Antisocial Personality Disorder

Treatments

No psychotherapy has been found to be efficacious

with these clients. Prevention, Behavioral
Approaches, Milieu therapy
Treatment Summary: It is generally considered that Antisocial Personality Disorder
(APD) is difficult to treat as evidenced by high recidivism rate even after a course of
psychotherapy, among offenders with this diagnosis. It is noted that both Canadian
and Americans are concerned that psychological therapy worsens outcomes leading
to increased recidivism. In conflict to this viewpoint, a psychodynamic approach has
been utilized that offers an inhibitory process that begins by teaching the client a
self-view that is consistent with socially acceptable behaviors. This treatment
focuses on developing empathy by focusing on the client's need for empathy and
validation. Confounding factors include the client's resistance to authority including
the therapist, lack of motivation to participate in treatment, and a lack of
accountability and empathy. Perhaps appropriate consequences for offending
behavior and confrontation in a structured group setting that consistently reveals the
effects of this behavior on victims while focusing on a shift of attention from self to
other. Reinforcement of empathic attitudes and framing offending behavior as self-
destructive uses the ego centered client attitude to provide motivation to modify
behavior. In other words, offending behavior leads to consequences that are self-
destructive.

 Reference: Lock, Martin P. (2008) Treatment of antisocial personality

disorder. The British Journal of Psychiatry 193: 426
http://bjp.rcpsych.org/content/193/5/426.1/short Malancharuvil, Joseph M.
(2012). Empathy deficit in antisocial personality disorder: a psychodynamic
formulation. The American Journal of Psychoanalysis, 72, 242 - 250.
 Submitter: Marinda Ross

Introjective Identification Therapy (IIT)

Treatment Summary: IIT is a treatment shown to be effective in the treatment of
Antisocial Personality Disorder when used in conjunction with another for of
treatment, such as Cognitive Behavioral Therapy. In IIT, patients with Antisocial
Personality Disorder identify their undesirable traits and learn to use more socially
desirable behaviors and attitudes through positive identification with a role model or
image. IIT involves studying and incorporating the pro-social characteristics of the
"idealized person" into daily use. Through the observation and practice of more
socially appropriate behaviors and attitudes, IIT hope to help the patient uncover his
or her innate pro-social characteristics.

Avoidant Personality Disorder

Treatments

Integrated Wilderness Therapy

Treatment Summary: An interesting treatment for Avoidant Personality Disorder is:
Integrated Wilderness Therapy (IWT). This is a form of group therapy that takes the
group into the great outdoors. As has been stated earlier there is little real in-depth
research into the effectiveness of APD treatments and therefore it is important to try
different approaches that might work in overcoming this personality disorder or at
least diminishing the incapacitating symptoms. In this study two groups were formed
with one being an inpatient comparison condition (CC) used individual and group
sessions in a hospital setting and the other was the IWT that used a similar approach
except took place in a wilderness setting. The goal was to make both the CC and
IWT similar in treatment to have "a psychodynamic approach with an interpersonal
focus" (Eikenæs et al. 2006, p. 276). There were group sessions, individual
sessions (though in the IWT these were not formalized), and art therapy. Then things
diverged from there with occupational therapy and physical therapy taking place for
the CC group and of course the IWT had a six day trip into an outdoor place that was
fairly wild and isolated. The IWT group also took a three day canoe trip near the end
of their time away. During the period they were outdoor the members of the group
were given different tests and experiences to be accomplished. Integrated
Wilderness Therapy proved to be about as affective as the comparison condition for
the in-patient hospital group. Both of the groups showed that symptoms were helped
and that group members improved in the social aspects and relationship problems
that had been prevalent before the treatment took place. The IWT group did have
slightly better improvement than the CC group. The clinical trial did show that the
IWT worked better with males in the group than with females. It also showed that the
males in the CC group tended to slip backwards when followed up with and the
males in the IWT actually got better in their follow up time.

Schizotypal Personality Disorder

Treatments

Cognitive behavioral therapy, cognitive training, and

omega-3 fatty acid supplementation
Treatment Summary: Clinical experts suggest psychotherapy for the first line of
treatment, but the studies of this line of treatment are scarce. The treatments that will
be discussed here are Cognitive behavioral therapy, cognitive training and omega-3
fatty acid supplementation. Cognitive behavioral therapy deals with the relationships
between most of the senses. Recent research that has examined the efficacy of this
treatment has reported drastic improvements in both positive and negative
functioning. Also CBT research shows that it may help aid in the prevention of
conversion to psychosis in Schizoid spectrum disorders. Cognitive training has three
categories. The categories are restorative, compensatory and environmental. These
three categories have the capability of being given in groups, individually or
electronically. With this treatment, performance has improved on cognitive tests, and
functioning has improved with schizoid patients. With Omega-3 fatty acid
supplementation, this helps to increase the fatty acids that help aid in normal brain
development. They have also shown to help improve cognitive performance in
individuals that are healthy. With omega-3 fatty acid supplementation, positive
effects have been shown on the symptoms of psychological disorders.

Paranoid Personality Disorder

Treatments

Metacognition-Oriented Therapy
Treatment Summary: This case study focused on individual and later, family,
therapy for paranoid personality disorder (PPD). The purpose of the therapy was to
reduce or eliminate the paranoid thoughts and delusions in subjects with PPD. The
therapy focused on promoting the awareness of the emotions that triggered these
delusions and recognizing the social situation which caused these emotions to occur.
The patient would then focus on becoming aware of how this situation and emotion
would link to their negative thoughts and persecutory delusions of others. Individual
therapy would also benefit the client by focusing on self-improvement and building
the client's strength and self-esteem. During this particular study, the subject was
involved in an extensive 8-month therapy treatment. The client was able to recognize
what triggered her paranoia and delusions. She was also able to cease her constant
need for perfection and criticism. This resulted in a smaller number of paranoid
thoughts. When the thoughts did occur, the client was able to question the delusion,
and regress to becoming aware of the situation and triggers, thus rationalizing that
there was not a need for the delusion or thought to occur in the first place.

Borderline Personality Disorder (BPD)

Treatments

Pharmacological Therapy/Psychotherapy
Treatment Summary: Because Borderline is such a difficult personality disorder to
treat and often comorbid with other personality disorders which also makes proper
diagnosis difficult a variety of methods have been explored in order to treat this
disorder. It has been found through many trials that drugs are only moderately
effective on their own. Many therapeutic models and techniques have been
employed in order to treat BPD. In the Harvard Mental Health Letter (2010) the
authors name four methods of therapy that are proving to be effective with this
particularly difficult disorder.

 Reference: The Treatment of Borderline Personality Disorder. Harvard

Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010
Harvard University
 Submitter: N/A
Dialectical therapy
Treatment Summary: The focus here is problem solving and relaxations techniques

 Reference: The Treatment of Borderline Personality Disorder. Harvard

Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010
Harvard University
 Submitter: N/A

Schema-Focused Therapy
Treatment Summary: The belief is that the patient has bpd because they hold to
faulty "schemas." The goal here is to redirect their cognitive focus to a healthy
"schema."

 Reference: The Treatment of Borderline Personality Disorder. Harvard

Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010
Harvard University
 Submitter: N/A

Transference-Focused Therapy:
Treatment Summary: Using aspects of psycho-dynamic theories of
transference/counter-transference the therapist and patient seek to understand
dynamics of past relationships and associated emotions.

 Reference: The Treatment of Borderline Personality Disorder. Harvard

Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010
Harvard University
 Submitter: N/A

Mentalization-Based Treatment (MBT):

Treatment Summary: MBT or structured clinical management showed positive
results in reducing the psychotic (including suicidal gesture/attempt) behavior in
patients.

 Reference: The Treatment of Borderline Personality Disorder. Harvard

Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010
Harvard University
 Submitter: N/A

Dynamic Deconstructive Psychotherapy (DDP)

Treatment Summary: DDP emphasizes growth in three neurocognitive skills:
Association. Association is the ability to comprehend emotional experiences and to
differentiate one emotion from another. DDP requires the client reflect on an
interpersonal exchange and to organize his or her emotions into a narrative. The
narrative includes their intent for the conversation, the replies received from others,
their response to replies, and emotions felt. The client reads back their narrative to
the therapist; this leads to reflection and a better understanding of their emotions
(Goldman and Gregory, 2010). Attribution. Attribution is the ability to grasp the
complexity of emotions, intentions, and motivations. Clients with BPD normally
struggle with ambiguity and see things as "black and white." Attribution is increased
when the client repeats their narrative to the therapist who challenges assumptions
of "black and white" thinking (Goldman and Gregory, 2010). Alterity. Alterity is the
ability to view one's actions objectively. Initially the therapist adopts an "ideal other"
posture, agreeing with the client's conclusions about interpersonal actions.
Gradually, the therapist becomes a "real other" who interprets the client's actions
objectively. By modeling alterity, the client gains insight into how to interpret and
challenge their assumptions (Goldman and Gregory, 2010). By increasing
association, attribution, and alterity the client will learn how to rethink and revise the
actions they choose and the conclusions that they draw.

 Reference: Goldman, G., & Gregory, R. (2010). Relationships Between

Techniques and Outcomes for Borderline Personality Disorder. American
Journal of Psychotherapy, 64, 359-371
 Submitter: Donald Ehrke

Dialectical behavior therapy (DBT)

Treatment Summary: It is interesting to note that Borderline Personality is a bit of a
misnomer because it was originally called that because of the thinking that it is on
the edge between psychosis and neurosis. This has been re-evaluated and the
understanding is that basically BPD is the instability in emotions in interpersonal
relationships and is sometimes called Emotionally unstable personality disorder.
According to Grohol (2014) Dialectical behavior therapy (DBT) was developed by
Marsha Linehan and is described as the approach that gets the best results in
treatment for BPD. Gill and Warburton (2014) say that DBT is based on the Biosocial
model of Borderline Personality Disorder, which states that there is a strong
connection between how one is raised by parents and his/her emotional make-up as
a child. The disruption from this connection leads to traits for borderline behavior to
develop. Gill and Warburton (2014) tested this theory to see if there was really a
correlation between these two forces. They stated that the results were less than
conclusive in proving that parenting that is not affirming to a child and the child's
uncertain emotional state leads to abnormal emotional development. In this
treatment the person with this disorder is taught to get a handle on his/her life by
learning to control emotions, knowing more about himself/herself and rearranging
thought processes. It is often used in group therapies to attain the results that are
necessary in dealing with BPD.

 Reference: Gill, D. & Warburton, W. (2014). An Investigation of the Biosocial

Model of Borderline Personality Disorder. Journal Of Clinical Psychology,
70(9), 866-873. Grohol, J., (2014). Borderline personality disorder treatment.
In Psych Central. Retrieved from http://psychcentral.com/lib/borderline-
personality-disorder treatment/0001065
 Submitter: Ben Ray
Cognitive Therapy
Treatment Summary: Patients with Borderline Personality Disorder, BPD, are
characterized by dysfunctional beliefs and distorted perceptions that appear to
be inflexible such as extreme emotional and behavioral reactions, angry outbursts,
impulsive behavior, and/or severe and sudden symptoms of anxiety and depression.
Cognitive Therapy, CT, gives the patient tools to identify and evaluate these
distorted perceptions in hopes that a realistic appraisal of one's circumstances will
reduce the severity of the patient's distress. A change in the dysfunctional belief is
the target of the cognitive therapy associated with BPD.

 Reference: Wenzel, A., Chapman, J. E., Newman, C. F., Beck, A. T., &

Brown, G. K. (2006). Hypothesized mechanisms of change in cognitive
therapy for borderline personality disorder. Journal of Clinical Psychology,
62(4), 503-516.
 Submitter: N/A

Mentalization-based Treatment
Treatment Summary: Borderline personality disorder (BPD) is a challenge to treat
not only because it is complicated and stigmatized, but also because its symptoms
reflect ingrained patterns of thinking and behavior. Although it is heterogeneous in
nature, causing different clusters of symptoms in different people, the disorder has
three major clinical components: a fragile sense of self that impairs relationships with
other people, impulsiveness, and emotional volatility. Many patients with BPD also
have other mental health problems, such as a mood disorder or post-traumatic
stress disorder. Drugs may be moderately helpful at reducing particular symptoms,
such as depression or anxiety, but they do not address core personality traits and
behaviors. As such, psychotherapy remains the mainstay of treatment for patients
with BPD, although there is no "one-size-fits-all" treatment. Dialectical behavior
therapy is probably the most common psychotherapy used for BPD, but other
options have emerged over the past decade. A review of four psychotherapies
concluded that all were equally effective overall, but that each had specific
advantages. As such, clinicians and patients can decide on an individual basis which
treatment is most appropriate. The impact of BPD extends well beyond the individual
patient, causing suffering in family members as well. Loved ones like, therapists,
may struggle with how to respond constructively to a patient's volatile moods and
demands. For that reason, family members may also benefit from psychotherapy.
Mentalization-based treatment: This therapy, developed by Drs. Peter Fonagy and
Anthony Bateman, psychologists at the University of London, is based on the
premise that patients with BPD suffer from difficulties in their ability to "mentalize" or
develop a mental picture of the emotions, feelings, or beliefs of themselves and
others. A long-term study reported that mentalization-based treatment reduced
antipsychotic use and the number of suicide attempts, and increased chances of
recovery five years after completing treatment (see Harvard Mental Health Letter,
April 2009). Because the investigators conducted their initial research in a partial
hospital setting, they conducted a separate study in an outpatient setting. In an 18-
month study, they randomly assigned 134 patients with BPD to mentalization-based
treatment or structured clinical management (consisting of case management,
supportive counseling, and problem-solving sessions). Although patients in both
interventions improved significantly (as measured by a decrease in suicide attempts,
hospitalizations, and other crisis events), those assigned to mentalization-based
treatment improved substantially more than those receiving structured clinical
management.

 Reference: Borderline personality disorder: Origins and symptoms. (cover

story). (2006). Harvard Mental Health Letter, 22(12), 1-3. Retrieved February
25, 2011, from https://zeus.tarleton.edu Treating borderline personality
disorder. (2010). Harvard Mental Health Letter, 26(12), 1. Retrieved February
25, 2011, from https://zeus.tarleton.edu
 Submitter: Roderick D. Swanson

Obsessive-Compulsive Personality
Disorder
Treatments

 
Treatment Summary: There have been some different treatment options that have
been tried for the disorder of obsessive compulsive disorder. The pharmaceutical
approach was one of the included approach using serotonin reuptake inhibitors, such
as clomipramine, and some selective serotonin reuptake inhibitors. One of the down
falls for these medications were it was only effective on some patients. However,
most treatment individuals showed lasting symptoms after an adequate trial of
medical treatment but the relapse after medication discontinuation is another issue.
Relapse rates varied from 24% after stopping the use of serotonin to 31-89% after
discontinuation of clomipramine. Many people with obsessive-compulsive disorder
have a good response to medication, but this is usually only a partial response.
(Baxter, Schwartz, Bergman, Szuba, Guze, Mazziotta, et al. 1992 Caudate glucose
metabolic rate changes with both drugs and behavior therapy for obsessive
compulsive disorder. Archives of General Psychology, 49, 681-689)There were also
attempts to use psychological treatment for obsessive-compulsive disorder by the
use of cognitive-behavioral therapy. This therapy involved exposure and response,
repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge
to perform compulsive rituals. The individuals who are affected with the disease
believe they may hurt some innocent people if they discontinue their behavior. In
order to convince a positive response from the individual a person who feared the
number 13 was instructed to write the number 13 and imagine something that is
positive. The individuals who performed any rituals to reduce anxiety or the chances
of bad luck by saying prayers, checking for reassurance were assured that these
behaviors did not assist in avoidance behavior and compulsive rituals are
unnecessary for averting harm. Overall, the findings from randomized controlled
trials suggest that exposure and response prevention-whether delivered in daily or
weekly sessions-substantially improve obsessive-compulsive symptoms, and its
effect is more than that produced by pharmacotherapy.
  Reference: (Rast, Johnson Drum (1984). Journal of the Experimental
Analysis of Behavior, 41, 125-134.)
 Submitter: N/A

Cognitive or behavioral therapy

Treatment Summary: Cognitive therapy identifies beliefs, assumptions and
strategies that perpetuate conduct and attitudes related to the disorder. Individuals
with obsessive-compulsive personality disorders have extreme desires to complete
tasks without making any mistakes. Cognitive therapy combats intrusive thoughts by
engaging the client in role playing that recreates a scene to evoke the intrusive
thoughts. The client can become aware of these thoughts and replace them with
more positive and rational thoughts with help from a therapist they can trust.
Practicing behaviors that were suggested by a therapist during a counseling session
may not be easily accepted by the client because they believe their ideas are the
only ones that will work. It helps the client to cooperate with plans from therapeutic
sessions if they can help construct it and if the plan has a succinct and sequential
outline. When the plan has order and certain steps take precedence over others it
gives the client the structure they are comfortable working with.

 Reference: Bienenfeld, D. (2007). Cognitive therapy of patients with

personality disorders. Psychiatric Annals, 37(2), 133-139. doi: 1230624671
Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of cluster c
personality disorders. Journal of Mental Health Counseling, 28(1), 1-17. doi:
975605981
 Submitter: N/A

Psychodynamic therapy
Treatment Summary: Freud described obsessive behaviors as stagnation in the
anal stage. Strict rules and verbal punishment during this stage transfers to strict
self-imposed rules and standards when the child becomes an adult. The
psychodynamic approach is modified to apply structure to free association and
introspection. Goals related to character change are established and the therapist
and client work toward those goal. Psychodynamic therapy that is structured and
goal oriented helps reduce the impairments of OCPD in in-patient, out-patient, and
day hospital care settings.

 Reference: Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of

cluster personality disorders. Journal of Mental Health Counseling, 28(1), 1-
17. doi: 975605981 Verheul, R., & Herbrink, M. (2007). The efficacy of various
modalities of psychotherapy for personality disorders: A systematic review of
the evidence and clinical recommendations. International Review of
Psychiatry, 19(1), 25-38. doi: 1250727381
 Submitter: N/A

Group therapy
Treatment Summary: Individuals with severe OCPD refrain from attending group
sessions until they can be classified as presenting with milder symptoms. Group
therapy can become an intense emotional experience. Strong emotions may cause
individuals to lose their sense of self control. When they recognize this possibility
they may become manipulative and attempt to control the direction of the group's
conversation or they may not share any experiences. Long-term group therapy is a
beneficial treatment after a client completes an in-patient program or even if they
only use the group out-patient program.

 Reference: Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of

cluster c personality disorders. Journal of Mental Health Counseling, 28(1), 1-
17. doi: 975605981 Verheul, R., & Herbrink, M. (2007). The efficacy of various
modalities of psychotherapy for personality disorders: A systematic review of
the evidence and clinical recommendations. International Review of
Psychiatry, 19(1), 25-38. doi: 1250727381
 Submitter: N/A

Drug therapy
Treatment Summary: Researchers added medication along with therapy to observe
any further improvements in quality of life. When a treatment plan is tailor made to fit
a client's specific needs there are major improvements. Miller and Kraus (2007)
conducted a case study involving a client who voluntarily requested help to cope with
OCPD, as it affected his performance at work. These researchers decided to
temporarily implement anxiety medication. During the interview process, evaluators
could address more issues and symptoms than if they were conducting a multiple
participant design. Since OCPD does not have a specific medication tailored to
reduce all symptoms, the researchers addressed the client's anxiety. The medication
relieved some stress related to the anxiety issues and this allowed the client to focus
on other aspects of the psychotherapeutic process.

 Reference: Miller, T.W., & Kraus, R.F. (2007). Modified dialectical behavior

therapy and problem solving for obsessive-compulsive personality disorder.
Journal of Contemporary Psychotherapy, 37(2), 79-85. doi: 1265264031
 Submitter: N/A

Cognitive Behavior Therapy

Treatment Summary: Cognitive behavior therapy was used with adolescents and
children in a clinical setting. The sessions were one hour in length on a weekly basis.
These sessions last approximately eight to twelve weeks depending upon the
patient's progress. Cognitive Behavior Therapy helps the patient to become aware of
inaccurate or negative thinking. This in turn allows the patient to view difficult
situations in a different light and respond to them in a more effective way.

 Reference: Nakatani, E., Mataix-Cols, D., Micali, N., Turner, C., & Heyman, I.
(2009). Outcomes of Cognitive Behavior Therapy for Obsessive Compulsive
Disorder in a Clinical Setting: A 10-Year Experience from a Specialist OCD
Service for Children and Adolescents. Child & Adolescent Mental Health,
14(3), 133-139. doi:10.1111/j.1475-3588.2008509.x.
  Submitter: Sarah Delozier

Deep brain stimulation (DBS)

Treatment Summary: DBS is a neurosurgical procedure involving the implantation
of a medical device called a brain pacemaker, which sends electrical impulses,
through implanted electrodes, to specific parts of the brain (brain nucleus) for the
treatment of movement and affective disorders"( Kringelbach, Jenkinson, Owen, Aziz
, 2007).

 Reference: Kringelbach ML, Jenkinson N, Owen SLF, Aziz TZ (2007).

"Translational principles of deep brain stimulation". Nature Reviews
Neuroscience. 8:623-635. PMID 17637800. Khol, S., Schonherr, D., Luigjes,
J., Denys, D., Mueller, U., Lenartz, D., & Visser-Vandewalle, V. (2014). Deep
brain stimulation for treatment-refractory obsessive compulsive disorder: A
systematic review. BMC Psychiatry, 14(214).
 Submitter: Jackelyn Ferrer

Metacognitive Interpersonal Therapy (MIT)

Treatment Summary: MIT involves two goals. One goal is to improve the client's
understanding of their own mental state. The therapist helps identify unused
emotions and facilitates the learning of their use. The second goal is to regulate
troublesome attitudes and behaviors, especially those that involve interpersonal
cycles, and develop helpful ones. The therapist is careful to establish a smooth,
helpful relationship and avoid getting involved in negative interpersonal cycles.
Group therapy is a useful addition to individual therapy as it offers peer feedback.
Individual therapy can then reinforce the peer feedback received. The case study
involved one year of weekly individual and group psychotherapy which reduced the
criteria for the personality disorder.

 Reference: Fiore, D., Dimaggio, G., Nicolo, G., Semerari, A., & Carcione, A.
(2008). Metacognitive Interpersonal Therapy in a case of Obsessive-
Compulsive and Avoidant Personality Disorders. Journal of Clinical
Psychology: In session, 64 (2), 168-180.
 Submitter: Martin

Cognitive Behavior Therapy (CBT) and Yoga

Treatment Summary: For patients who suffer with obsessive or compulsive
disorders, most research focused on helping the patient improve their quality of life
by learning to change or control their thoughts that brought on the limiting behavior.
Most treatments were centered around cognitive and/or behavioral approaches that
helped the patient face their fears of negative outcome and adjust their
understanding or learn to help control their inaccurate thoughts or repeated
behaviors. With CBT, the development of problem-solving skills helped them develop
a higher quality of life. But a bit more untraditional approach was found for patients
that suffered from OCPD but objected to the issue of having a mental disorder. The
treatment was with the relaxation and concentration of yoga exercise. The use of
meditation, controlled breathing, and gentle stretching worked with patients who had
less severe interruptions to their life. The anxiety that these patients suffer was well
addressed by a schedule of regular yoga exercise.

 Reference: Abramowitz, J., Taylor, S., & McKay, D. (2005). Potentials and

Limitations of Cognitive Treatments for Obsessive-Compulsive Disorder.
Cognitive Behavior Therapy, 34, 140-147. Kirkwood, G., Rampes, H., Tuffrey,
V., Richardson, J., & Pilkington, K. (2005). Yoga for Anxiety: a Systematic
Review of the Research Evidence. British Journal of Sports Medicine, 39,
884-889.
 Submitter: N/A

Treatment for Compulsive Hoarding

Treatment Summary: The typical treatment for hoarding is individual cognitive
behavioral therapy. In an effort to increase motivation as well as cost effectiveness, a
combination of group cognitive behavioral therapy as well as home visits were used.
Group treatment was found useful as many hoarders are increasingly isolated. Each
group met once a week for 2 hours for over 16 weeks. Each group member also
received two home visits lasting 1.5 hours each. These home visits were conducted
around week 3 and week 12. Group therapy concentrated on hoarding-specific areas
including hoarding education, beliefs, emotional attachments, decision making,
identifying barriers, and maintaining gains. The group cognitive behavioral therapy
did have modest success in improving hoarding outcomes. This type of therapy was
not only cost-effective, but it also created greater motivation among participants
through the social networking of the group.

Narcissistic Personality Disorder

Treatments

Psychotherapy
Treatment Summary: Narcissistic Personality Disorder is difficult to treat because
the narcissistic person does not think they have a problem. What brings most people
with narcissistic personality disorder into treatment is substance abuse issues,
martial problems, lose of a job or when aging and illness threatens their sense of
superiority. Psychotherapy can uncover defense mechanisms and trace their origins
to emotional conflicts early in life. An important part of this process is transference,
the re- emergence of childhood feelings for parents in the relationship with the
therapist. Group therapy can also be effective in treating this disorder but the
challenge is getting the person with NPD to stop talking about themselves and
realize how their behavior effects the others in the group.

 Reference: (2004). Narcissism and self-esteem. (cover story). Harvard

Mental Health Letter, 20 (8), 1. Retrieved from MasterFILE Premier database.
 Submitter: Ron Beltz
Transference-focused psychotherapy (TFP)
Treatment Summary: This object relations approach harnesses the transference
reactions of the client to the therapist in order to enhance the client's emotional,
affective, and behavioral self-regulation, as well as his or her self-efficacy, intimacy,
and relationship quality. Treatment occurs twice per week for a period of at least one
year. The client and counselor devise and adhere to a specific treatment contract
with defined and measurable goals. The client's projections and the way he or she
treats the counselor are interpreted as reflections of the relationship dynamics
outside of the therapeutic setting.

 Reference: Clarkin, J.F., Levy, K.N., & Schiavi, J.M. (2005). Transference

focused psychotherapy: Development of a psychodynamic treatment for
severe personality disorders. Clinical Neuroscience Research, 4, 379-386.
Diamond, D., & Meehan, K. (2013). Attachment and Object Relations in
Patients With Narcissistic Personality Disorder: Implications for Therapeutic
Process and Outcome.Journal of Clinical Psychology, 69(11), 1148-1159.
 Submitter: Daniela L. Galvez Nelson

Self-psychology
Treatment Summary: Self-psychology, a form of psychoanalysis, is a theory
developed by Heinz Kohut. The theory is based on the crucial component of
establishing an empathetic relationship with the client in order to build trust.
Negligent parenting during early childhood may lead to insecure attachment, which is
believed to be one of the factors related to NPD. Kohut's theory proposes that
healthy self-development in children stems from nurturing relationships with
caregivers in which the child's emotional needs are met through proper interaction in
three areas: mirroring response, idealizing response, and twinship response. Within
these responses, children's needs of being understood and appreciated, need for a
strong emotional attachment to others, and the need to feel a sense of closeness
with others like themselves are met. During treatment, the client with NPD may
experience transference with the therapist which mimics these same needs that
were unmet in childhood. Using the self-psychology approach in treatment helps the
therapist to interact with rather than react to the client. The goal of this form of
treatment of NPD is to assist the client in reaching a more mature and healthier self-
development.

Schizotypal Personality Disorder

Treatments

Cognitive behavioral therapy, cognitive training, and

omega-3 fatty acid supplementation
Treatment Summary: Clinical experts suggest psychotherapy for the first line of
treatment, but the studies of this line of treatment are scarce. The treatments that will
be discussed here are Cognitive behavioral therapy, cognitive training and omega-3
fatty acid supplementation. Cognitive behavioral therapy deals with the relationships
between most of the senses. Recent research that has examined the efficacy of this
treatment has reported drastic improvements in both positive and negative
functioning. Also CBT research shows that it may help aid in the prevention of
conversion to psychosis in Schizoid spectrum disorders. Cognitive training has three
categories. The categories are restorative, compensatory and environmental. These
three categories have the capability of being given in groups, individually or
electronically. With this treatment, performance has improved on cognitive tests, and
functioning has improved with schizoid patients. With Omega-3 fatty acid
supplementation, this helps to increase the fatty acids that help aid in normal brain
development. They have also shown to help improve cognitive performance in
individuals that are healthy. With omega-3 fatty acid supplementation, positive
effects have been shown on the symptoms of psychological disorders.

Histrionic Personality Disorder

Treatments

Interpersonal Therapy and Functional Analytic

Psychotherapy
Treatment Summary: The treatments typically provided to clients meeting criteria
for HPD are psychodynamic, are longer-term treatments and focus on interpersonal
process. The interpersonal psychotherapy approach used here, Functional Analytic
Psychotherapy (FAP) allows the therapist and supervisor to gather data to
demonstrate the effectiveness of this treatment for this type of client consistent with
other behavioral and cognitive behavioral approaches. FAP is based upon a simple
theory, that all people act the way we do because of the contingencies of
reinforcement we have experienced in past relationships. Based on that, it follows
that clinical improvements, healing, or psychotherapeutic change, all of which are
certain acts of the client, also involve contingencies of reinforcement that occur in the
relationship between the client and therapist. Important therapeutic implications, to
be discussed below, follow from the combination of this theory of change and
behavioral definitions of "act" and "contingency." We complete this section on theory
with discussions of context, rule governance, and functional similarity, all of which
provide guidance for FAP as an integrative approach.

 Reference: Callaghan, G., Summers, C. & Weidman, M. (2003). The

Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A
Single-Subject Demonstration of Clinical Improvement Using Functional
Analytic Psychotherapy. Journal of Contemporary Psychotherapy, 33 (4),321 -
339.
 Submitter: Barry Crum

Functional Analytic Psychotherapy

Treatment Summary: "This article presents single-subject data for the treatment of
histrionic and narcissistic personality disorder behaviors using relatively brief course
of interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai,
1991)." (Callaghan, Summers, & Weidman, 2003, p. 321). "Functional Analytic
Psychotherapy (FAP) is an interpersonally oriented psychotherapy that uses basic,
behavioral concepts to specify the process of clinical change as a function of the
therapeutic relationship. The therapy is especially helpful with client problems that
are interpersonal in nature."(Callaghan, Summers, & Weidman, 2003, p. 323). Based
on the findings of this research, the clients were able to report that they had
experienced a decreased in histrionic and narcissistic symptomology over the course
of the treatment.

 Reference: Callaghan, G., Summers, C., & Weidman, M. (2003). The

Treatment of Histrionic And Narcissistic Personality Disorder Behaviors: A
Single-Subject Demonstration Of Clinical Improvement Using Functional
Analytic Psychotherapy. Journal of Contemporary Psychotherapy, 33(4), 321-
339. Kohlenberg, R., & Tsai, M. (1991). Functional Analytic psychotherapy:
Creating intense and curative therapeutic relationships. New York: Plenum.
 Submitter: N/A

Cognitive Analytic Therapy

Treatment Summary: Treatment for Histrionic disorder involves the use of
cognitive-analytic therapy (CAT) that is a structured time-limited focal psychotherapy.
Once the patient has been assessed the patient's history is drawn up in a sequential
diagrammatic reformation (SDR) that describes their current "triggers" and what may
have caused this. From the SDR, the therapist can outline the target problems. CAT
involves the active use of the SDR in constructing therapeutic 'exits' from the roles
and procedures identified on the SDR. In the beginning, the therapist uses a letter
created by the therapist that is read to the patient to reformulate the origins of their
distress and stating target problems and procedures. Throughout the therapy
sessions, the patient works on the different "triggers" and techniques that will help
the patient. The last session set up between the patient and the therapist, both will
prepare and read a 'goodbye letter'. The function of the letter from the therapist is to
summarize achievements made in the therapy, to signal challenges that appear to lie
ahead for the patient and acknowledge the abandonment issues that can be brought
up at termination of therapy.

 Reference: Kellett, S. (2007). A time series evaluation of the treatment of

histrionic personality disorder with cognitive analytic therapy. Psychology and
Psychotherapy: Theory, Research and Practice, 80, 389-405.
 Submitter: Melva Terpstra

Psychodynamically Oriented Individual Therapy

Treatment Summary: Psychodynamically oriented therapy is the most common
form of treatment for Histrionic Personality Disorder (HPD). Other forms of treatment
are gaining recognition as possible treatments, such as cognitive and behavioral
approaches, but currently neither have enough empirical evidence to be a definitive
form of treatment (Callaghan, Summers, & Weidman, 2003; Kellett, 2007). DR
Horowitz a professor at the University of California San Francisco has done
extensive research on the treatment of HPD (Horowitz, M.J. 1997). His
recommendation is a three phase approach. These three phases consist of
stipulating the problems of the patient, then the states of mind are defined, and the
last phase is clarifying topics of concern and defensive obstacles. This treatment
attempts to bring together psychodynamic and cognitive conceptualizations. In
phase one the client is encouraged to restrain from harmful and immediately
gratifying behavior. Phase two consists of modifying defensive processes. These
defenses are identified and explored while more rational choices are identified. The
third phase consists of encouraging the client to modify interpersonal behavior. This
phase focuses on modifying what internal events mean; this being their irrational
beliefs about themselves and others. The focus is to develop more healthy patterns
of though, feeling and action.

 Reference: Callaghan, G.M., Summers, C.J., & Weidman, M. (2003). The

treatment of histrionic and narcissistic personality disorders behaviors: a
single subject demonstration of clinical improvement using functional analytic
psychotherapy. Journal of Contemporary Psychotherapy, 33(3), 321-339.
Horowitz, M.J. (1997). Psychotherapy for histrionic personality disorder.
Journal of Psychotherapy Practice and Research, 6, 93-107. Kellett, S.
(2007). A time series evaluation of the treatment of histrionic personality
disorder with cognitive analytic therapy. Psychology and Psychotherapy:
Theory Research and Practice, 80, 389-405. Doi:
10.1348/147608306X161421
 Submitter: Carina M. Robinson

Psychodynamic Therapy
Treatment Summary: Psychodynamic Therapy involves a close examination into
certain past relationships in which their dependent behavior was encouraged. These
behaviors are discussed to determine how they are shown in their self-concepts and
when dealing with others around them. Cognitive therapists use questioning to
expose and resolve certain incorrect beliefs regarding relationships. The therapist
would emphasize to the client that the opposite of submission in relationships is not
control over others, but instead independence and confidence. When working with
clients who have dependent personality disorder, the therapist should be careful to
ensure they are not playing into the dependency of the client. The therapist should
promote independence.

 Reference: Harvard Mental Health Letter. (2007). Dependent Personality

Disorder. Harvard Mental Health Letter, 23(10), 1-4.
 Submitter: Katie Cantu

Psychotherapy
Treatment Summary: The most effective approach is one that focuses on the life
problems that the patient is having. Some of the goals for individuals with Dependant
Personality Disorder are: Building self-confidence is important so that the patient is
able to meet their own needs and able to endure the feeling of being alone,
Implement assertiveness training, Convey insight into need to try and meet other
people's expectations, Verbally clarify boundaries with others, Reduce dependence
on relationships while starting to met his or her own needs. Care must be taken in
the therapeutic relationship so that the client does not become dependent on
counselor.

 Reference: Demetri, J (2006, Jan. 1). Etiology and treatment of Cluster C

personality disorders. Journal of Mental Health Counseling. issn: 1040-2861.
 Submitter: Becky Ramirez

Cognitive-Existential Therapy
Treatment Summary: The client with dependent personality disorder (DPD) often
exhibits an ingrained and pervasive pattern of excessively decision-avoidant
behavior related to a need to be taken care of. Cognitive-existential therapy (CET)
incorporates psychoeducation with cognitive and existential theories and approaches
in order to first teach the client mindfulness, then reframe care-seeking behavior in a
conceptual framework centered around mindful decision-making. CET is
conceptualized as a four-step process: engagement, pattern search, change, and
termination. At the outset of CET, the counselor explores the client's presenting
problems through whichever lens, cognitive or existential, best explains the client's
personality organization. During the pattern search phase, counselor and client work
together to identify which behaviors persist or are inconsistent among the domains of
the client's life. Although the counselor will bring these behaviors to the client's
awareness, the counselor must be careful to avoid blaming or shaming the client. In
the change phase, the counselor brings the client's attention to existential resistance,
or the client's pattern of dependency-related behaviors that protect the client from his
or her own agency and, by extension, his or her own responsibility for potential
negative outcomes. Changes will then be initiated using a series of homework
assignments, skills training, and experiential learning tasks. Finally, the termination
phase contains the process of solidifying the gains that the client has made in the
therapeutic setting.

 Reference: Bornstein, R. F. (2004). Integrating cognitive and existential

treatment strategies in psychotherapy with dependent patients. Journal of
Contemporary Psychotherapy, 34 (4), 293-309. doi: 10.1007/s10879-004-
2525-7
 Submitter: Daniela L. Galvez Nelson

Psychodynamic therapy along with cognitive

behavior therapy
Treatment Summary: Psychodynamic therapy would involve helping the client to
examine past relationships; why they were unhealthy and resulted in the feelings that
the client felt. Cognitive therapy would involve guiding the patient, not instructing or
mentoring, through the process of self-examination of the client's feelings about self.
The client needs to discover why they feel they are not able to be self-reliant or self-
sufficient. Homework is a helpful tool along with role playing.

 Reference: Harvard Mental Health Letter; Apr2007, Vol. 23 Issue 10, p1-4, 4p

 Submitter: Leasa Arms
Integrated Cognitive and Existential Therapy
Treatment Summary: Cognitive and Existential therapy techniques are combined
and used to help the patient. Both therapies focus on the role of self-distortions and
practicing new ways to responding to outside therapy. The multifaceted nature of
dependency suggests that integrated treatment strategies may hold more promise
than traditional approaches.

 Reference: Bornstein, R. (2004) Integrating cognitive and existential

treatment strategies in psychotherapy with dependent patients. Journal of
Contemporary Psychotherapy, 34 (4), 293-309.
 Submitter: N/A

Integrated Cognitive and Existential therapies

Treatment Summary: One of the primary focuses of treatment for DPD is to change
the patient's self-concept to one that seeks greater independence and accepts
responsibility for their own choices. Cognitive-behavioral therapy (CBT) approaches
this task through cognitive restructuring. Patients are encouraged to explore how and
when their maladaptive, dependent schema formed, what currently helps maintain
the schema, what strategies they use to avoid related anxiety, and what coping
mechanisms relieve unavoidable anxiety. Existential therapy sees the primary issue
of DPD as a belief that the patient is no longer in control of their own life. Being
unable to cope with their own mortality leaves them feeling powerless, and causes
them to externalize personal responsibility onto others. For this reason, treatment
should remain focused on the "here and now" rather than future. Therapy should
focus on helping patients recognize new opportunities and choices in their lives, and
encourage ways to explore their true self. CBT and Existential methods share
several common traits that lend to an integrative approach. While CBT strategies
open patients to new ways of thinking, Existentialism supports this by working to
decrease the patient's defense mechanisms and confront their distorted beliefs about
themselves. They both seek to promote change by encouraging more open and real
experiences of self and others. In addition, experiential practice and learning outside
of therapy can be easily incorporated through activities such as social-skills training,
problem-solving, journal writing, skill building tasks, role play scenarios, and safe
risk-taking both in and out of therapy sessions.

 Reference: Bornstein, R.F. (2004). Integrating cognitive and existential

treatment strategies in psychotherapy with dependent patients. Journal of
Contemporary Psychotherpa, 34 (4), 293-309.
 Submitter: Sarah Duke