Personality disorder interventions
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]
Overview
Psychotherapy or Psychoanalysis has been used for the treatment of personality disorders for long times. It is the mainstay and core management for PDs. The studies have revealed up till seven times improvement in such patients with psychotherapy alone. They focus on thoughts, emotions, and perspectives of patients and help to modify them to produce event appropriate responses. Cognitive- behavioural therapy is the most commonly used for it.
Psychotherapy
It is a collaborative treatment that aims to improve the perception of the disease and rectify the response to social and personal problems with ameliorated behavior.
Psychodynamic Psychotherapy
- Psychodynamic psychotherapy (PDT) focuses on self-reflection and the identification of perceptual distortions. It then enables an individual to develop adaptive responses to varying stimuli. Emotional conflicts, defence mechanisms and unconscious thoughts are recognised and analysed. This is then used to counter and resolve the unconscious conflicts and relational difficulties. It is performed twice to four weeklies for many months. [1]
Cognitive-behavioral therapy
- Cognitive-behavioral therapy (CBT) is based on recognizing distortion in thought processes and rectify the cognition pattern, thus establishing emotional stability and behavioral regulation. It is done once weekly for many months to years. It is used in ASPD, BPD, and substance use disorder. [2] [3]
Dialectical-behavioral therapy
- Dialectical-behavioral therapy is s subtype of CBT that reinforces and integrates positive emotions, thoughts, and behaviors by changing the negative thinking patterns. The word 'dialect' means 'synthesis or integration of opposites.' It equips patients with new enhanced coping skills to manage their painful conflicting emotions and control their impulses and self-destructing behavior. It is a significant therapy in cluster-B PDs. [4]
Interpersonal therapy
- Interpersonal therapy comprises individual sessions that focus on improving interpersonal and social relationships. It involves finding triggers such as adjustment difficulty, role transition or dispute, and interpersonal deficit; and working together with the individual to challenge them and establish new positive roles. It is used for mood disorders and can be used in BPD. It is conducted weekly for 6-12 months. [5]
Dynamic Group psychotherapy
- Dynamic Group psychotherapy harnesses the dynamic existing among individuals and utilizes it to bring out constructive and optimistic behaviors. Feedback from patients is beneficial to produce a therapeutic response. It is also carried out weekly for months.[6]
A multi-wave study done by Clarkin et al. in 2007 studied the PDT, Dialectal behavioral therapy, and dynamic supportive therapy in the management of BPD. It demonstrated that PDT and DST were associated with improvement in anger and impulsivity, PDT and dialectical behavioral therapy lead to improvement in suicidality, and only PDT was found to be a predictor of verbal and direct assault [7]. European guidelines have the strongest recommendation for psychotherapy for BPD. Cognitive-behavioral therapy for ASPD is recommended by British and German guidelines. American society of Psychiatry recommends dialectical behavioral therapy and psychodynamic therapy for BPD.
References
- ↑ ""Psychodynamic Psychotherapy for Personality Disorders: A Systematic Re" by Kimberly Rorie".
- ↑ Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW (2010). "The effectiveness of cognitive behavioral therapy for personality disorders". Psychiatr Clin North Am. 33 (3): 657–85. doi:10.1016/j.psc.2010.04.007. PMC 3138327. PMID 20599139.
- ↑ "Redirecting".
- ↑ Chapman AL (2006). "Dialectical behavior therapy: current indications and unique elements". Psychiatry (Edgmont). 3 (9): 62–8. PMC 2963469. PMID 20975829.
- ↑ Bozzatello P, Bellino S (2020). "Interpersonal Psychotherapy as a Single Treatment for Borderline Personality Disorder: A Pilot Randomized-Controlled Study". Front Psychiatry. 11: 578910. doi:10.3389/fpsyt.2020.578910. PMC 7518215 Check
|pmc=value (help). PMID 33061926 Check|pmid=value (help). - ↑ Kulawik H (1982). "[Combination of dynamic group psychotherapy with psychodynamic individual therapy]". Psychiatr Neurol Med Psychol (Leipz). 34 (4): 222–8. PMID 7201651.
- ↑ Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF (2007). "Evaluating three treatments for borderline personality disorder: a multiwave study". Am J Psychiatry. 164 (6): 922–8. doi:10.1176/ajp.2007.164.6.922. PMID 17541052. Review in: Evid Based Ment Health. 2008 Feb;11(1):24