The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments

Budge, Stephanie L.; Moore, Jonathan T.; Re, A. C. Del; Wampold, Bruce E.; Baardseth, Timothy P.; Nienhuis, Jacob B.

doi:10.1016/j.cpr.2013.08.003

Cited by 66 publications

(55 citation statements)

References 49 publications

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“…Nevertheless, the relative benefits of the available SUD/PTSD treatments are unclear because these treatments have been compared to a heterogeneous group of control conditions ranging from manualized SUD care matched to the experimental interventions on time and attention, SUD‐oriented treatment as usual (TAU), to attention placebos, minimal care, and no care. Variability in the quality of control conditions may influence the estimation of treatment effects (Budge et al., ; Wampold et al., ).…”

mentioning

confidence: 99%

No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co‐Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder

Simpson

Lehavot

Petrakis

2017

Alcoholism Clin & Exp Res

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Prior reviews of behavioral treatments for individuals with comorbid alcohol and drug use disorders (substance use disorder SUD) and posttraumatic stress disorder (PTSD) have not systematically considered whether comparison conditions are matched to target treatments on time and attention. A systematic literature search using PubMed MESH terms for alcohol and substance use disorders, PTSD, and treatment identified relevant behavioral randomized clinical trials (RCTs) that evaluated PTSD-oriented exposure-based treatments, addiction-focused treatments, and coping-based treatments that do not involve exposure to trauma memories. Information pertaining to within-subject changes over time and between-subject differences, quality of control condition, recruitment efficiency, and assessment and treatment retention was synthesized. Alcohol and drug outcomes were described separately when possible. Twenty-four behavioral RCTs were identified: 7 exposure based, 6 addiction focused, and 11 coping based. Seven studies included SUD intervention comparison conditions matched to the target intervention on time and attention. Most of the 24 studies found that participants in both the experimental and control conditions improved significantly over time on SUD and PTSD outcomes. No study found significant between-group differences in both SUD and PTSD outcomes favoring the experimental treatment. Despite greater treatment dropout, there was greater improvement in some PTSD outcomes for exposure-based interventions than the control conditions, including when the control conditions were matched for time and attention. Addiction-focused and coping-based interventions did not generally show an advantage over comparably robust controls, although some coping-based interventions yielded better drug use outcomes than control conditions. When available, interventions that integrate exposure-based PTSD treatment and behavioral SUD treatment are recommended as they are associated with better PTSD outcomes than SUD care matched for time and attention. However, the results of this critical review also suggest that people with SUD/PTSD can benefit from a variety of treatment options, including standard SUD care.

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confidence: 99%

No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co‐Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder

Simpson

Lehavot

Petrakis

2017

Alcoholism Clin & Exp Res

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“…Budge et al, 2013) rather than use a control group (see Bamelis et al, 2014 for a notable exception), which is reflected in the fact that no treatment for a non-BPD PD currently meets APA Division 12 criteria to be an “evidence-based treatment.” One disadvantage to comparing specialized therapies head-to-head without an active control group or a dismantling design (e.g., that therapists cannot use a particular technique in one group but are encouraged to in the other) is that it is unclear to what extent techniques uniquely provided or emphasized by a given specialized therapy for PD (e.g., affect-focused PDT for Cluster-C patients; McCullough et al, 2003) are responsible for any observed change.…”

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confidence: 99%

In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders.

Keefe¹,

Webb²,

DeRubeis³

2016

Journal of Consulting and Clinical Psychology

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Objective Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients’ core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT’s efficacy for these patients. Method CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD – predominantly Cluster-C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. Results As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. Conclusions Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.

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“…Generally, we found higher but decreasing effects in short‐term outpatient and short‐term inpatient psychotherapies and lower but increasing effects in long‐term outpatient and long‐term inpatient psychotherapies. This led to insignificant differences between treatment groups at long‐term follow‐up, which is in line with earlier effectiveness studies on psychotherapeutical treatments and supports the conclusion that differences in effectiveness of active treatments in PD are negligible, also called ‘equivalence effect’ or ‘dodo‐bird effect’ (Wampold et al ., ; Budge et al ., ). Five possible explanations for the results found are set out hereafter.…”

Section: Discussionmentioning

confidence: 97%

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities

Horn

Bartak

Meerman

et al. 2014

Clin Psychology and Psychoth

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The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.

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The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments

Cited by 66 publications

References 49 publications

No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co‐Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder

No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co‐Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder

In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders.

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities

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