Table
2: Psychotherapeutic
interventions in APD.
Article |
Kind of study |
Sample |
Result |
Alden
[53] |
76
APD unmarried subjects (34 F) randomized to (10 weeks treatment): 1.
waiting list 2.
skill training 3.
graduated exposure 4.
a regimen targeting intimate issues |
Patients
in the waiting list control group ameliorated significantly less than
patients in the other groups. No
dramatic differences were found in the 3 active arms of the study, regimen #4
was associated with a slight increase in the frequency of the social
activities. |
|
Emmelkamp et al. [54] |
Randomized
controlled study |
62
APD patients randomized to (20 weeks treatment): 1.
brief dynamic therapy-based 2.
cognitive - behavioral therapy 3.
waiting list |
Cognitive
behavioral treatment was associated with better results in a number of
measures including the avoidant scale and the SPAI social phobia test. CBT
was the only treatment to be effective against PDBQ dependent and PDBQ
obsessive symptoms. |
Leichsenring et al. [56] |
Multicenter
randomized controlled trial |
495
patients with SP (25% had also APD) were randomized to: 1.
CBT 2.
psychodynamic therapy 3.
waiting list |
Remission
rates for the 3 groups were: 36%, 26% and 9%. Response
rates for the 3 groups were: 60%, 52% and 15%. Both
CBT and psychodynamic intervention were significantly
more efficacious than the control group. CBT
was significantly more efficacious for remission rates, but not for response
rates. |
Beretta
et al. [57] |
Open
label study |
70
patients (27 with cluster C diagnosis) were treated with an ultra-brief
psychodynamic intervention (4 times session, Gilleron
1989) |
33%
of patients ameliorated at the end of the treatment. Results were maintained
after 3 and 6 months. |
Wintson et al. [58] |
Randomized
controlled study |
81
patients with personality disorders (36 with APD) were randomized to (40
weeks treatment on average): 1.
brief adaptive psychotherapy 2.
short-term dynamic psychotherapy 3.
waiting list |
Patients
in the two active arms ameliorated significantly more than the patients in
the control group. |
Svartberg et al. [59] |
Randomized
study |
50
patients with cluster C diagnosis (16 with APD) randomly assigned to (40
weeks treatment): 1.
short-term psychodynamic treatment 2.
CBT |
There
were no significant differences between groups at termination and follow-up |
Karterud et al. [60] |
Open
label study |
1244
patients consecutively admitted to eight different treatments programs. 1010
diagnosed with PD, 481 had APD. The
treatment programs are based on group therapy and typically consist of a
mixture of psychodynamic and CBT groups. |
The
completion rate was 76%, having a diagnosis of PD was associated with a
higher risk of early termination. 59%
of patients were taking medications at admittance. This number increased to
68% in the course of the treatment. Patients
were discharged with a better performance in a number of tests including:
GAF, CGI, CIP and QoL. |
PD:
personality disorder; MDD: major depressive disorder; APD: avoidant personality
disorder; SPAI: social phobia anxiety inventory; PDBQ: personality disorder
belief questionnaire; CBT: cognitive-behavioral therapy;
GAF:
global assessment of functioning; CGI: global severity indenx;
CIP: circumplex of interpersonal problems; QoL: quality of life