Follow-up psychotherapy outcome of patients with dependent, avoidant and obsessive-compulsive personality disorders: A meta-analytic review

International Journal of Psychiatry in Clinical Practice (Impact Factor: 1.31). 01/2009; 13(2):153-165. DOI: 10.1080/13651500802570972

ABSTRACT Assessing the number of patients who maintain their gains after the completion of therapy has been of interest to psychotherapy outcome researchers. The current study examines evidence related to the maintenance of treatment gains in individuals diagnosed with Cluster C personality disorders. Fifteen studies, published between 1982 and 2006, met the criteria for inclusion. The effect size standardized mean difference statistic was applied. In the majority of cases, most of the improvement occurred between pretreatment and posttreatment. However, social skills training often produced effect sizes that were larger for posttreatment follow-up. The study indicates that therapy gains are usually maintained at follow-up for Cluster C clients treated with cognitive-behavioral and psychodynamic approaches as well as social skills training. Uncertainty remains whether DPD, AVPD or OCPD patients benefited most from therapy.

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    ABSTRACT: Interpersonal dependency—the tendency to look to others for nurturance, guidance, protection, and support, even in situations where autonomous functioning is possible—has become associated with passivity, immaturity, and dysfunction in the minds of mental health professionals. However, research suggests that dependent persons behave quite actively—even aggressively—in certain contexts. Although dependency is associated with certain forms of dysfunction (e.g., perpetration of domestic violence when close relationships are threatened), it is also linked with an array of adaptive behaviors (e.g., conscientiousness in complying with medical and psychotherapeutic treatment regimens). The cognitive/interactionist (C/I) model of interpersonal dependency provides a framework for understanding contextual variations in dependency-related responding: Although dependent behaviors vary from situation to situation based on perceived opportunities and risks, the dependent person’s core beliefs (a perception of oneself as helpless and weak) and motives (a desire to strengthen ties to potential caregivers) remain constant. Here I discuss theoretical and practical implications of the C/I model and summarize current trends in research on interpersonal dependency.
    Current Directions in Psychological Science 04/2011; 20(2):124-128. DOI:10.1177/0963721411403121 · 3.93 Impact Factor
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    ABSTRACT: Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD. In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST. This trial is the first to compare ST and COP head-to-head with TAU for people with a cluster C, paranoid, histrionic and/or narcissistic PD. By combining clinical effectiveness data with an economic evaluation and with direct information from primary stakeholders, this trial offers a complete and thorough view on ST as a contribution to the improvement of treatment for this PD patient group. Netherlands Trial Register (NTR): NTR566.
    BMC Public Health 01/2012; 12(3):75. DOI:10.1186/1471-2458-12-75 · 2.32 Impact Factor
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    ABSTRACT: Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identified through searches of electronic databases and classified based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identified. We identified 33 RCTs that evaluated the efficacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several efficacious treatments and one well-established treatment for this disorder. In contrast, only five RCTs examined the efficacy of treatments for Cluster C personality disorders, and no RCTs tested the efficacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the first line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.
    International Review of Psychiatry 06/2011; 23(3):282-302. DOI:10.3109/09540261.2011.586992 · 1.80 Impact Factor