Differential Effects of Psychological Interventions in Online and Face-to-Face Settings on DSM-5 and ICD-11 Maladaptive Trait Domains: An Exploratory Pilot Study.

André Kerber,Christine Knaevelsrud,Carmen Schaeuffele,Heleen Riper,Antoine Urech,Johanna Boettcher,Thomas Berger,Tobias Krieger

doi:10.3389/fpsyt.2021.648367

Abstract

While mental health treatments have proven to be effective for a range of mental health problems, there is comparably little research on its effects on personality disorders or difficulty (PD). New dimensional conceptualizations of PD such as the ICD-11 PD model enable the cost- and time-effective dimensional assessment of severity and style of PD. Furthermore, they constitute a promising tool to investigate PD, not only as a treatment endpoint but also as a predictive or influencing factor for mental health treatments. In this study, we investigated the effects in two different mental health treatment settings [online (N = 38); face-to-face and blended [FTF/blended] (N = 35)] on the reduction of maladaptive personality traits as well as the interaction between maladaptive personality patterns and the response on primary endpoints (i.e., mental distress). Results indicate that both treatment settings have comparable within-group effects on the reduction of distress symptoms, while the treatment in the FTF/blended setting seems to have a stronger impact on the reduction of maladaptive traits. Further, reduction of maladaptive trait expressions was a reliable predictor of treatment response in the FTF/blended setting while explaining less variance in the online setting. Beyond the promising findings on the utility of maladaptive trait change as an outcome measure, we discuss possible applications as an information source for treatment decisions.

Highlights

The ICD-11 includes a dimensional model for personality disorders (PD) comprising an assessment of severity of personality dysfunction and maladaptive personality traits or patterns [1]
Maladaptive trait domain expressions at the beginning of the treatments were found to be significantly higher for Negative Affectivity, d = 1.18 [1.05–2.43] and Detachment, d = 1.22 [0.99–2.25] in the online setting, while Antagonism, d = 0.82 [0.47–1.75], was significantly higher in the FTF/blended setting
The exploratory results of the present study showed that both treatments had comparably large within-group effects on the reduction of mental distress while differing in their effects on maladaptive personality traits

Summary

Introduction

The ICD-11 includes a dimensional model for personality disorders (PD) comprising an assessment of severity of personality dysfunction and maladaptive personality traits or patterns [1]. Research showed moderate to strong associations of maladaptive personality patterns with a range of other mental disorders, e.g., anxiety and depression [6], internalizing and externalizing disorders [7], psychotic disorders [8], substance-related disorders [9], and posttraumatic stress disorder [10]. They have been shown to be related to transdiagnostic variables, such as interpersonal problems [11], childhood maltreatment [12], maladaptive schemas [13], pathological beliefs [14], emotion dysregulation [15] or attachment anxiety and avoidance [16]

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