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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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CBT is Effective for Axis II Disorders

in Case Reports

• Morrison (2000)

• Bizzini (1998)

• Davidson & Tyrer (1996)

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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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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

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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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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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GENERAL COGNITIVE MODEL

Situation

Automatic Thoughts

and Images

Reaction

Emotional

Behavioral

Physiological

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Core Beliefs

Assumptions

Coping Strategies

Situation

Automatic Thoughts

Reaction

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Categories of Core Beliefs about the Self

• Helplessness

• Unlovability

• Worthlessness

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Core Beliefs about the World and

Others

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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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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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Building the Therapeutic Alliance

• Standard techniques

• When patients react negatively

• Using the alliance to achieve therapeutic goals

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Structuring Sessions

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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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Evaluating Automatic Thoughts and Images

• Standard techniques

• When automatic thoughts are true

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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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�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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TECHNIQUES TO MODIFY CORE

BELIEFS

1. Educating patients about core beliefs

2. Presenting an information processing

model

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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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3. Developing a new core belief

4. Motivating patients to modify old core beliefs

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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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8. Creating yardsticks of evaluation

9. Devising behavioral experiments

10. Acting “as if”

11. Doing intellectual/emotional roleplays

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12. Metaphors

13.Cognitive Continuum

14.Historical Review of Evidence

15.Restructuring the Meaning of Early Experiences through Imagery

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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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– 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