Cognitive-behavioral Therapy

Abstract

Cognitive-behavioral therapy (CBT) is a relatively efficacious treatment for personality disorders based on the theory that the way people think about stressful situations influences their emotional, behavioral, and physiological responses to them. It is a structured intervention characterized by specific cognitive and behavioral skills that are taught in session and practiced by patients between sessions. These skills are designed to help patients identify and examine the evidence regarding maladaptive thought patterns. CBT skills include cognitive skills (e.g., cognitive restructuring, downward arrow technique), behavioral skills (e.g., behavioral experiments, activity scheduling), and mindfulness and experiential skills (e.g., guided meditation, imagery practice). CBT has typically been studied as a year-long, once-weekly treatment. However, two brief variants of CBT that may be helpful for some patients with personality disorders have received preliminary analysis. One, manual assisted cognitive therapy (MACT), is a six-session, guided self-help protocol designed to help patients apply cognitive, behavioral, and relapse prevention skills to maladaptive and self-harming behaviors. The second, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, has been studied as a 12–16 week treatment for borderline personality disorder. It is designed to teach patients five cognitive, behavioral, and mindfulness skills that allow them to experience difficult emotions and learn to tolerate them. Because they are under-researched, these treatments generally have moderate strength of evidence. In this chapter, we describe these treatments, their approach to treating patients with personality disorders, and the evidence regarding their use. We include clinical vignettes throughout to illustrate specific CBT skills.