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Weme AV, Sørensen KD, Binder PE. Agency in avoidant personality disorder: a narrative review. Front Psychol 2023; 14:1248617. [PMID: 37790232 PMCID: PMC10543493 DOI: 10.3389/fpsyg.2023.1248617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Objectives Avoidant personality disorder (AvPD) is a highly prevalent personality disorder, especially in clinical settings, yet scarcely researched. People diagnosed with AvPD have severe impairments in functioning and suffer greatly, yet we still lack meta-analytic evidence for therapy and only a few RCTs are conducted. Patient factors are the most important for outcome in therapy, in general. Lack of agency might be a core deficit in people diagnosed with AvPD. Their conditions might be improved if we understand their agency better. We review previous research regarding psychological mechanisms and interpersonal relationships that facilitate or hinder agency in AvPD in daily life and psychotherapy. Methods Summarizing original literature in a narrative review with reflexive thematic analysis. Results People diagnosed with AvPD seem to have significant impairments in their sense of agency due to a lack of emotional awareness, an overweight of inhibiting vs. activating emotions, and difficulties regulating emotions. Difficulties also seem related to high levels of attachment avoidance and fear, creating strong ambivalence in social needs, in addition to a strong tendency to subordinate to others. A weak sense of self with a poor narrative, self-doubt, and harsh self-critique makes a reflexive and intentional stand increasingly difficult for these people. Conclusion This review gives a clinically meaningful understanding of core strengths and deficits in the personality functioning of AvPD that can help clinicians map out important therapeutic work, identify barriers to client-agency in therapy, and work through relational difficulties in the therapeutic alliance.
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Affiliation(s)
- Andrea Varga Weme
- Group Therapy Team, Voss Outpatient District Psychiatric Unit NKS Bjørkeli AS, Voss, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Kristine Dahl Sørensen
- Group Therapy Team, Aust-Agder Country Outpatient Psychiatric Unit, Sørlandet Hospital, Arendal, Norway
| | - Per-Einar Binder
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Baljé A, Greeven A, van Giezen A, Korrelboom K, Arntz A, Spinhoven P. Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial. Trials 2016; 17:487. [PMID: 27717405 PMCID: PMC5055701 DOI: 10.1186/s13063-016-1605-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) with comorbid avoidant personality disorder (APD) has a high prevalence and is associated with serious psychosocial problems and high societal costs. When patients suffer from both SAD and APD, the Dutch multidisciplinary guidelines for personality disorders advise offering prolonged cognitive behavioral therapy (CBT). Recently there is increasing evidence for the effectiveness of schema therapy (ST) for personality disorders such as borderline personality disorder and cluster C personality disorders. Since ST addresses underlying personality characteristics and maladaptive coping strategies developed in childhood, this treatment might be particularly effective for patients with SAD and comorbid APD. To our knowledge, there are no studies comparing CBT with ST in this particular group of patients. This superiority trial aims at comparing the effectiveness of these treatments. As an additional goal, predictors and underlying mechanisms of change will be explored. METHODS/DESIGN The design of the study is a multicentre two-group randomized controlled trial (RCT) in which the treatment effect of group cognitive behavioral therapy (GCBT) will be compared to that of group schema therapy (GST) in a semi-open group format. A total of 128 patients aged 18-65 years old will be enrolled. Patients will receive 30 sessions of GCBT or GST during a period of approximately 9 months. Primary outcome measures are the Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) for social anxiety disorder and the newly developed Avoidant Personality Disorder Severity Index (AVPDSI) for avoidant personality disorder. Secondary outcome measures are the MINI section SAD, the SCID-II section APD, the Schema Mode Inventory (SMI-2), the Inventory of Depressive Symptomatology Self-Report (IDS-SR), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Difficulties in Emotion Regulation Scale (DERS), the Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action Questionnaire (AAQ-II). Data will be collected at the start, halfway and at the end of the treatment, followed by measurements at 3, 6 and 12 months post-treatment. DISCUSSION The trial will increase our knowledge on the effectiveness and applicability of both treatment modalities for patients suffering from both diagnoses. TRIAL REGISTRATION Dutch Trial Register: NTR3921 . Registered on 25 March 2013.
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Affiliation(s)
- Astrid Baljé
- Department of Anxiety, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
| | - Anja Greeven
- Department of Anxiety, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Anne van Giezen
- Department of Anxiety, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Kees Korrelboom
- Department of Anxiety, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Department of Medical and Clinical Psychology Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, PO Box 15933, 1001 NK Amsterdam, The Netherlands
| | - Philip Spinhoven
- Department of Anxiety, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
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Mroczkowski MM, Goes FS, Riddle MA, Grados MA, Bienvenu OJ, Greenberg BD, Fyer AJ, McCracken JT, Rauch SL, Murphy DL, Knowles JA, Piacentini J, Cullen B, Rasmussen SA, Pauls DL, Nestadt G, Samuels J. Dependent personality, separation anxiety disorder and other anxiety disorders in OCD. Personal Ment Health 2016; 10:22-8. [PMID: 26542617 DOI: 10.1002/pmh.1321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to investigate whether dependent personality and/or general personality dimensions might explain the strong relationships between separation anxiety disorder (Sep-AD) and three other anxiety disorders (agoraphobia, panic disorder and social anxiety disorder) in individuals with obsessive compulsive disorder (OCD). METHODS Using data from 509 adult participants collected during the OCD Collaborative Genetic Study, we used logistic regression models to evaluate the relationships between Sep-AD, dependent personality score, general personality dimensions and three additional anxiety disorders. RESULTS The dependent personality score was strongly associated with Sep-AD and the other anxiety disorders in models adjusted for age at interview, age at onset of OC symptoms and worst ever OCD severity score. Several general personality dimensions, especially neuroticism, extraversion and conscientiousness, were also related to Sep-AD and the other anxiety disorders. Sep-AD was not independently related to these anxiety disorders, in multivariate models including general personality and dependent personality disorder scores. CONCLUSIONS The results suggest that Sep-AD in childhood and these other anxiety disorders in adulthood are consequences of dependent personality disorder (for agoraphobia and panic disorder) or introversion (for social phobia). It is unknown whether these results would be similar in a non-OCD sample.
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Affiliation(s)
- M M Mroczkowski
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - F S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M A Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B D Greenberg
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - A J Fyer
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY, USA
| | - J T McCracken
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - S L Rauch
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D L Murphy
- Laboratory of Clinical Science, NIMH, NIH, Bethesda, MD, USA
| | - J A Knowles
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J Piacentini
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - B Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S A Rasmussen
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - D L Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Borge FM, Hoffart A, Sexton H. Predictors of outcome in residential cognitive and interpersonal treatment for social phobia: do cognitive and social dysfunction moderate treatment outcome? J Behav Ther Exp Psychiatry 2010; 41:212-9. [PMID: 20153460 DOI: 10.1016/j.jbtep.2010.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 01/07/2010] [Accepted: 01/13/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND The predictors of residential cognitive (RCT) and residential interpersonal Treatment (RIPT) for social phobia were explored. (1) Sotsky et al. (1991) found differential effects of CT and IPT for depression, suggesting that the level of cognitive or social dysfunction predicted differential outcome. We examined whether an analogous effect could be demonstrated in 10 weeks of residential treatment of 80 social phobia subjects. (2) We also included expectations, age of onset, severity of illness, concurrent anxiety, mood, avoidant personality disorder, and body dysmorphic disorder as predictors in this exploratory study. METHOD Main outcome was the social phobia subscale of Social Phobia and Anxiety Inventory (SPAI SP). DSM-IV axis I and II interviews were completed. RESULTS (1) Sotsky et al. (1991) findings were not reproduced. However, RIPT subjects with poor general functioning were less improved following treatment. Subjects with concurrent agoraphobia responded better with RCT than subjects without agoraphobia. (2) Age of onset and expectations were the most powerful predictors of post treatment outcome. CONCLUSION Some patient characteristics appear to impact outcome with RIPT and RCT differentially. The findings are discussed.
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