Skip to main content Accessibility help
×
Home
  • Print publication year: 2020
  • Online publication date: February 2020

20 - Brief Therapeutic Approaches for Personality Disorders

from Part V - Treatment

Summary

The last several decades have witnessed the emergence of several efficacious treatments for personality disorders, yet many of these treatments are lengthy and resource-intensive. There is a pressing public health need to identify briefer treatment options for the treatment of personality disorders. The present contribution is a comprehensive review of brief (i.e., less than one-year) psychosocial interventions for personality disorders. The authors' search criteria yielded 66 articles, which they summarize in this chapter. Of note, only a minority of these studies were randomized controlled trials, and nearly half focused on borderline personality disorders. A few brief treatments appear to be efficacious for personality disorders, namely short-term dynamic psychotherapy for Cluster C personality disorders, as well as manual-assisted cognitive therapy, six-month dialectical behavior therapy, and emotion regulation group therapy for borderline personality disorder and/or self-injury. Recommendations for future research in this area are discussed.

Related content

Powered by UNSILO
Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57(6), 756764.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Amianto, F., Ferrero, A., Pierò, A., Cairo, E., Rocca, G., Simonelli, B., … Fassino, S. (2011). Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: A two-year follow-up preliminary randomized study. BMC Psychiatry, 11(1), 181. https://doi.org/10.1186/1471-244X-11-181
Andreasson, K., Krogh, J., Wenneberg, C., Jessen, H. K. L., Krakauer, K., Gluud, C., … Nordentoft, M. (2016). Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality traits and disorder: A randomized observer-blinded clinical trial. Depression and Anxiety, 33(6), 520530.
Andreoli, A., Burnand, Y., Cochennec, M.-F., Ohlendorf, P., Frambati, L., Gaudry-Maire, D., … Frances, A. (2016). Disappointed love and suicide: A randomized controlled trial of “abandonment psychotherapy” among borderline patients. Journal of Personality Disorders, 30(2), 271287.
Ansell, E. B., Sanislow, C. A., McGlashan, T. H., & Grilo, C. M. (2007). Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Comprehensive Psychiatry, 48(4), 329336.
Ball, S. A. (2007). Comparing individual therapies for personality disordered opioid dependent patients. Journal of Personality Disorders, 21(3), 305321.
Ball, S. A., Cobb-Richardson, P., Connolly, A. J., Bujosa, C. T., & O’Neall, T. W. (2005). Substance abuse and personality disorders in homeless drop-in center clients: Symptom severity and psychotherapy retention in a randomized clinical trial. Comprehensive Psychiatry, 46(5), 371379.
Bartak, A., Spreeuwenberg, M. D., Andrea, H., Holleman, L., Rijnierse, P., Rossum, B. V., … Emmelkamp, P. M. G. (2010). Effectiveness of different modalities of psychotherapeutic treatment for patients with cluster C personality disorders: Results of a large prospective multicentre study. Psychotherapy and Psychosomatics, 79(1), 2030.
Berggraf, L., Ulvenes, P. G., Øktedalen, T., Hoffart, A., Stiles, T., McCullough, L., & Wampold, B. E. (2014). Experience of affects predicting sense of self and others in short-term dynamic and cognitive therapy. Psychotherapy, 51(2), 246257.
Blum, N., Pfohl, B., John, D. S., Monahan, P., & Black, D. W. (2002). STEPPS: A cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder: A preliminary report. Comprehensive Psychiatry, 43(4), 301310.
Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., … Linehan, M. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42(5), 487499.
Bohus, M., Haaf, B., Stiglmayr, C., Pohl, U., Bohme, R., & Linehan, M. M. (2000). Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder: A prospective study. Behaviour Research and Therapy, 38, 875887.
Bos, E. H., van Wel, E. B., Appelo, M. T., & Verbraak, M. J. P. M. (2010). A randomized controlled trial of a Dutch version of Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder. Journal of Nervous and Mental Disease, 198(4), 299304.
Budge, S. L., Moore, J. T., Del Re, A. C., Wampold, B. E., Baardseth, T. P., & Nienhuis, J. B. (2013). The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments. Clinical Psychology Review, 33(8), 10571066.
Carmel, A., Rose, M., & Fruzzetti, A. E. (2013). Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Administration and Policy in Mental Health and Mental Health Research Services, 18(9), 11991216.
Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. The Australian and New Zealand Journal of Psychiatry, 44(2), 162173.
Center for Substance Abuse Treatment. (1999). Brief interventions and brief therapies for substance abuse. In Treatment Improvement Protocol Series (Vol. 34). Rockville, MD: Substance Abuse and Mental Health Services Administration.
Christensen, E. (2007). Methodology of superiority vs. equivalence trials and non-inferiority trials. Journal of Hepatology, 46(5), 947954.
Chugani, C. D., Ghali, M. N., & Brunner, J. (2013). Effectiveness of short term dialectical behavior therapy skills training in college students with cluster B personality disorders. Journal of College Student Psychotherapy, 27(4), 323336.
Crits-Christoph, P., & Barber, J. P. (2007). Psychological treatments for personality disorders. In Nathan, P. E. & Gorman, J. M. (Eds.), A Guide to Treatments That Work (3rd ed., pp. 641658). New York: Oxford University Press.
Davanloo, H. (1980). Short-Term Dyanmic Psychotherapy. New York: Jason Aronson.
Davidson, K. M., Brown, T. M., James, V., Kirk, J., & Richardson, J. (2014). Manual-assisted cognitive therapy for self-harm in personality disorder and substance misuse: A feasibility trial. Psychiatric Bulletin, 38(3), 108111.
Davidson, K. M., Tyrer, P., Tata, P., Cooke, D., Gumley, A., Ford, I., … Crawford, M. J. (2009). Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: An exploratory randomized controlled trial. Psychological Medicine, 39(4), 569577.
Dixon-Gordon, K. L., Chapman, A. L., & Turner, B. J. (2015). A preliminary pilot study comparing dialectical behavior therapy emotion regulation skills with interpersonal effectiveness skills and a control group treatment. Journal of Experimental Psychopathology, 6(4), 369388.
Dixon-Gordon, K. L., Turner, B. J., & Chapman, A. L. (2011). Psychotherapy for personality disorders. International Review of Psychiatry, 23(3), 282302.
Doyle, M., Khanna, T., Lennox, C., Shaw, J., Hayes, A., Taylor, J., … Dolan, M. (2013). The effectiveness of an enhanced thinking skills programme in offenders with antisocial personality traits. Journal of Forensic Psychiatry and Psychology, 24(1), 115.
Emmelkamp, P. M. G., Benner, A., Kuipers, A., Feiertag, G. A., Koster, H. C., & Van Apeldoorn, J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. British Journal of Psychiatry, 189, 6064.
Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., … Thompson, S. (1999). Manual-assisted cognitive-behaviour therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29(1), 1925.
Feliu-Soler, A., Pascual, J. C., Borràs, X., Portella, M. J., Martín-Blanco, A., Armario, A., … Soler, J. (2014). Effects of dialectical behaviour therapy-mindfulness training on emotional reactivity in borderline personality disorder: Preliminary results. Clinical Psychology and Psychotherapy, 21(4), 363370.
Fok, M. L.-Y., Hayes, R. D., Chang, C. K., Stewart, R., Callard, F. J., & Moran, P. (2012). Life expectancy at birth and all-cause mortality among people with personality disorder. Journal of Psychosomatic Research, 73(2), 104107.
Fonagy, P., & Bateman, A. (2008). The development of borderline personality disorder: A mentalizing model. Journal of Personality Disorders, 22(1), 421.
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., Van Tilburg, W., Dirksen, C. D., Van Asselt, T., … Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649658.
Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37(1), 2535.
Gratz, K. L., Lacroce, D. M., & Gunderson, J. G. (2006). Measuring changes in symptoms relevant to borderline personality disorder following short-term treatment across partial hospital and intensive outpatient levels of care. Journal of Psychiatric Practice, 12(3), 153159.
Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 2(4), 316326.
Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 44(10), 20992112.
Harvey, R., Black, D. W., & Blum, N. (2010). Systems Training for Emotional Predictability and Problem Solving (STEPPS) in the United Kingdom: A preliminary report. Journal of Contemporary Psychotherapy, 40, 225232.
Hellerstein, D. J., Rosenthal, R. N., Pinsker, H., Samstag, L. W., Muran, J. C., & Winston, A. (1998). A randomized prospective study comparing supportive and dynamic therapies: Outcome and alliance. Journal of Psychotherapy Practice and Research, 7(4), 261271.
Horn, E. K., Bartak, A., Meerman, A. M. M. A., Rossum, B. V, Ziegler, U. M., Thunnissen, M., … Verheul, R. (2015). Effectiveness of psychotherapy in personality disorders not otherwise specified: A comparison of different treatment modalities. Clinical Psychology and Psychotherapy, 22(5), 426442.
Horn, E. K., Verhuel, R., Thunnissen, M., Delimon, J., Soons, M., Meerman, A. M. M. A., … Busschbach, J. J. V. (2015). Effectiveness of short-term inpatient psychotherapy based on transactional analysis with patients with personality disorders: A matched control study using propensity score. Journal of Personality Disorders, 29(5), 663683.
Huband, N., McMurran, M., Evans, C., & Duggan, C. (2007). Social problem-solving plus psychoeducation for adults with personality disorder. British Journal of Psychiatry, 190, 307314.
Kleindienst, N., Limberger, M. F., Schmahl, C., Steil, R., Ebner-Priemer, U. W., & Bohus, M. (2008). Do improvements after inpatient dialectical behavioral therapy persist in the long term? Journal of Nervous and Mental Disease, 196(11), 847851.
Kröger, C., Harbeck, S., Armbrust, M., & Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behavior Research and Therapy, 51, 411416.
Lewis, G., & Appleby, L. (1988). Personality disorder: The patients psychiatrists dislike. British Journal of Psychiatry, 153(1), 4449.
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
Lis, E., & Myhr, G. (2016). The effect of borderline personality pathology on outcome of cognitive behavior therapy. Journal of Psychiatric Practice, 22(4), 270282.
McMain, S. F., Guimond, T., Barnhart, R., Habinski, L., & Streiner, D. L. (2017). A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatrica Scandinavica, 135(2), 138148.
Meaney-Tavares, R., & Hasking, P. (2013). Coping and regulating emotions: A pilot study of a modified Dialectical Behavior Therapy. Journal of American College Health, 61(5), 303309.
Munroe-Blum, H., & Marziali, E. (1995). A controlled trial of short-term group treatment for borderline personality disorder. Journal of Personality Disorders, 9(3), 190198.
Muran, J. C., Safran, J. D., Samstag, L. W., & Winston, A. (2005). Evaluating an alliance-focused treatment for personality disorders. Psychotherapy: Theory, Research, Practice, Training, 42(4), 532545.
National Collaborating Centre for Mental Health. (2009). Borderline Personality Disorder: Treatment and Management. British Psychology Society and the Royal College of Psychiatrists.
Nenadić, I., Lamberth, S., & Reiss, N. (2017). Group schema therapy for personality disorders: A pilot study for implementation in acute psychiatric in-patient settings. Psychiatry Research, 253, 912.
Ogrodniczuk, J. S., Lynd, L. D., Joyce, A. S., Grubisic, M., Piper, W. E., & Steinberg, P. I. (2011). Predicting response to day treatment for personality disorder. Canadian Journal of Psychiatry, 56(2), 110117.
Olesek, K. L., Outcalt, J., Dimaggio, G., Popolo, R., George, S., & Lysaker, P. H. (2016). Cluster B personality disorder traits as a predictor of therapeutic alliance over time in residential treatment for substance use disorders. Journal of Nervous and Mental Disease, 204(10), 736740.
Østby, K. A., Czajkowski, N., Knudsen, G. P., Ystrom, E., Gjerde, L. C., Kendler, K. S., … Reichborn-Kjennerud, T. (2014). Personality disorders are important risk factors for disability pensioning. Social Psychiatry and Psychiatric Epidemiology, 49(12), 20032011.
Pabst, A., Schauer, M., Bernhardt, K., Ruf, M., Goder, R., Rosentraeger, R., … Seeck-Hirschner, M. (2011). Treatment of patients with borderline personality disorder and comorbid posttraumatic stress disorder using narrative exposure therapy: A feasibility study. Psychotherapy and Psychosomatics, 81(1), 6163.
Paris, J. (2013). Stepped care: An alternative to routine extended treatment for patients with borderline personality disorder. Psychiatric Services, 64(10), 10351037.
Paris, J. (2015). Stepped care and rehabilitation for patients recovering from borderline personality disorder. Journal of Clinical Psychology, 71(8), 747752.
Pasieczny, N., & Connor, J. (2011). The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial. Behaviour Research and Therapy, 49(1), 410.
Perroud, N., Uher, R., Dieben, K., Nicastro, R., & Huguelet, P. (2010). Predictors of response and drop-out during intensive dialectical behavior therapy. Journal of Personality Disorders, 24(5), 634650.
Petersen, B., Toft, J., Christensen, N. B., Foldager, L., Munk-Jorgensen, P., Lien, K., & Valbak, K. (2008). Outcome of a psychotherapeutic programme for patients with severe personality disorders. Nordic Journal of Psychiatry, 62(6), 450456.
Prunetti, E., Bosio, V., Bateni, M., & Liotti, G. (2013). Three-week inpatient Cognitive Evolutionary Therapy (CET) for patients with personality disorders: Evidence of effectiveness in symptoms reduction and improved treatment adherence. Psychology and Psychotherapy: Theory, Research and Practice, 86(3), 262279.
Quirk, S. E., Berk, M., Chanen, A. M., Koivumaa-Honkanen, H., Brennan-Olsen, S. L., Pasco, J. A., & Williams, L. J. (2016). Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review. Personality Disorders: Theory, Research, and Treatment, 7(2), 136146.
Renner, F., van Goor, M., Huibers, M., Arntz, A., Butz, B., & Bernstein, D. (2013). Short-term group schema cognitive-behavioral therapy for young adults with personality disorders and personality disorder features: Associations with changes in symptomatic distress, schemas, schema modes and coping styles. Behaviour Research and Therapy, 51(8), 487492.
Rizvi, S. L., Hughes, C. D., Hittman, A. D., & Vieira Oliveira, P. (2017). Can trainees effectively deliver dialectical behavior therapy for individuals with borderline personality disorder? Outcomes from a training clinic. Journal of Clinical Psychology, 73(12), 15991611.
Ryle, A., & Golynkina, K. (2000). Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: Factors associated with outcome. British Journal of Medical Psychology, 73(Pt 2), 197210.
Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjärehed, J., … Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design. BMJ Open, 7(10), 112. https://doi.org/10.1136/bmjopen-2017-016220
Samuels, J., Eaton, W. W., Bienvenu, O. J., Brown, C. H., Costa, P. T., & Nestadt, G. (2002). Prevalence and correlates of personality disorders in a community sample. British Journal of Psychiatry, 180, 536542.
Schanche, E., Stiles, T. C., McCullough, L., Svartberg, M., & Nielsen, G. H. (2011). The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders. Psychotherapy, 48(3), 293303.
Schindler, A., Hiller, W., & Witthöft, M. (2013). What predicts outcome, response, and drop-out in CBT of depressive adults? A naturalistic study. Behavioural and Cognitive Psychotherapy, 41(3), 365370.
Skewes, S. A., Samson, R. A., Simpson, S. G., & van Vreeswijk, M. (2015). Short-term group schema therapy for mixed personality disorders: A pilot study. Frontiers in Psychology, 6, 19.
Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., … Pérez, V. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353358.
Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., … Pérez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150157.
Sollberger, D., Gremaud-Heitz, D., Riemenschneider, A., Agarwalla, P., Benecke, C., Schwald, O., … Dammann, G. (2015). Change in identity diffusion and psychopathology in a specialized inpatient treatment for borderline personality disorder. Clinical Psychology and Psychotherapy, 22(6), 559569.
Springer, T., Lohr, N. E., Buchtel, H. A., & Silk, K. R. (1996). A preliminary report of short-term cognitive-behavioral group therapy for inpatients with personality disorders. Journal of Psychotherapy Practice and Research, 5(1), 5771.
Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11(4), 337341.
Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. American Journal of Psychiatry, 161, 810817.
Thylstrup, B., Schrøder, S., Fridell, M., & Hesse, M. (2017). Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs. BMC Psychiatry, 17(1), 7. https://doi.org/10.1186/s12888–016-1165-2
Thylstrup, B., Schrøder, S., & Hesse, M. (2015). Psycho-education for substance use and antisocial personality disorder: A randomized trial. BMC Psychiatry, 15(1), 283. https://doi.org/10.1186/s12888–015-0661-0
Trull, T. J., Distel, M. A., & Carpenter, R. W. (2011). DSM-5 borderline personality disorder: At the border between a dimensional and a categorical view. Current Psychiatry Reports, 13(1), 4349.
Ulvenes, P. G., Berggraf, L., Hoffart, A., Stiles, T. C., Svartberg, M., McCullough, L., & Wampold, B. E. (2012). Different processes for different therapies: Therapist actions, therapeutic bond, and outcome. Psychotherapy, 49(3), 291302.
Vinnars, B., Barber, J. P., Norén, K., Gallop, R., & Weinryb, R. M. (2005). Manualized supportive-expressive psychotherapy versus therapy for patients with personality disorders: Bridging efficacy and effectiveness. American Journal of Psychiatry, 162(17), 19331940.
Weinberg, I., Gunderson, J. G., Hennen, J., & Cutter, C. J. Jr. (2006). Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. Journal of Personality Disorders, 20(5), 482492.
Weinberg, I., Ronningstam, E., Goldblatt, M. J., Schechter, M., & Maltsberger, J. T. (2011). Common factors in empirically supported treatments of borderline personality disorder. Current Psychiatry Reports, 13(1), 6068.
Westerman, M. A., Foote, J. P., & Winston, A. (1995). Change in coordination across phases of psychotherapy and outcome: Two mechanisms for the role played by patients’ contribution to the alliance. Journal of Consulting and Clinical Psychology, 63(4), 672675.
Winston, A., Laikin, M., Pollack, J., Samstag, L. W., McCullough, L., & Muran, J. C. (1994). Short-term psychotherapy of personality disorders. American Journal of Psychiatry, 151(2), 190194.
Winston, A., Pollack, J., McCullough, L., Flegenheimer, W., Kestenbaum, R., & Trujillo, M. (1991). Brief psychotherapy of personality disorders. Journal of Nervous and Mental Disease, 179(4), 188193.
Yen, S., Johnson, J., Costello, E., & Simpson, E. B. (2009). A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: Predictors of outcome from a 3-month follow-up study. Journal of Psychiatric Practice, 15(3), 173182.
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorder in psychiatric outpatients. American Journal of Psychiatry, 162, 19111918.