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Summary Week 3 Personality Disorders
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Week 3: Personality DisordersIs the Dodo Bird Endangered in the 21st
Century?
Introduction
The Dodo bird hypothesis asserts that when bona fide treatments are compared – they yield
roughly equal outcomes
The Dodo bird debate – addresses an essential question about how psychotherapy works
- Which may account for why there are such “diametrically opposed
interpretations” of this literature
Overall – psychotherapy is more effective than no treatment or placebo controls – but:
1) How is psychotherapy effective?
2) Are some psychotherapies more effective than other psychotherapies?
The Empirically Supported Treatment (EST) Movement
A report by Task Force on Promotion and Dissemination of Psychological Procedures
initiated the empirically supported treatment (EST) movement
The report included a list of empirically validated treatments – and the Task Force
recommended:
1) These treatments be taught in programs
2) The public, policy makers, and third parties be informed about these treatments
The aim of the report – was to ensure that clinical psychologists use ESTs in their practice
Compelling evidence – either supporting or refuting the Dodo bird hypothesis – would have
implications for psychotherapy research – including:
, 1) Whether research efforts should be directed toward discovering and validating
specific techniques
2) Whether factors common to most therapies – e.g., therapeutic alliance and installation
of hope – should be the primary focus of psychotherapy research
Such findings also have implications for practice – including:
1) The extent to which therapists should rely on treatment manuals in their practices
The Cognitive Contrast
Closely connected with both the Dodo bird hypothesis – and the EST debate – are the
questions of whether CBT is superior to other treatments
- And whether the EST movement is biased toward CBT treatments
There is mixed empirical support for the relative efficacy of CBT – particularly depending on
the outcome measures utilized
Discussion
One’s interpretation of the literature on the Dodo bird research – strongly associated with
one’s beliefs about how psychotherapy works
To the extent that the aim of psychotherapy is to reduce the severity of targeted symptoms at
the end of treatment
- It appears that some treatments are incrementally more effective than other
treatments
The Dodo bird hypothesis – had greater support with respect to secondary outcomes at both
(1) termination and (2) follow-up
- And perhaps in terms of primary outcomes at follow-up
Bona fide treatments – yield similar outcomes with respect to quality of (1) life measures and
(2) other measures of psychopathology – that were not the specific target of the treatment
There is stat sig heterogeneity among the primary outcomes at termination – the following are
studies that yielded the largest effect sizes:
, 1) One study- yielded the largest ES – which was almost twice as large as the next
largest difference
- Found that habit reversal therapy was more effective for reducing tic severity in
adults with TS – than supportive therapy
2) The next three studies with largest ES – found that CBT was superior to either
applied relaxation or to meditation – for the symptoms of social phobia
- CBT was superior to applied relaxation for treating panic attacks
A highly symptom-focused treatment – more effective than a less focused treatment – at
reducing a very or relatively specific symptom
There may be higher levels of treatment equivalence for some disorders – e.g., depression –
and greater treatment differences for other disorders – e.g., panic disorder
- There may be Dodo disorders and non-Dodo disorders
Cognitive Contrast
CBT – superior to psychodynamic therapies for treating specific symptoms – or targeted
problems – both at termination and at follow-up
CBT – stat more effective than other therapies at termination – for treating anxiety
Failed to find differences b/n CBT and other treatments – for secondary or non-disorder
specific outcomes
Implications and Conclusions
Some issues and diagnoses – require specific treatment techniques – e.g., habit reversal
therapy for tic disorders; CBT for panic disorder
- Others may respond equally well to variety of interventions
Psychotherapists should be cognitively flexible and capable of assessing (1) when specialized
techniques would be beneficial – and (2) when common factors may be most important
1) Need to be able to determine whether one treatment is better over another vs when
they are treating “Dodo disorders”
, 2) Need to be capable of helping clients articulate whether their main goal is symptom
relief – i.e., primary outcomes – or more general life changes – i.e., secondary
outcomes
The Dodo bird verdict – is a proxy for the debate between:
1) Medical Model of psychotherapy – i.e., common factors are important, but the
specific active ingredients are the key to healing
2) Contextual Model – i.e., psychotherapy as “a cultural healing practice”
The meta-analysis provided support for each model
1) In support of specific ingredients – at termination some treatments were more
effective than others for treating focused symptoms
- Here, CBT was stat more effective than alternative treatments
2) In support of contextual model – these effects were generally small
- These treatment differences do not extend to secondary outcomes – and usually
dissipate at follow-up
Efficacy of Psychotherapies for Borderline
Personality Disorder
Abstract
Borderline PD – is a debilitating condition
- Several psychotherapies are considered effective
Psychotherapies – most notably (1) dialectical behavioral therapy and (2) psychodynamic
approaches – effective for BPD symptoms and related problems
- Effects were small – inflated by risk of bias and publication bias – and particularly
unstable at follow-up
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