cognitive therapy for personality disorders
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© 2009 JSBeck
COGNITIVE THERAPY
FOR PERSONALITY DISORDERS
Judith S. Beck, Ph.D.
Director, Beck Institute for Cognitive Therapy and Research
Clinical Associate Professor of Psychology in Psychiatry
University of Pennsylvania
www.beckinstitute.org
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© 2009 JSBeck
• Definition of Cognitive Therapy
• Techniques Used In Cognitive
Therapy
• Dysfunctional Assumptions of Axis
II Patients that Interfere with
Treatment
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© 2009 JSBeck
CBT is Effective for Axis II Disorders
in Case Reports
• Morrison (2000)
• Bizzini (1998)
• Davidson & Tyrer (1996)
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© 2009 JSBeck
Co- Morbid Axis II Disorders
Do Not Affect Axis I Outcome
with CBT Treatment
• Leibbrand, Hiller & Fichter (1999)
• Simun (1999)
• Comer (1998)
• Dreessen, Hoekstra & Arntz (1997)
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© 2009 JSBeck
CBT Studies Showing Poorer Outcome
for Axis I Disorders with Co-Morbidity
on Axis II
• Kuyken et al (2001)
• Woelwer (2001)
• Vallis, Howes & Standage (2000)
• Marchand et al (1998)
• Chambless, Tran & Glass (1997)
• De Haan et al (1997)
• Hoffart & Hedley (1997)
• Steiger & Stotland (1996)6
© 2009 JSBeck
CBT is Effective for Co-Morbid (Axis I
and Axis II) Diagnoses
• Koerner & Linehan (2000)
• Leibbrand, Hiller & Fichter (1999)
• Black et al (1996)
• Fisher & Bentley (1996)
• Nelson-Gray (1996)
• Neziroglu et al (1996)
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Research on CBT for
Borderline Personality Disorder
• Davidson et al (2006)
• Giesen-Bloo et al (2006)
• Weinberg et al (2006)
• Brown et al (2004)
• Linehan et al (1991)
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© 2009 JSBeck
Cognitive Therapy Checklist
1. Cognitive conceptualization
2. Strong therapeutic alliance
3. Agenda
4. Homework
5. Problem-solving orientation
6. Evaluation of thoughts and beliefs
7. Relapse prevention
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© 2009 JSBeck
GENERAL COGNITIVE MODEL
Situation
Automatic Thoughts
and Images
Reaction
Emotional
Behavioral
Physiological
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© 2009 JSBeck
Core Beliefs
Assumptions
Coping Strategies
Situation
Automatic Thoughts
Reaction
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© 2009 JSBeck
Categories of Core Beliefs about the Self
• Helplessness
• Unlovability
• Worthlessness
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© 2009 JSBeck
Core Beliefs about the World and
Others
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© 2009 JSBeck
TYPICAL OVERDEVELOPED and
UNDERDEVELOPED STRATEGIES
Personality Disorder Overdeveloped Underdeveloped
Obsessive-Compulsive
ControlResponsibilitySystematization
SpontaneityImpulsivityLight-heartedness
Dependent Help-seekingClingingSubjugation
Self-sufficiencyDecision-making
Passive-Aggressive ResistancePassivitySabotage
NegotiationAssertivenessCooperation
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© 2009 JSBeck
COGNITIVE CONCEPTUALIZATION DIAGRAM
RELEVANT CHILDHOOD DATA
CORE BELIEFS
CONDITIONAL ASSUMPTIONS/ BELIEFS/ RULES
COPING STRATEGIES
SITUATION #1
AUTOMATIC THOUGHT
MEANING OF AT
Emotion
Behavior
SITUATION #2
AUTOMATIC THOUGHT
MEANING OF AT
Emotion
Behavior
SITUATION #3
AUTOMATIC THOUGHT
MEANING OF AT
Emotion
Behavior
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© 2009 JSBeck
Building the Therapeutic Alliance
• Standard techniques
• When patients react negatively
• Using the alliance to achieve therapeutic goals
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© 2009 JSBeck
Structuring Sessions
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© 2009 JSBeck
In-Session Treatment Planning Questions
• How can I help the patient feel better by
the end of the session?
• How can I help the patient have a better
week?
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© 2009 JSBeck
Structure of the Therapeutic Interview
1. Mood check
2. Setting agenda
3. Bridge from last session
4. Discussion of today’s agenda items
5. Homework assignment
6. Capsule summaries plus summarization of session
7. Feedback from patient
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© 2009 JSBeck
Evaluating Automatic Thoughts and Images
• Standard techniques
• When automatic thoughts are true
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© 2009 JSBeck
Socratic Questions
�What is the evidence that my thought is true? What is the evidence that my thought is not true?
�What’s an alternative explanation or viewpoint?
�What’s the worst thing that could happen? How could I cope with that?
What’s the best that could happen?
What’s the most likely outcome?
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© 2009 JSBeck
�What is the effect of telling myself ______ [this thought]? What could be the effect of changing my thinking?
�What would I tell ______[a specific friend/family member] if he/she viewed this situation in this way?
�What should I do now?
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© 2009 JSBeck
TECHNIQUES TO MODIFY CORE
BELIEFS
1. Educating patients about core beliefs
2. Presenting an information processing
model
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© 2009 JSBeck
I am bad.________
Forgot sister’s birthday
Made mistakes at work
+Work
+Helped sick neighbor
Turned Neil down for date
+Work+
Work
+Stayed late at work
Should have worked harder
Should have helped more
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© 2009 JSBeck
3. Developing a new core belief
4. Motivating patients to modify old core beliefs
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© 2009 JSBeck
5. Monitoring the strength of core beliefs
over time
6. Modifying core beliefs daily
7. Contrasting with more extreme
negative role models
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© 2009 JSBeck
8. Creating yardsticks of evaluation
9. Devising behavioral experiments
10. Acting “as if”
11. Doing intellectual/emotional roleplays
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© 2009 JSBeck
12. Metaphors
13.Cognitive Continuum
14.Historical Review of Evidence
15.Restructuring the Meaning of Early Experiences through Imagery
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© 2009 JSBeck
CT for Personality Disorder References
– Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
– Beck, J.S. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. New York: Guilford
– Beck, A.T., Freeman, A., Davis, D. and Assoc. (2004). Cognitive therapy of personality disorders, 2nd ed. New York: Guilford.
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© 2009 JSBeck
– Layden, M.A., Newman, C.F., Freeman, A., & Morse, S.B. (1993). Cognitive therapy of borderline personality disorder. Boston: Allyn & Bacon.
– Leahy, R. Overcoming resistance in cognitive therapy. New York, Guilford.
– Young, J. (1999). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Exchange.
– Young, J., Klosko, J. and Weishaar, M. (2003). Schema therapy. New York, Guilford.
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© 2009 JSBeck
Academy of Cognitive Therapy
Certifies Cognitive Therapists
Referrals Consumer InformationTraining Opportunities
ListserveNewsletter
www.academyofct.org
Email: info@academyofct.org610-664-1273
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© 2009 JSBeck
Beck Institute for Cognitive
Therapy and Research
Training
Clinical Care
Research
Reference lists, educational materials, downloadable patient brochure, newsletter
www.beckinstitute.org
beckinst@gim.net
610-664-3020
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