Tioning (8 recovered). In sum, there is data to support the efficacy of short-term CBGT in reducing symptoms of AVPD, anxiety, depression, as well as symptomatic behaviors and overall social functioning. Although cognitive restructuring and skills training are both associated with positive gains in treatment, they do not seem to improve outcomes beyond the effect of graduated exposure. However, because many patients continued to experience significant impairment following CBGT, further research is warranted to identify the optimal treatment composition and dose. Longer-term, comprehensive interventions may be necessary to change longstanding cognitive and behavioral patterns (62, 65).NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptIndividual CBTWhereas studies of group treatment for AVPD found the strongest evidence for behavioral treatment components (i.e., exposure, skills training and rehearsal), the four published studies on individual CBT for AVPD favor a cognitively-oriented approach (67, 68). The cognitive model of AVPD holds that the emotional and behavioral problems associated with the disorder are based on dysfunctional schemata and irrational beliefs (69). HS-173 clinical trials Therefore CBT emphasizes the identification and modification of negative automatic thoughts and maladaptive schemata using thought monitoring, Socratic dialogue and disputation of irrational beliefs (10, 67, 68). In addition to cognitive restructuring, it is notable that the treatment includes a range of behavioral exercises, such as activity monitoring and scheduling, as well as behavioral experiments that are designed to highlight and undermine cognitive distortions. Notably, only one publication, a case study of individual CBT, included social skills training (67). Strauss and colleagues (67) conducted an open trial of treatment outcomes among outpatients with AVPD (n = 24) and OCPD (n = 16). All patients received up to 52 weekly sessions of individual CBT and were assessed before and after treatment. Among those with AVPD, the majority reported clinically significant improvements across a range of symptoms and HS-173 price problematic behaviors. For example, 67 of patients no longer met diagnostic criteria for AVPD at the end of treatment, and 65 experienced remission of depressive symptoms. These encouraging findings were replicated in an RCT conducted by Emmelkamp and colleagues (68). Patients were assigned to CBT (n = 26), brief dynamic therapy (BDT; n = 28) or a waitlist condition (n = 16). The two active treatments consisted of 20 sessions delivered over six months, and patients were assessed at the end of treatment and six months after treatment termination. Although both CBT and BDT both produced significant improvements in anxiety symptoms, behavioral avoidance and dysfunctional beliefs at the end of treatment, CBT was significantly superior to BDT on all outcome measures. Moreover, BDT did not differ from the waitlist control condition on any measure at the end of treatment. At follow-up, treatment gains were maintained, with 91 of the CBT group and 64 of the BDT group no longer meeting diagnostic criteria for AVPD, a statistically significant difference.Psychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewicz et al.PageObsessive-Compulsive Personality Disorder (OCPD) Individual CBT for OCPD has been evaluated in one open trial. In the study described above, Strauss and colleague (2006) conducted an open trial.Tioning (8 recovered). In sum, there is data to support the efficacy of short-term CBGT in reducing symptoms of AVPD, anxiety, depression, as well as symptomatic behaviors and overall social functioning. Although cognitive restructuring and skills training are both associated with positive gains in treatment, they do not seem to improve outcomes beyond the effect of graduated exposure. However, because many patients continued to experience significant impairment following CBGT, further research is warranted to identify the optimal treatment composition and dose. Longer-term, comprehensive interventions may be necessary to change longstanding cognitive and behavioral patterns (62, 65).NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptIndividual CBTWhereas studies of group treatment for AVPD found the strongest evidence for behavioral treatment components (i.e., exposure, skills training and rehearsal), the four published studies on individual CBT for AVPD favor a cognitively-oriented approach (67, 68). The cognitive model of AVPD holds that the emotional and behavioral problems associated with the disorder are based on dysfunctional schemata and irrational beliefs (69). Therefore CBT emphasizes the identification and modification of negative automatic thoughts and maladaptive schemata using thought monitoring, Socratic dialogue and disputation of irrational beliefs (10, 67, 68). In addition to cognitive restructuring, it is notable that the treatment includes a range of behavioral exercises, such as activity monitoring and scheduling, as well as behavioral experiments that are designed to highlight and undermine cognitive distortions. Notably, only one publication, a case study of individual CBT, included social skills training (67). Strauss and colleagues (67) conducted an open trial of treatment outcomes among outpatients with AVPD (n = 24) and OCPD (n = 16). All patients received up to 52 weekly sessions of individual CBT and were assessed before and after treatment. Among those with AVPD, the majority reported clinically significant improvements across a range of symptoms and problematic behaviors. For example, 67 of patients no longer met diagnostic criteria for AVPD at the end of treatment, and 65 experienced remission of depressive symptoms. These encouraging findings were replicated in an RCT conducted by Emmelkamp and colleagues (68). Patients were assigned to CBT (n = 26), brief dynamic therapy (BDT; n = 28) or a waitlist condition (n = 16). The two active treatments consisted of 20 sessions delivered over six months, and patients were assessed at the end of treatment and six months after treatment termination. Although both CBT and BDT both produced significant improvements in anxiety symptoms, behavioral avoidance and dysfunctional beliefs at the end of treatment, CBT was significantly superior to BDT on all outcome measures. Moreover, BDT did not differ from the waitlist control condition on any measure at the end of treatment. At follow-up, treatment gains were maintained, with 91 of the CBT group and 64 of the BDT group no longer meeting diagnostic criteria for AVPD, a statistically significant difference.Psychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewicz et al.PageObsessive-Compulsive Personality Disorder (OCPD) Individual CBT for OCPD has been evaluated in one open trial. In the study described above, Strauss and colleague (2006) conducted an open trial.
