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Personality disorders: New perspectives in CBT oriented evaluation and treatments

Fabio Monticelli,Tullio Scrimali, David Koppers Speaker

A review of the literature on DP, shows how these move in a range from 4.4% to 13.4% with an average of 9.6% (Samuels, 2011). Many of these are in co-morbidity with other mental disorders or even in co-morbidity between DP. In addition, the DSM 5 classification proposes integrating a more innovative functional classification (appendix III, DSM 5) into the traditional category description of the DP. The aim of this symposium is to present some innovations in the functional evaluation of DP. Monticelli will show us how some functional variables (metacognition and interpersonal motivational systems) are present in different ways in the categories of DP. This implies the search for new CBT oriented treatments. Procacci proposes a comparison study MIT AvPd patients with social withdrawal with individual therapy and individual therapy + skills therapy; Scrimali describes a neuroscience-based conceptualization and assessment of BPD patients and his research on integrating biofeedback with the CBT into the treatment of BPD. Finally, thanks to Koppers, we consider that the comorbidity between depressive disorder and PD influences the outcome of treatments both CBT and short-term psychodynamic. The proposal that CBT-oriented treatments are ready to consider the novelties proposed in the current classifications and are ready to introduce innovations in the evaluation and treatment systems proposed to patients.

Symposium Convenor: Michele Procacci (Italy), e-mail: procacci@terzocentro.it EABCT Special Interest Group Symposia in Personality Disorders (SIG in Pd’s)

Symposium Chair/Discussant: Arnoud Arnzt (Nederland)

Symposium Presenters

1 Presenter: Fabio Monticelli (Italy), MD, Clinical Centre De Sanctis, International Attachment Network Director of Dissociative Unit, Trainer of Italian Society Behavioural and Cognitive Therapy (SITCC), e-mail: fabio_monticelli@yahoo.it

2 Presenter: Michele Procacci (Italy), MD, Third Centre Cognitive Psychotherapy Rome, Secretary and Treasurer of Italian Society Behavioural and Cognitive Therapy (SITCC), e-mail: procacci@terzocentro.it

3 Presenter: Tullio Scrimali (Italy) MD, University of Catania and ALETEIA International, European School of Cognitive Therapy,rainer of Italian Society Behavioural and Cognitive Therapy (SITCC), e-mail:tscrima@tin.it

4 Presenter David Koppers (Nederlands),Klinisch Psycholoog BIG/supervisor VGCT

Manager Behandelzaken INFORSA-FPK Zorgprogramma lang

e-mail: David.Koppers@inforsa.nl

DEVELOPMENT OF A SELF-REPORT MEASURE TO DETECT THE SPONTANEOUS ATTITUDE TO USE SOME SPECIFIC INTERPERSONAL MOTIVATIONAL SYSTEMS TO REGOLATE AND MAKE SENSE TO THE INTERPERSONAL EXPERIENCES: THE ASSESSING INTERPERSONAL MOTIVATION. (AIM 17; Monticelli, Tombolini, Farina, Pedone, in press) INSTRUMENT DESCRIPTION AND FACTOR STRUCTURE

Fabio Monticelli

Centro Clinico De Sanctis Roma (Italy)

Interpersonal Motivational Systems (IMS) regulate social interactions in all mammals. These systems (the attachment system -whose main goal is care-seeking-, the care-giving system, the ranking system to achieve dominance through competitive behavior, the sexual mating system and the cooperative system) are the result of evolutionary processes and can be conceptualized as universal, inborn dispositions aimed at pursuing each a specific biopsicosocial goal.

On this theory we already elaborated the AIMIT method (Assessing Interpersonal Motivation in Transcripts; Liotti & Monticelli, 2008), that allows 1) to detect the IMS by specific linguistic markers, within sessions 2) to identify moment by moment the patient’s cooperation trend, indicating the therapeutic impasse or ruptures 3) to evaluate the interventions of both, therapist and patient, that favour the impasse or rupture phases of Therapeutic Alliance.

There has seemed useful to set up an instrument able to identify the spontaneous attitude to use some specific IMS to regulate and make sense to the interpersonal experiences. Understanding at the beginning of treatment such patient’s spontaneous inclinations to activate dis-functionally one or more specific IMS, can be useful to understand the patient complexity in a dimensional approach. I’ll present 1) the AIM 17 (Assessing Interpersonal Motivation; Monticelli et al. In press) a Self-report questionnaire in course of validation and 2) the preliminary results of a research in wich the AIM 17 was administered to 70 patients with the ADP-4 and Self-report MSAS (Metacognition Self-Assessment Scale, Pedone et al. 2017) to value the subject metacognitive abilities.

MIT for severe social withdrawal:

How an integrated MIT model based on individual and social group could make the difference?

Michele Procacci2, Livia Colle1,2, , Paola Mallozzi2, Fabio Moroni2, Giovanni Pellecchia2Nino Carcione2, Giuseppe Nicolò2, Antonio Semerari2,

1Department of Psychology, University of Turin, Italy

2 Third Centre of Cognitive Psychotherapy, Rome, Italy

Objectives

The aim of this study is to present an original individual and group treatment protocol developed specifically for patients with severe social withdrawal and for AvPD patients in particular. These patients are associated with elevated levels of interpersonal problems, low levels of social support and intimacy and limited emotional expressivity and self-disclosure within close relationships. The Third Centre of Cognitive Psychotherapy developed a treatment of Avpd based on the hypothesis that the core deficit of AvPD patients were: mindreading impairment (the capacity of understanding our own mental states and those of others) and lack of social sharing. Based on the same framework, the Third Centre recently developed an additional MIT Group Therapy Intervention for patient with social withdraw (MIT social skills training, Colle et al 2017).

The aim of this study is to present and describe the rational of the MIT social group intervention in patients with social withdrawal, Additonally, we aim to provide a preliminary evaluation of the role of the MIT social group comparing to the MIT individual therapy in two sample of AvPd patients.

Methods

Two sample of patients with AvPD referred to the Third Centre of Cognitive Psychotherapy are compared. Both sample were diagnosed using both structured interviews (SCID II) and self-report measures for a) symptom distress (SCL-90R), b) interpersonal problems (Inventory of Interpersonal Problems), c) psychosocial functioning (Work and Social Adaptation Scale). Treatment was focused group therapy targeting the development of specific social abilities. In order to assess impact and efficacy of the treatment, a semi-structured interview designed to evaluate different aspects of mindreading (MAS) was administered to all participating patients at the start of treatment and after six months of treatment; patients also completed self-reports on their subjective perceptions of social inclusion and social sharing at the start of treatment and after six months of treatment.

Results/conclusions.

Work in progress and ongoing; preliminary results will be presented and discussed.

NEUROSCIENCE-BASED COGNITIVE THERAPY

FOR BORDELINE PERSONALITY DISORDER

From Neuroscience to Clinical Setting with BPD Patients.

Tullio Scrimali

Professor of Clinical Psychology and Psychotherapy, Medical School, University of Catania

Founder and Director of ALETEIA International, European School of Cognitive Therapy

E-mail: tscrima@tin.it; Web site: www.tullioscrimali.it

Summary

The Author introduces a neuroscience-based model of borderline personality disorder. Then, a new integrated CBT protocol, based on a bio-psycho-social and complex approach, is presented. It includes a new technique, coming from ALETEIA Applied Neuroscience LAB (ALAN), which can be easily applied, to the clinic setting of Cognitive and Behavioural Therapy. This new technique is the digital monitoring and biofeedback of electrodermal activity, applied thanks to the use of a new and original device, developed by the Author, and named MindLAB Set (see: www.psychotech.it). This new device can be used, both when assessing a BPD patient and during its treatment. It allows any Cognitive Therapist to apply some new powerful methods of self-regulation, such as Biofeedback and Biofeedback Based Mindfulness, when working with BPD patients. Furthermore, a MindLAB Set is very useful for monitoring the arousal and the warning signs of relapse and for preventing any critic episode of emotional dyscontrol in BPD patients. This increase the sense of mastery and the self-esteem, usually very low in BPD patients. A single case research study, concerning the use of a Neuroscience-based cognitive protocol for the BPD is presented.

The effect of personality pathology on depression outcome after cognitive behavioural therapy or short term psychodynamic therapy.

David Koppers (Nederlands)

Introduction

Several meta-analyses show that time-limited psychotherapy for depression is effective, with large effect sizes at treatment termination. However, full remission rates after treatment is reported between 23% and 62% and are relatively low, possibly due to the high proportion (45% to 74%) of co-morbid personality disorders. While there is a broad consensus that personality disorders influence negatively depression outcome, studying the role of comorbid personality pathology while directly comparing two treatment modalities are scarce.

Method

We conducted a randomized clinical trial comparing 16-sessions Cognitive Behavioural Therapy (CBT) and Short Psychodynamic Supportive Psychotherapy (SPSP) in depressed patients (n=196) with or without a comorbid personality disorder (MDD-PD). The presence of personality pathology was determined by a self-report version of the International Personality Disorder Examination. Primary outcome was symptom improvement of the HAM-D at treatment termination and at one year follow up. Secondary outcome were social functioning according to the OQ-45 scales social role functioning and interpersonal relations and Quality of Life according to the EQ-5D.

Results

The results on symptom reduction show a large pre-post treatment effect size at treatment termination (ES=0.88-1.23) and at one year follow-up (ES=1.23-1.73) in both patient-groups.

Personality pathology had a significant worse influence at treatment termination (emd=-2.37, SE=1.12) and follow-up (emd=-4.47, SE=1.21) and the two patient groups were not ameliorated differentially by treatment modality (emd=-0.23, SE=2.25). ES for social functioning according to the OQ-45 were medium to large for both patient-groups. This was also the case for Quality of Life. Depressive patients with comorbid personality disorders had significant more problems in social functioning and a significant worse Quality of Life than without comorbidity. Treatment condition has also no differential influence on these results.

Discussion

The results confirms that personality psychopathology has a negative influence on depression outcome after treatment termination and one year follow up.This is also the case on social functioning and quality of life. While both patient groups profit from the two short term psychotherapies, treatment modality doesn’t make difference in treatment outcome.

Conclusion

CBT and SPSP contributes to improvement depressive symptoms and interpersonal problems for depressed patients with and without comorbid personality pathology. Both treatments are an effective first step in a stepped care approach, but probably not enough for a large amount of patients with comorbid personality pathology.