An examination of the common and unique processes associated with early symptom change as a function of cognitive therapy for avoidant and obsessive-compulsive personality disorders

Personality disorders are chronic, inflexible, and maladaptive patterns of thoughts, emotions, and behaviors that impact almost every aspect of an individual\u27s life. The disorders found within Cluster C of the DSM-IV Axis II are especially prevalent in outpatient psychotherapy samples, and avoidant and obsessive-compulsive personality disorders (AVPD and OCPD, respectively) have been reported to be among the most frequently occurring of the personality disorders in clinical outpatient samples. AVPD and OCPD have especially high rates of comorbidity with depression and anxiety disorders, and some studies suggest that the presence of a comorbid personality disorder is associated with earlier onset, more severe symptoms, and a poorer prognosis of Axis I disorders. Unfortunately, there are not yet any empirically supported therapies for AVPD and OCPD, and treatment development is sorely needed. The focus of the current study was to investigate the process of both Axis I and II symptom changes that occurred in a sample of 30 patients with AVPD and OCPD as a result of participation in the first open trial of Cognitive Therapy for Personality Disorders. The timing of both Axis I and II symptom change were examined, with a particular interest in the role of early symptom change as a predictor of treatment outcome. In order to add to our understanding of the association between therapist intervention procedures and symptom change within an Axis II sample, common and unique cognitive therapy techniques were examined as predictors of early symptom change. Results indicated that Axis I symptoms declined significantly by sessions four and eight, and that the use of unique therapeutic strategies (i.e., techniques specific to cognitive therapy) during the second session predicted a rapid response in Axis I symptoms by session eight. Axis II symptoms also significantly decreased by session 17. Use of common therapeutic techniques during session two was found to be associated with less improvement in Axis II symptoms by session 17. The changes in Axis I and II symptoms were not significantly associated with the other. The implications for the treatment and future research of personality disorders are discussed