Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment

Simonsen, Sebastian; Popolo, Raffaele; Juul, Sophie; Frandsen, Frederik Weischer; Sørensen, Per; Dimaggio, Giancarlo

doi:10.1097/nmd.0000000000001432

Cited by 15 publications

(22 citation statements)

References 97 publications

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“…A meta‐analysis on 15 treatment effectiveness studies has shown that cognitive‐behavioural and psychodynamic approaches (along with social skills training) were beneficial for Cluster‐C PDs, although contradictory results were found and uncertainty remains regarding the relative effectiveness for DPD, APD and OCPD (Simon, 2009). More recent studies exploring new approaches show promising results but point to difficulty comparing established to newer treatments due to differing methodologies (Simonsen et al, 2022). Moreover, studies are often underpowered, focused solely on APD or did not study differences between PDs (Popolo et al, 2022; Simonsen et al, 2022; Skewes et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…More recent studies exploring new approaches show promising results but point to difficulty comparing established to newer treatments due to differing methodologies (Simonsen et al, 2022). Moreover, studies are often underpowered, focused solely on APD or did not study differences between PDs (Popolo et al, 2022; Simonsen et al, 2022; Skewes et al, 2015). Regarding the differences between the Cluster‐C PDs in treatment effectiveness, previous studies are inconclusive; one study found that OCPD patients improved most (Barber et al, 1997), while other studies favoured APD patients (Karterud et al, 2003) or DPD patients (Seivewright et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

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Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study

Wibbelink,

Venhuizen,

Grasman

et al. 2023

Clin Psychology and Psychoth

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BackgroundGroup schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster‐C PDs. Individual ST has proven to be effective for Cluster‐C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster‐C PD. Moreover, differences between the specific Cluster‐C PDs (avoidant PD, dependent PD and obsessive‐compulsive PD) were explored.MethodsA multicentre open trial was conducted, including 137 patients with a Cluster‐C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive‐compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster‐C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD‐related beliefs, self‐esteem, self‐ideal discrepancy, schemas and schema modes were assessed at baseline until 2‐year follow‐up with semi‐structured interviews and self‐report measures. Change over time and differences between the specific Cluster‐C PDs were analysed with mixed regression analyses.ResultsThe outcome measures showed significant improvements for all Cluster‐C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster‐C PDs in severity at baseline, change trajectories and effectiveness of GST.ConclusionsThis study demonstrated that GST is a promising treatment for Cluster‐C PDs. The following step is a randomized controlled trial to further document the (cost‐)effectiveness of GST.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study

Wibbelink,

Venhuizen,

Grasman

et al. 2023

Clin Psychology and Psychoth

View full text Add to dashboard Cite

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“…Improvement of symptom distress in the present study seems better than demonstrated for patients with AvPD in a former study of traditional group-based psychodynamic treatments ( 10 , 124 ). Although research and treatment developments targeting this patient group are in progress ( 125 – 127 ), studies on AvPD features are still underrepresented ( 128 ). Our study specifically points to the pattern of prevailing restricted social engagement which may require more tailored intervention.…”

Section: Discussionmentioning

confidence: 99%

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

Kvarstein,

Frøyhaug,

Pettersen

et al. 2023

Front. Psychiatry

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ObjectiveEvidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.MethodAn observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.ResultsThirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.ConclusionPersonality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

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“…There is, however still a scarcity of treatment research focusing on AvPD ( 27 ). Only four randomized controlled trials (RCT) with a small number of patients have focused particularly on AvPD ( 28 – 31 ), and some additional natural design studies ( 32 – 35 ). A few RCTs have been conducted on cluster C personality disorders which have included more than 60% patients with AvPD ( 36 , 37 ).…”

Section: Introductionmentioning

confidence: 99%

Combined group and individual therapy for patients with avoidant personality disorder—A pilot study

et al. 2023

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ObjectiveAvoidant personality disorder (AvPD) is a common disorder within mental health services, associated with significant psychosocial impairment. The disorder has been neglected in research. There are currently no evidence-based treatments for AvPD, and there is a need for treatment studies focusing particularly on this form of personality pathology. The present study was a pilot study of combined group and individual therapy for patients with AvPD, based on mentalization-based and metacognitive interpersonal therapy. The aim was to investigate the feasibility of the treatment program and the course of symptoms and personality functioning during treatment and 1-year follow-up.MethodsThe study included 28 patients. Clinical evaluation at baseline comprised structured diagnostic interviews and patients' self-report of symptoms, psychosocial function, interpersonal problems, personality functioning, alexithymia, self-esteem, attachment style, therapeutic alliance, and client satisfaction. Patients' self-report were repeated at the end of treatment and 1-year follow-up.ResultsThe drop-out rate was 14%. Average treatment length among the 22 treatment completers was 17 months. Mean levels of therapeutic alliance and client satisfaction were satisfactory. Effect sizes were large for global symptom distress, depression, anxiety, and psychosocial adjustment, and in the moderate range for aspects of personality functioning. Yet, the results showed a wide range of outcomes among the patients.ConclusionsThis pilot study shows promising results for combined group- and individual therapy for AvPD patients with moderate to severe impairment. Larger scale studies should be conducted to increase empirically based knowledge to guide development of differentiated treatments adapted to patients' various levels of AvPD severity and profiles of personality dysfunction.

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Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment

Cited by 15 publications

References 97 publications

Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study

Group schema therapy for cluster‐C personality disorders: A multicentre open pilot study

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

Combined group and individual therapy for patients with avoidant personality disorder—A pilot study

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