title: Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse.
abstract: Many patients with substance abuse problems present with co-occurrent cluster C personality disorders. Focusing on both disorders disrupts the maintenance mechanisms and the vicious cycle between the 2 conditions; however, treatment teams often neglect this issue. In this work, we describe the features of metacognitive interpersonal therapy as applied to a man with avoidant and depressive personality disorders and heroin, cocaine, and alcohol abuse. Psychotherapy proceeded through the following steps: (a) conducting drug therapy to deal with symptoms of abstinence from heroin; (b) forming a therapeutic bond to overcome the patient's severe emotional withdrawal; (c) fostering basic metacognitive capacities such as awareness of emotions and their triggers; (d) sharing formulations of maladaptive interpersonal schemas and descriptions of the associated states of mind; (e) conveying an understanding of the link between interpersonal events (recent ones and traumatic memories) and substance abuse; (f) facilitating the acquisition of critical distance from maladaptive schemas; and (g) promoting the use of adaptive coping skills instead of resorting to substance abuse. Implications for generalizing these procedures to the treatment of other patients with co-occurrent personality disorders and substance abuse are described.
authors.affiliation: Center for Metacognitive Interpersonal Therapy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Dimaggio
authors.forename: Maddalena
authors.initials: M
authors.lastname: D'Urzo
authors.forename: Manuela
authors.initials: M
authors.lastname: Pasinetti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Salvatore
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lysaker
authors.forename: Dario
authors.initials: D
authors.lastname: Catania
authors.forename: Raffaele
authors.initials: R
authors.lastname: Popolo
mesh_terms: D000328:Adult; D015897:Comorbidity; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010554:Personality Disorders / Q000453:epidemiology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D056345:Theory of Mind / Q000502:physiology*
keywords: avoidant personality disorders; mentalizing; metacognition; substance abuse