Cognitive Therapy for Personality Disorders

人格障碍的认知疗法

• 批准号: 6471946
• 负责人: ADELE HAYES
• 金额: $ 18.75万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-06-01 至 2005-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6471946
• 关键词: audiotape; behavioral /social science research tag; clinical research; cognitive behavior therapy; human data; human therapy evaluation; obsessive compulsive disorder; personality disorders; psychoanalysis; psychotherapy; technology /technique development

DESCRIPTION (provided by applicant): The Cluster C personality disorders (obsessive-compulsive, avoidant, and dependent) are the most prevalent personality disorders (PDs) in outpatient samples. These PDs are highly comorbid with mood and anxiety disorders. Patients with comorbid PD and Axis I disorders present with more severe and chronic symptom profiles, and they do not respond well to psychotherapy or pharmacotherapy. It is particularly difficult to establish a therapeutic alliance, a well-documented predictor of treatment outcome, and treatment retention and compliance are often compromised. Given the prevalence of Cluster C PDs and their significant impact on psychosocial functioning, treatment response, and health care utilization, it is surprising that little attention has been paid to treatment development for this population. Cognitive therapy has been demonstrated to be an effective treatment across a number of Axis I disorders and recently has been extended to PDs. In a sample of patients with obsessive-compulsive (OCPD) and avoidant (AVPD) PDs, the first open trial of cognitive therapy for PDs (CT-PD) demonstrated significant improvements in personality symptoms, as well as in symptoms of depression and anxiety. Because the therapy is in early stages of development, general principles and guidelines for treatment of PDs are provided, but there are few specific details on how to treat OCPD and AVPD. This lack of specificity limits the extent to which the manual can be used to conduct larger scale clinical trials outside of the Center for Cognitive Therapy, where the manual was developed. The goal of this R-21 treatment development research is to identify active ingredients of the therapy and to use this process research to improve the specificity of the manual. CT-PD is thought to have its effects by exposing patients to corrective information challenging existing personality patterns, identifying the historical roots of these patterns, and providing exercises to facilitate generalization. The proposed study will examine these interventions as predictors of three hypothesized precursors of change: turbulence in defensiveness and avoidance (protection), the therapeutic alliance, and in-session affect. Growth curve modeling will be used to examine sequencing and timing of therapist interventions and relations between these interventions and the hypothesized precursors of change, which will then be examined as predictors of symptom reduction. Quality of therapeutic alliance in early sessions will be examined as a predictor of treatment retention. With this information, sections of the treatment manual on OCPD and AVPD can be refined, strategies to facilitate therapeutic alliance and symptom change can be specified, and the refined manual can be used in future proposals examining treatment efficacy.

描述（由申请人提供）：C类人格障碍 （强迫型、回避型和依赖型）是最普遍的 人格障碍（PD）的门诊样本。这些PD是高度 与情绪和焦虑障碍共病合并PD和轴I的患者 疾病呈现出更严重和慢性的症状，他们确实 对心理治疗或药物治疗反应不佳。显得尤为 很难建立一个治疗联盟，一个有据可查的预测 治疗结果、治疗保留率和依从性通常 暴露了鉴于C类PD的普遍性及其重大影响， 心理社会功能、治疗反应和卫生保健利用， 令人惊讶的是， 对于这个人口。认知疗法已被证明是一种有效的 治疗跨越许多轴I障碍，最近已扩展到 PD在强迫症（OCPD）和回避症患者的样本中， （AVPD）PD，首个PD认知疗法（CT-PD）开放试验 在人格症状方面表现出显着的改善， 抑郁和焦虑的症状。因为治疗还处于早期阶段 发展，治疗PD的一般原则和指南是 提供了，但很少有关于如何治疗OCPD和AVPD的具体细节。 这种缺乏具体性的情况限制了手册可用于 在认知中心之外进行更大规模的临床试验 治疗手册就是在这里制定的。R-21治疗的目的是 开发研究的目的是确定治疗的活性成分， 利用这一过程的研究，以提高手册的具体性。 CT-PD被认为是通过使患者暴露于矫正剂而产生效果的。 挑战现有人格模式的信息， 这些模式的历史根源，并提供练习，以促进 一般化拟议的研究将审查这些干预措施， 三个假设的变化前兆的预测： 防御和回避（保护），治疗联盟，以及 在会议影响。生长曲线建模将用于检查测序和 治疗师干预的时机以及这些干预与 假设的变化的前兆，然后将被检查为 症状减轻的预测因素。早期联合治疗的质量 疗程将作为治疗保留的预测因素进行检查。与此 信息，治疗手册中关于OCPD和AVPD的章节可以细化， 可以采取促进治疗联盟和症状改变的策略， 修订后的手册可用于今后的提案审查 治疗效果