Effectiveness of compassion-focused therapy for self-criticism in patients with personality disorders: a multiple baseline case series study.

OBJECTIVE: Targeting self-criticism, the tendency to negatively evaluate and judge aspects of oneself, may improve treatment efficacy for personality disorders (PDs). This study aimed to test whether adding 12-week group compassion-focused therapy (CFT) that explicitly targets self-criticism to treatment as usual (TAU) would reduce self-criticism in patients with PDs. METHOD: Twelve patients with PDs participated in a multiple baseline study, randomly allocated to different baseline lengths. The primary outcome was twice-weekly assessed self-critical beliefs during baseline, treatment, and follow-up phases. Secondary outcomes were self-criticism, self-compassion, and PD severity at the end of CFT and follow-up (trial registered: NL8131). Nine participants completed the intervention. No significant changes were observed during CFT, but at follow-up significant decrease in self-critical beliefs (Cohen's d = -0.43; 95% CI = -0.73 to -0.12) was reported compared to baseline. On secondary outcomes, most participants showed reliable improvement on self-reported criticism (66.7%) and self-compassion (55.6%), and a minority of patients showed reliable improvement in PD severity (33.3%). CONCLUSIONS: This study seems to provide preliminary evidence for the effectiveness of 12-week CFT for self-critical beliefs in patients with PDs compared to TAU. CFT for self-criticism in PDs may complement treatment offerings and warrant further research.

Life stories of patients with personality disorders before and after treatment: Change and stability in agency and communion.

Introduction: Studying written life stories of patients with personality disorders (PDs) may enhance knowledge of how they understand themselves, others and the world around them. Comparing the construction of their life stories before psychotherapy to their reconstruction after psychotherapy may provide insight in therapeutic changes in the understandings of their lives. Methods: As few studies addressed this topic, the current study explored changes in agency (i.e., perceived ability to affect change in life), and communion (i.e,, perceived connectedness to other persons) in written life stories of 34 patients with various PDs, before and after intensive psychotherapy treatment. Results: Life stories showed a positive increase in agency from pre- to posttreatment, in particular regarding internal agency, societal success, and occupational success. No significant changes were observed for communion as a whole. However, the perceived number and quality of close relationships revealed a significant positive increase. Discussion: The increased agency in the reconstruction of patients' life story after psychotherapy suggests that patients improved their perceived ability to affect change in their own lives. This can be seen as an important step in the treatment of PDs towards further recovery.

Acceptance and commitment therapy group-treatment for non-responsive patients with personality disorders: An exploratory study.

Patients with personality disorders who did not respond to previous outpatient treatment are among the most challenging patients to treat and are often referred to specialized settings. Acceptance and commitment therapy (ACT) is an innovative therapy that has shown effectiveness in treatment-resistant cases with chronic or recurrent depression with or without co-morbid personality disorders. The central role that ACT accords to positive values and experiential avoidance may enhance treatment responsivity in patients with personality disorders that did not respond to previous treatments. The current nonrandomized study explored the effectiveness of a 26-week ACT-based group treatment (n = 60) for personality disorders compared to treatment-as-usual (n = 21) based on cognitive behaviour therapy (CBT-TAU) at a specialized setting for patients with personality disorders. Individuals in both treatment conditions demonstrated small to moderate decreases in general psychological functioning and personality pathology. There was no main effect of therapy condition. Overall, results suggest that ACT is a possible treatment option for individuals with difficult-to-treat personality pathology and further outcome research is warranted.