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Are Short-Term Psychotherapies Helpful for Cluster C Personality Disorders?

Two years after receiving short-term cognitive therapy or dynamically oriented psychotherapy, patients with personality disorders showed significant improvement on most measures.

Personality disorders, often intransigent, usually inspire treatment plans favoring long-term psychotherapies. To examine the impact of short-term therapies, researchers randomized 50 patients with at least one DSM-IIIR cluster C personality disorder or self-defeating personality disorder to 40 weekly sessions of short-term, dynamically oriented psychotherapy (based on the model of Vaillant and Malan) or cognitive therapy (based on the model of Beck and Freeman).

Most patients had avoidant, obsessive-compulsive, and/or dependent personality disorders. More than 90% had comorbid axis I diagnoses, mostly mood or anxiety disorders. The study excluded patients with past psychosis, concurrent substance abuse, eating disorders, active suicidal behavior, organic brain disorder, or other serious physical illness.

At mid-treatment and at the 2-year follow-up, the overall patient group had improved significantly on most measures; no significant between-group differences were detected. At 2 years, symptomatic recovery was assessed in 54% of dynamically treated and 42% of cognitive-treatment patients; about 40% in each group were rated as recovered on scales measuring personality functioning and interpersonal problems. Only three patients used antidepressants during the trial.

Comment: Although the lack of a control group deprives us of knowing the rates of spontaneous remission, these encouraging results suggest that personality-disorder symptoms may improve in the course of well-conducted, short-term psychotherapies. The researchers did not examine associations between changes in axis I symptoms and "personality-disorder" symptoms, although the two may be strongly linked. Further, the comparable effectiveness of the two psychotherapies suggests that factors other than those linked to the specific psychotherapeutic models -- i.e., factors involving patients, therapists, and their interactions -- may have contributed to these outcomes.

— Joel Yager, MD

Published in Journal Watch Psychiatry June 9, 2004

Citation(s):

Svartberg M et al. Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Am J Psychiatry 2004 May; 161:810-7.

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