Personality Disorders

Brown, G. K., Newman, C. F.; Charlesworth, S. E., Crits-Christoph, P., & Beck, A. T. (2004). An Open Clinical Trial of Cognitive Therapy for Borderline Personality Disorder. Journal of Personality Disorders, 18(3), 257-271.

Correspondence Address:
Gregory K. Brown, 3535 Market St., Room 2030, Philadelphia, PA, US, 19104-3309, , gregbrow@mail.med.upenn.edu .

Abstract
Although borderline personality disorder (BPD) is a major public health concern, psychotherapeutic trials have been limited. The present uncontrolled clinical trial examines whether cognitive therapy for BPD is associated with significant improvement on measures of psychopathology. A total of 32 patients with BPD, who also reported suicide ideation or who engaged in self-injury behavior, received weekly cognitive therapy sessions over a 1-year period as described by Layden et al. (1993). The results revealed significant and clinically important decreases on measures of suicide ideation, hopelessness, depression, number of borderline symptoms and dysfunctional beliefs at termination and 18-month assessment interviews. Implications for further research with this difficult-to-treat patient population are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317-328.

Correspondence Address:
Joan M. Farrell, Indiana University, School of Medicine, Department of Psychiatry, Center for Borderline Personality Disorder Treatment & Research, Larue D. Carter Memorial Hospital, 2601 Cold Spring Road, Indianapolis, IN, US, 46222, joan.farrell@fssa.in.gov .

Abstract
This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N = 32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p < .001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Matusiewicz, Alexis K., Christopher J. Hopwood, Annie N. Banducci, and C.W. Lejuez. “The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders.” Psychiatric Clinics of North America, Vol. 33, Issue 3 (September 2010): 657-685.

Correspondence Address:
Center for Addictions, Personality and Emotion Research, University of Maryland, 2103 Cole Field House, College Park, MD 20742, USA. clejuez@psyc.umd.edu

Abstract
“This article provides a comprehensive review of cognitive behavioral therapy (CBT) treatments for personality disorders (PDs), including a description of the available treatments and empirical support, drawing on research published between 1980 and 2009. Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs, thereby making it a useful framework for clinicians working with patients with PD symptomatology. There is a clear need, however, to develop and evaluate CBT in order to provide specific and more unambiguous treatment recommendations with particular relevance for understudied PDs.”

Ryum, T., Stiles, T.C., Svartberg, M., & McCullough, L. (2010) The effects of therapist competence in assigning homework in cognitive therapy with cluster C personality disorders: Results from a randomized controlled trial. Cognitive and Behavioral Practice .

Correspondence Address:
Trull Ryum, Norwegian University of Science and Technology, Norway.. , truls.ryum@svt.ntnu.no .

Abstract
Therapist competence in assigning homework was used to predict mid- and posttreatment outcome for patients with Cluster C personality disorders in cognitive therapy (CT). Twenty-five patients that underwent 40 sessions of CT were taken from a randomized controlled trial (Svartberg, Stiles, & Seltzer, 2004). Therapist competence in assigning homework was rated by 2 independent raters assessing a session early in treatment (mostly Session 6) using the Cognitive Therapy Scale (CTS; Young & Beck, 1980). Higher ratings of therapist competence in assigning homework predicted a positive outcome at both mid- and posttreatment, even when controlling for initial symptom improvement. The results indicated that therapist competence in assigning homework is important for both symptom reduction and personality change in CT in the treatment of patients with Cluster C personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., Laurenceau, J. P., & Beck, A. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74, 337-345.

Correspondence Address:
Adele M. Hayes, University of Delaware, Department of Psychology, 108 Wolf Hall, Newark, DE, US, 19716-2577, ahayes@psych.udel.edu.

Abstract
Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last session. Alliance variables were patients' first alliance rating and "rupture-repair" episodes, which are disruptions in the therapeutic relationship that can provide corrective experiences and facilitate change. Stronger early alliances and rupture-repair episodes predicted more improvement in symptoms of personality disorder and depression. This work points to potentially important areas to target in treatment development for these personality disorders. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Van Wel, B., Kockmann, I., Blum, N., Pfohl, B., Black, D. W., & Heesterman, W. (2006). STEPPS group treatment for borderline personality disorder in the Netherlands. Annals of Clinical Psychiatry, 18, 63-67.

Correspondence Address:
Donald W. Black, Psychiatry Research, University of Iowa Carver College of Medicine, 2-126-B MEB, Iowa City, IA, US, 52242, donald-black@uiowa.edu.

Abstract
Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a new cognitive group treatment for outpatients with borderline personality disorder. Methods: The English and Dutch language literature was reviewed on the STEPPS program. Results: STEPPS was introduced in The Netherlands in 1998 under the acronym VERS. Reasons for its rapid dissemination throughout Holland include a user-friendly manual, its 20-week duration, ability to maintain the patient's current treatment team, and ease of therapist training. Two pilot studies, one in the US and one in The Netherlands, suggest its efficacy. Randomized controlled trials are now underway. Conclusions: STEPPS has become widespread in The Netherlands, and is now being modified for other settings, such as programs for adolescents. (PsycINFO Database Record (c) 2006 APA, all rights reserved)