Impact of personality disorder comorbidity on cognitive-behavioral therapy outcome for mood and anxiety disorders: results from a university training clinic

Abstract

This study examined the impact of co-occurring personality disorder (PD) pathology on mood and anxiety symptom improvement in response to non-manualized, short-term, cognitive-behavioral therapy (CBT) delivered by trainees. The sample comprised 305 adult outpatients treated individually for mood (unipolar depression) and anxiety disorders [generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD), specific phobia, obsessive-compulsive disorder (OCD)] by doctoral students within a university training clinic. After comprehensive assessment of psychopathology, symptom-specific measures were administered at pre- and end-treatment. Both magnitude of disorder-specific mood and anxiety symptom change, as well as treatment outcome classification (via reliable change and clinical significance indices) were utilized to assess treatment response. Results indicated that patients treated for depression, GAD, panic disorder, SAD, and specific phobias evidenced significant reductions in symptoms, irrespective of PD presence, and there was no interaction between PD comorbidity and level of symptom improvement. Among patients treated for OCD, PD pathology negatively impacted OCD symptom improvement. When treatment outcome was determined categorically, PD presence had a deleterious effect on clinical recovery only among patients treated for GAD. Neither the number of PD diagnoses nor PD cluster type moderated results. In conclusion, in most instances (with the exception of GAD and OCD patients), individuals with PDs treated by graduate student trainees within a university training clinic experienced significant mood and anxiety symptom improvement in response to short-term CBT, and these improvements were comparable to those without co-occurring PDs.

Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis

“…PD cases were also more likely to have a higher number of comorbid Axis I disorders and overall clinical and social impairment at intake. However, few studies (k = 4) analysed treatment outcome comparisons adjusted for intake depression severity (Hardy et al 1995;Harte & Hawkins II;Shea et al 1990;Tyrer et al 1990).…”

“…Newer studies have emerged on the relation between PD and depression treatment outcomes (e.g., Harte and Hawkins 2016;van Bronswijk et al 2018), warranting a more focussed review of the evidence pertinent to contemporary CBT practice, and specifically of the effectiveness of CBT for depression in patients with comorbid PDs. This has potentially profound clinical implications.…”

Anxiousness, Self-esteem, and Anxiety: Which Variable is a Predictor?

“…Currently, along with a psychological construct self-esteem, the studies on anxiety and anxiety disorder have been widely discussed and their correlated risks and protective factors by the scientists mediating relation of personality variables to the relation of anxiety to other illnesses or personality constructs; as well as to the impacts of anxiety disorders and a high level of anxiety for experiencing, behaviour or personality of an individual and the research of moderators or mediators or impacts of treatments or psychological and therapeutic interventions on particularly diagnosed disorder and/ or other indicators of the quality of life of an individual with anxiety disorder [10][11][12][13][14][15][16][17][18][19][20][21]. We can also state that the studies on anxiety and anxiety disorders have been carried out throughout many cohorts of population, e.g.…”

The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial

“…7 However, there were also psychotherapy studies which failed to find a negative effect of personality disorder on treatment outcome. 8,9 The strong treatment focus of the examined therapies (in other words, CBT) on depression may explain why the presence of comorbid personality disorder had no effect on that treatment focus.…”