The efficacy of various modalities of psychotherapy for personality disorders: a systematic review of the evidence and clinical recommendations.
The aim of this paper is to review the level of empirical evidence for four different formats and settings that are available for psychotherapy delivery, i.e., group psychotherapy, out-patient individual psychotherapy, day hospital psychotherapy, and in-patient psychotherapy. The focus is on studies which include a wide range of DSM-IV-TR Axis II personality disorders. The results show that various psychotherapeutic treatments have proven to be efficacious with respect to reducing symptomatology and personality pathology, and improving social functioning in patients with Cluster A, B, C, or not-otherwise-specified personality disorders. This is especially true for cognitive-behaviorally or psychodynamically oriented out-patient individual psychotherapies. However, some evidence indicates that this also applies to (1) long-term, psychodynamically oriented group psychotherapy, (2) short-term, psychodynamically oriented psychotherapy in a day hospital setting, and (3) various duration variants of psychodynamically oriented, in-patient psychotherapy programmes. The available evidence mostly applies to borderline, dependent, avoidant and not-otherwise-specified personality disorder, and perhaps also paranoid, obsessive-compulsive, and schizotypal personality disorder. It is unknown whether these conclusions also apply to schizoid, antisocial, narcissistic, and histrionic personality disorder.
Verheul
Roel
R
Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. roel.verheul@deviersprong.nl
Herbrink
Marjolein
M
D000553:Ambulatory Care / Q000379:methods; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003631:Day Care, Medical / Q000379:methods; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011575:Psychoanalytic Therapy / Q000379:methods; D011613:Psychotherapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods; D012917:Social Adjustment; D016896:Treatment Outcome