A new study from Holland has found that cognitive-behavioural
therapy (CBT) was more effective than brief dynamic therapy, or
being on the waiting list, for people with avoidant personality
disorder. Brief dynamic therapy was no better than the waiting list
control condition.
Until now there have been few controlled trials examining the
effectiveness of individual psychotherapy in personality disorders,
especially in patients with what are called ‘Cluster C’
disorders.
These include dependent, obsessive compulsive and avoidant
personality disorders. Of all the personality disorders, the
avoidant type has been found to be the most persistent, even
tending to worsen over time.
Published in the July issue of the British Journal of
Psychiatry, the study compared the effectiveness of the two
therapies as outpatient treatment for people with avoidant
personality disorder with a waiting list control group.
62 patients aged between 24 and 61 who met the criteria for
avoidant personality disorder were randomly assigned to 20 weekly
sessions of either brief dynamic therapy or CBT over a 6-month
period, or they were assigned to the waiting list control
group.
After the waiting period, patients in the control group were
randomly assigned to one of the two therapies. All groups were
followed up at 6 months, and self-reports were completed by
patients before treatment, immediately after treatment, and 6
months after the treatment was completed.
It was found that patients receiving CBT showed significantly
more improvements on a number of measures, in comparison with those
who had brief dynamic therapy or were in the waiting list control
group. These results were maintained at follow-up.
The authors of the study comment that it is unclear whether
prolonged treatment would have resulted in superior results.
Although there have been studies on behavioural treatments for
avoidant personality disorders, none have looked at cognitive
therapy. Whether cognitive therapy enhances the effects of
behavioural therapy deserves further study.
It should be noted that the therapists in this study were
experts in their fields, and were selected and trained for this
project. It is unknown whether the same results would apply to
untrained therapists working in other kinds of community
setting.
Given the high prevalence of avoidant personality disorder in
the community, the persistence of the disorder, and the high level
of functional impairment associated with it, the effectiveness of
CBT in treating this condition provides an important step forward
for community mental healthcare.
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127
References:
Emmelkamp P. M. G, Benner A, Kuipers A, Feiertag G. A, Koster H. C (2006) Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder, British Journal of Psychiatry, 189, 60 - 64