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Cognitive Behavioural-Therapy more effective than brief dynamic therapy for avoidant personality disorder
By British Journal of Psychiatry,
Jul 10, 2006 - 6:21:37 PM
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.
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