Difficulties in treating PDs Issues are long-standing, pervasive throughout several domains of life Lack of flexibility is a feature of PDs High levels of comorbidity Clinician bias and burnout Interpersonal issues seen in PDs can make rapport-building difficult No single agreed upon etiology High dropout rates Low motivation/engagement in treatment Cognitive therapy Aaron Beck (1921-2021) Disorders have evolutionary roots People react according to patterns shaped by evolutionary history Disorders = “persistent phylogenetic patterns designed to accommodate to the vicissitudes of prehistoric life.” Axis I = coping with maladaptive conditions PDs = maladjustment to more stable circumstances Cognitive therapy Strategy PD Predatory Antisocial Help-eliciting Dependent Competitive Narcissistic Autonomous Schizoid Defensive Paranoid Withdrawal Avoidant Ritualistic Compulsive  CBT Core Beliefs Intermediate Beliefs Automatic Situation Emotion Behavio Thoughts (interpretatio s rs n)  Example: narcissism Core belief I am a failure. Conditional belief If I don’t succeed, I am a failure. Compensatory belief I am special. Succeeding proves I’m special. I must be the best at everything. People must regard me as the best. Rule Succeed at everything. Demonstrate my superiority. Strategy Treating ASPD/psychopathy Challenges: Predicting dangerousness and recidivism is incredibly difficult! No generally accepted treatments developed “A review of the literature suggests that a chapter on effective treatment should be the shortest in any book concerned with psychopathy. In fact, it has been suggested that one sentence would suffice: No demonstrably effective treatment has been found.” (Suedfeld & Landon, 1978, p. 347) Treating ASPD/psychopathy Summary Not a lot of research (BPD excepting) Motivation for change?