Cognitive Therapy for Personality Disorders

人格障碍的认知疗法

• 批准号: 6740128
• 负责人: ADELE HAYES
• 金额: $ 4.87万
• 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 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6740128
• 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(申请人提供)：C类人格障碍 (强迫症、回避症和依赖症)是最普遍的 门诊样本中的人格障碍(PD)。这些掌上电脑是高度 同时患有情绪和焦虑症。帕金森病合并轴心I期患者 疾病呈现出更严重和更慢性的症状特征，而且确实如此 对心理治疗或药物治疗反应不佳。它特别是 难以建立治疗联盟，这是一个有据可查的预测因素 治疗结果、治疗保留率和依从性通常 妥协了。鉴于C群组PD的流行及其重大影响 关于心理社会功能、治疗反应和卫生保健利用， 令人惊讶的是，几乎没有人注意到治疗的发展 对这群人来说。认知疗法已被证明是一种有效的 治疗一系列轴心I疾病，最近已扩展到 PDS。在强迫症(OCPD)和回避症患者的样本中 (AvPD)PD，首个认知疗法治疗PD的开放试验(CT-PD) 在人格症状方面以及在 抑郁和焦虑的症状。因为这种疗法还处于早期阶段 PDS的发展、一般原则和治疗指南如下 提供，但关于如何治疗OCPD和AVPD的具体细节很少。 这种缺乏针对性的做法限制了该手册可用于 在认知中心之外进行更大规模的临床试验 治疗，手册就是在那里开发的。这种R-21疗法的目标是 开发研究是为了确定治疗的有效成分，并 利用这一过程研究来提高手册的专用性。 CT-PD被认为是通过使患者接受矫正剂而起作用的 挑战现有人格模式的信息，确定 这些模式的历史根源，并提供练习以促进 泛化。拟议的研究将审查这些干预措施，如 三个假设的变化前兆的预报器：湍流 防御性和回避(保护)，治疗联盟，以及 会话中的影响。将使用生长曲线建模来检查测序和 治疗师干预的时间以及这些干预和 假设的变化的前兆，然后将被检查为 症状减轻的预测指标。早期治疗联盟的质量 疗程将作为治疗保留的预测因素进行检查。有了这个 信息，治疗手册中关于OCPD和AvPD的部分可以改进， 促进治疗联盟和症状改变的策略可以是 详细说明，改进后的手册可用于将来的提案审查 治疗效果。