Handout day 2 Copenhagen 21.8.17 - Wattar Gruppen

21/08/17

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CBTpd Day 2

Professor Kate Davidson 2017

Feedback from yesterday

•  Think of two pieces of knowledge that you gained from yesterday?

•  In what way might this change how you think

about PD?

Plan: applicaGon of CBT to pd

Day 2 •  ImplicaGons of formulaGon for change •  Phases and structure of therapy

•  RegulaGon of emoGons, behaviour and thinking •  Generic Structured Clinical Care •  CBTpd for ASPD

•  Hints to help families and staff

APer agreeing the formulaGon

What next?

What are the implicaGons fo the formulaGon? What would you prioriGse?

Developmental perspecGve

Under-‐

developed

behaviours

Core

beliefs

Structured

Interpersonal

focus

Formula>on

CBTpd

Cognitive therapy for PD

Differences from standard CBT

Greater emphasis on therapeutic relationship

Narrative formulation

Past history more important

More session over longer time period

Levels of affect higher during sessions focused on

core beliefs

More emphasis on developing new ways of

behaving and thinking

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Aims of therapy

Enhance quality of life, reduce self -‐harm & improve interpersonal funcGoning by

developing new ways of thinking

&

new ways of behaving

Aims

•  Build therapeutic alliance

•  Motivational enhancement of change

•  Promote more adaptive and coherent

view of self and others

•  Managing emotions and behaviour

•  Improved self nurturance

•  Improved communication

Targets of CBTpd

Behavioural regulaGon

EmoGonal regulaGon

Interpersonal sensiGvity

Develop new beliefs about

self and others

Interpersonal

problem solving

Empathic shared

formulation

Changes in

interpretation of view of self

& others

changes emotional

response

Behavioural experiments to test out assumptions self & others

General principles of change

 Therapy alliance – Empathy, posiGve regard, respect, limits set but also some flexibility.

– Therapist honest about own limitaGons – Clarity about what the treatment is and is not.

 Shared understanding of problem development through formulaGon  Shared agreement in treatment goals

Therapy change procedures

•  Focus on core beliefs

•  Focus on under-developed behaviours

•  Focus on change but balance with empathy regarding how change is difficult to come about

•  Promote more positive and adaptive ways of thinking and behaving

•  Work with others if possible to promote and reinforce change

Initial phases of therapy

Engagement.

IdenGfy core beliefs & over-‐developed behaviours.

Develop & agree formulaGon. Agree problems & goals

Decrease self destrucGve behaviour.

Develop new ways of behaving (under-‐developed behaviours) and the skills needed to maintain these. PracGce in daily life

Work on new ways of thinking about self and others to improve relaGonships (core beliefs work). Work done in session.

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Middle and end of therapy

Client gains experience of new ways of thinking & new ways of behaving in their day to day life. Therapist reinforces new behaviours & thinking about self and others. PracGce pracGce pracGce! May involve significant others at this stage to reinforce changes.

Review & encourage new sense of self and accompanying behaviour change. Therapist summarises changes in wriGng for the client to reinforce change.

Ending therapy

General psychiatric management

Compared to DBT

DBT vs GPM (McMain et a. 2009)

DBT General Psychiatric

management

TheoreGcal basis

Learning theory, Zen & dialecGcal philosophy.

Psychodynamic (Gunderson)

Underlying problem Deficit in emoGonal regulaGon Disturbed acachment relaGonships related to emoGonal dysregulaGon

Treatment structure MulGmodal: individual session + skills group + coaching (5 hours per week) Team consultaGon (2 hours)

One hour individual session per week includes medicaGon management using structured drug algorithm. 90 mins therapist supervision per week.

Hierarchy of targets suicide treatment interfering, quality of life interfering behaviors.

PaGent preference. No hierarchy of targets Focus moves away from suicidal behaviors and self harm

DBT vs GPM McMain et al. 2009

DBT GPM

Primary strategy PsychoeducaGon BPD Helping relaGonship Here and no focus ValidaGon and empathy EmoGon focus

PsychoeducaGon BPD Helping relaGonship Here and no focus ValidaGon and empathy EmoGon focus

DialecGcal strategies Irreverent and reciprocal communicaGon style Formal skills training Behavioural techniques : Exposure, conGngency management, diary cards behavioral analysis.

AcGve listening for signs of negaGve transference

Crisis Manages on OutpaGent basis preferred/ coaching

HospitalizaGon if indicated

MedicaGon Skills over pills Meds for specific symptoms

Generic Structured Clinical Care

Knowledge of … • personality disorders

• value and content of structured care (clear roles, consistency etc)

Skill to…

• assess problems including client’s motivation for change and understanding of therapy

• formulate problems

• discuss the content of the intervention with the client

• develop a care plan

Kate Davidson PD workshop 2017 17

Therapeutic stance

Patience, compassion, and sensitivity

Maintain a focus on hope

- especially in the face of the client’s

subjective experience of adversity

Maintain a consistently “inquisitive” stance

in relation to the client


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Therapeutic stance

o Authentic and open therapeutic stance e.g. reflect on own mental state and actions (including non-verbal behaviours) and the impact that this may have on clients

o Accepting that they won’t always be able to comprehend the client’s subjective experience, and being open and honest about this

o Acknowledging and “owning” errors made during the course of the intervention


Therapeutic stance

An ability to foster the client’s sense of self-efficacy

Examples

o  Refrain from taking a ‘knowing’ stance (e.g. by providing solutions to the client’s problems or offering “interpretations’ of their behaviour)

o  Reinforcing examples of the client’s positive coping skills

o  Helping clients to increase their problem-solving skills


Therapeutic alliance

o  An ability to employ active listening techniques

including:

o  listening attentively

o  encourage reflection and exploration by using open

questions

o  clarifying and summarising the content of sessions

regularly throughout a session

o  An ability to maintain positive regard by adopting a

warm and responsive non-judgemental approach


Developing a therapeutic alliance

Monitor alliance. Quality may vary

Build by taking an active interest in the client’s life

circumstances, interests and strengths by:

o  Ensuring the client is clear about the rationale for the

intervention

o  Being active & remaining flexible, respectful, open and

interested in the client

o  Answering questions about the intervention in a

straightforward manner, non-defensive manner

o  Showing an understanding of the impact that any

previous problematic contacts with services


Maintain alliance

Responding to negative events in treatment

and using such events to:

o  revisit the rationale for treatment

o seek out and clarify any

misunderstandings about treatment

o  refocus on the tasks and goals which are

seen as relevant to the client


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Summary main BOSCOT findings

Outcome p

Number of suicidal acts 0.02

Anxiety 0.013

Beliefs (YSQ) 0.0064

BSI – Positive Symptoms

Distress Index 0.0047

Central problems in BPD

EmoGonal regulaGon

CogniGve regulaGon/ Interpersonal



  Different categories of suicidal/self-‐harming behaviour have different causes, different funcGons, different maintaining factors (Silverman & Maris, 1995)

About self harm

Mclean Longitudinal study BPD 20 year follow up in 2012 (50%)

 Self muGlaGon decreases over Gme decreases  Reasons: angry, frustrated, gekng acenGon control emoGonal pain.  Prevent being harmed in worse way.

Mary Zanarini et al 2013 ISSPD Copenhagen

Mclean Longitudinal study BPD 20 year follow up in 2012 (50%)

 Self muGlaGon decreases over Gme decreases  Reasons: angry, frustrated, gekng acenGon control emoGonal pain.  Prevent being harmed in worse way.

Mary Zanarini et al 2013 ISSPD Copenhagen

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Self harm & regulation of affect

NegaGve

affect

Self harm

Affect improves

Problem with Self harm

§  It works very well in helping regulate emoGons

§  But only for that Gme -‐ short term only §  Stops people solving their problems in a non destrucGve way.

Change in suicidal self harm with CBTpd at follow up Average episodes per month CBTpd

0

1

2

3

4

5

6

year 1 year 3-6

DSH

Self harm

20% repeat within a year (return to same hospital)

1 in 25 die by suicide in year aPer S-‐H (>50% general populaGon risk of DH)

> 50% of people dying by suicide have a history of self-‐harm.

15% of those have presented at hospital the year before die by suicide.

Specialist services Approximately 1/3 of people who end their lives by suicide are under the care of specialist mental health services.

Professor Louis Appleby told SC

“You have to do crisis teams properly; they have to be 24-‐hour services; they have to be services that provide the right level of skill in their frontline staff and the right level of contact. They cannot just be an occasional drop-‐in to check that someone is taking their medicaGon; they have to be a proper subsGtute, an alternaGve, as they were originally designed, to in-‐paGent care. What appears to have happened in some parts of the country is that crisis teams are not now providing an adequate alternaGve to in-‐paGent care: they do not have the seniority of staff; they are taking on a lot of paGents who are at a very high degree of risk who probably need something more protecGve “ Single riskiest >me in the 3 days following discharge from inpa>ents services.

Consensus statement on sharing informaGon with families

•  Powerful evidence from those bereaved by suicide that professionals should be sharing informaGon with families of those who are suicidal.

PaGents have a legal right to confidenGality BUT encouraging the opGon to involve trusted family or friends can improve support and aid recovery.

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Hamish Elvidge on gaining consent

One way is to say “Do we have your consent to share informaGon with a family member, friend or colleague?” The chances are that the answer will be, “No.”

Or you could say, “In our experience, it is always much becer to involve a family member, friend or colleague whom you trust in your treatment and recovery, and we know the triangle of care is likely to result in a greater chance of successful recovery. This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?”

The Machew Elvidge Trust

House of Commons report 300

Assessment of Risk of SH

•  There is no evidence that assessing risk of self harm prevents SH

•  Use as a risk management tool

•  We need to manage SH

•  Hawton et al Lancet 2012 379: 2373-‐2382

Which intervenGons are best at reducing S-‐H

Strongest evidence

CBT-‐based psychological therapy -‐ can result in fewer individuals repeaGng S-‐H

Lower quality of evidence for DBT for people with mulGple episodes of SH/probable personality disorder -‐ may lead to a reducGon in frequency of S-‐H

No evidence of benefit for reducing S-‐H for Case management / remote contact intervenGons did not appear to have any benefits in terms of reducing repeGGon of SH.

Brief CBT based interven>ons for self-‐harm in adults

suicidal idea>on at 6 months

Cochrane Database of Systema>c Reviews 12 MAY 2016 DOI: 10.1002/14651858.CD012189 hcp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012189/full#CD012189-‐fig-‐00115

Brief therapies more effective than intensive

therapies

Most therapies under 10 sessions

Between 4 and 6 sessions.

No clear evidence supporting prolonged exposure

to DBT or long term psychotherapy

• Cochrane Review 2016


In Depression Williams, Crane, Barnhofer & Duggan, 2005

NegaGve thinking during episodes of depression

Hopelessness & suicidal ideaGon

Events related to humiliaGon, defeat, entrapment

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If depressed mood, reacGvaGon

APer several episodes depression, even mild low mood sufficient to act as context to reinstate habitual suicidal configuraGons

Depressed

mood Hopelessness

&

Suicidal idea>on

Relationship between psychological and social problems

and self-harm (adapted from Horrocks, 2002)

increased life stress

interpersonal difficulties

poor social support

attachment problems

rejecting or overprotective parental styles

sexual, physical emotional abuse in early life

hopelessness

poor interpersonal problem solving

autobiographical memory style

Psychological Factors

Memory style

Suicidal individuals take longer to retrieve positive autobiographical memories but not negative events memories than non-depressed control (like depressed). (Williams & Broadbent, 1986)

Retrieve more overgeneral (as opposed to specific) autobiographical memories compared to controls. (Evans et al., 1992)

Over-general memories associated with frequency of parasuicidal acts but borderline patients with greatest n overgeneral memories reported fewest acts – Is this a protective factor ? Do borderline patients avoid distressing memories (Startup et al, 2001)?

Autobiographical Memory task (adapted)

•  In pairs

•  One person writes down answers from partner. Other respond to cue word

•  I will Gme – tell you when to start and when to stop. You will have 1 minute for each cue word.

Task

 When you see the cue try to recall a specific event, i.e. something that happened at a parGcular place and Gme and lasted less than a day.

Overdose paGents

Cue Response

Happy Being with John

Sorry Sorry if I’ve hurt anyone, any

time

Arguments

Safe Being in my flat

Angry A lot of the time

A lot of people make me angry

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Control subjects

Cue Response

Happy When I went to see my daughter in

her new house

Sorry When I went to see my sister after

her husband had a heart attack

Safe After reaching home after driving a

long way (from Hull)

Angry I was very angry after I found that

my older son had been misbehaving

Williams & Broadbent, 1986


Interpersonal problem solving

Deficits in problem solving in those with suicidal behaviour

Suicidal paGents provide fewer than half as many ways of solving problems as non-‐suicidal (but equally depressed) (MEPS).

Give more passive, less versaGle and less relevant types of soluGons.

Plac et al., 1987; Schoce and Clum, 1987; Howat & Davidson, 2002 (older

adults)

MEPS: EffecGve Problem Solving

First thing is to introduce herself to the immediate neighbours,

explaining that she had just moved in, possibly inviting the

people for a coffee anytime, and also if they seem interested

in her, if they invite her, making it clear that she intends to take

it up anytime. Chatting to people in the local shops, joining

clubs, offering to be helpful in some ways, e.g. baby-sitting,

gardening for old people. One tactic would be to get a dog

and take it for walks – that’s easy to get in contact. Similarly if

she has children, it’s easy to get in contact. Inviting people

round for dinner or drinks (rated 7 – extremely effective)


Future directed thinking (MacLeod)

Suicidal patients

High levels of hopelessness at the time of an attempt

predict future harm at 6 months and greater risk of

suicide at 10 years (Beck et al., 1989)

Less able to think of future positive events but do not

differ from controls in being able to anticipate negative

events.

MacLeod et al., 1993

Macleod et al., 1998

Conaghan & Davidson, 2002 (older adults)

Over-generality - a maladaptive mode of

processing self-relevant material

•  Overgeneral memory is a particular feature of those individuals who habitually use rumination and avoidance strategies to deal with negative situations, thoughts or emotions (Hermans et al, 2005; Raes et al., 2005).

Reducing deliberate self-harm

Main strategies §  Increase understanding of self-harm through formulation

of problems - relationship between core beliefs and self-harm behaviours

§  Decrease hopelessness

§  Explore consequences of self-harm, both short and long term

§  Attend to self-nurturing behaviours (eating, sleeping, activity etc.)

§  Shift focus to increasing awareness of more adaptive coping responses (practical & interpersonal) & positive future events

§  Attend to when the patients manages not to self-harm.


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EmoGonal regulaGon


When upset, how do you calm yourself?

Please think of 3 ways from

your repertoire?




EmoGonal regulaGon

Cogni>ve

regula>on/

Interpersonal


Cognitive behaviour therapy

working on different levels of cognition

Structural level

Automatic thoughts

Assumptions

Core beliefs

Treatment technique

Thought records

Behavioural experiments

Continuum

Historical test of schema

Notebook to strengthen more adaptive beliefs


Continuum for core beliefs

New belief

I am able cope on my own

0% x 100%


Historical test of belief (5 to 10 years)

Old belief: I am not worthy of love

New belief: Others may like me & I can be loved

Evidence for the old belief

• My mother criticised me a

lot

• I was bullied at school

• The teachers never said I

was good at anything

Evidence for my new belief

§ My aunt cuddled me

§ My mother was unhappy because my father was often drunk, not because of me

§ Susie liked me


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Behavioral Experiments

•  Relationship very important - based in trust

•  Induce sprit of curiosity & willingness to experiment

•  Guided discovery & Socratic questions

•  Also a number of other skills: e.g. encouragement, coaxing, modelling, coaching, creativity, use of humour, think on your feet.


Types of Experiment

• Active Experiments

1. Real situations

2. Simulated (e.g. role-plays)

• Observational Experiments

1. Direct observation

2. Surveys

3. Data gathering from other sources (e.g. internet)


Core beliefs and behaviour

Develop new core belief

Increase under-developed behaviours

ENVIRONMENT

Stages & process of change in therapy

Engagement

Develop understanding of self

NarraGve formulaGon to help client understand problems in non-‐blaming way

Developing skills and understanding of relaGonships Increase ability and skill to recognise & manage thoughts & feelings & how these relate to self & relaGonship

Increase self resilience

RelaGonships improved through enhanced interpersonal skills, self-‐resilience & robustness

Stages of therapy From the formulaGon – what would you do next?

Change beliefs about

self and others

Change behaviour

Regulate emoGons


EmoGonal regulaGon



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Reducing deliberate self-harm

Main strategies §  Increase understanding of self-harm through formulation

of problems - relationship between core beliefs and self-harm behaviours

§  Explore consequences of self-harm, both short and long term

§  Attend to self-nurturing behaviours (eating, sleeping, activity etc.)

§  Shift focus to increasing awareness of more adaptive coping responses

§  Attend to when the patients manages not to self-harm.


•  RelaGonship very important -‐ based in trust •  Induce sprit of curiosity & willingness to experiment

•  Guided discovery & SocraGc quesGons •  Also a number of other skills: e.g. encouragement, coaxing, modelling, coaching, creaGvity, use of humour, think on your feet.


I.  Behavioral experiments are:

•  Usually planned (occasionally spontaneous) •  ExperienGal acGviGes •  Undertaken by parGcipants in or between sessions

•  Based on experimentaGon or observaGon

Types of Experiment

• Active Experiments

1. Real situations

2. Simulated (e.g. role-plays)

• Observational Experiments

1. Direct observation

2. Surveys

3. Data gathering from other sources (e.g. internet)

Planning the experiment

 Be specific  Be clear  Elicit what is being predicted?  How will expt be carried out? When Where With whom?

 Worst case scenario/ ways of coping  ReporGng what happened

Angela and self harm

Role play

§  Acend to when Angela has not self harmed (when would have in the past in response to a similar situaGon) §  Clarify what she did that was different from self harming §  How did she cope with emoGons? §  What happened aPer not self harming?

Define the strategy used clearly. Ask her to imagine this is a strategy she could use again. Envisage using the strategy again DifficulGes vs Advantages

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Role play

In pairs Swap over paGent / therapist roles




EmoGonal regulaGon

Emotional sensitivity

•  Emotional sensitivity may have a

hereditable component.

•  Infants may be hypersensitive

•  May lead to disorganised attachment

•  Cohen (separation may be deliberate and

wilful)(interpretation of separations

important)

DifficulGes in EmoGonal RegulaGon Scale: some examples.

Kaufman, Xia, Fosco, et al 2015

ALMOST NEVER (0-‐10%) SOMETIMES (11-‐35%) ABOUT HALF THE TIME (36-‐65%) MOST OF THE TIME (66-‐90%) ALMOST ALWAYS (91-‐100%) I pay a?en@on to how I feel

I have no idea how I am feeling

I have difficulty making sense of my feelings

I am confused about how I feel

When I’m upset, I become embarrassed for feeling that way

When I’m upset, I feel out of control

When I’m upset, I have difficulty concentra@ng

When I’m upset, I lose control over my behaviour

When I’m upset, I believe there is nothing I can do to make myself feel be?er •  18 items short form (DERS-‐SF)

When upset, how do you calm yourself?

Please think of 3 ways from

your repertoire?

Your clients & emoGonal regulaGon exercise

Think of a client with difficulty controlling their emoGonal reacGons to situaGons. e.g. they may become highly distressed, they may self–harm,

they may shout at people, they may throw things, they may take

drugs or alcohol, etc.

What techniques might you suggest to help them to re-‐gain control of their emoGons?

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Techniques

CogniGve techniques Recognising that a core belief is acGvated AcenGonal shiP Changing the scene Physical distracGon Seeking out posiGve relaGonships CatharGc wriGng DistracGng with opposite emoGons



EmoGonal regulaGon

Cogni>ve

regula>on/

Interpersonal

EmoGon-‐related cogniGve processing in BPD

MaladapGve cogniGve processes SelecGve acenGon and memory: –  Habitually acend to negaGve sGmuli, –  DisproporGonate access to negaGve memories –  Endorse negaGve beliefs about self and others –  Make negaGvely biased interpretaGons of neutral or ambiguous sGmuli

–  Distorted beliefs and interpretaGons CogniGve processing characterised by ruminaGon & thought suppression -‐ associated with more severe symptoms Baer et al 2012, Clinical Psychology Review, 32, 359-‐369

RuminaGon

•  RuminaGon is a form of repeGGve thought (Watkins, 2008)

•  Habit. Many believe ruminaGon necessary to gain insight and solve problems.

•  Depressive ruminaGon intensifies negaGve mood, impairs concentraGon and memory and problem solving, reduces moGvaGon for acGon, works to maintain SH, post trauma stress, disordered eaGng and substance abuse (Nolen-‐Hoeksema et al 2008, Watkins, 2008)

RuminaGve processing style

BPD abstract ruminaGve thinking focused oPen on anger and interpersonal concerns. “Why does this always happen to me?”

“Why is my life a mess?”

“Why does everyone leave me?”

“Why does everyone hate me?”

“Why am I such a loser?”

“It’s all my fault”

“I always get the blame”

“People are out to get me”

ShiP style from abstract to more concrete

•  Train client to ask how quesGons rather than why quesGons? This is more adapGve to situaGons that cause distress.

•  What happened? Focus on concrete details. How did it begin? Details described. The sequence that lead up to the event. What can s/he do next?

•  FuncGonal analysis •  Use imagery •  Detailed prompts and quesGons from therapist.

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Thought suppression in BPD

•  Deliberate acempt to push unpleasant thoughts out of awareness. Almost never successful and associated with increased negaGve affect when thoughts recur (Najmi et al 2009)

•  Strong tendency to avoid negaGve emoGons and stress (Chapman et al., 2005; Wegner & Zanakos, 1994).

Thought suppression

•  People with BPD afraid of their own negaGve emoGons and may turn to thought suppression of emoGon inducing thoughts in a misguided acempt to manage their emoGonal states. (Baer et al., 2012)

Needs further exploraGon in BPD as only few observaGonal studies and none focused on treatment.

working at different levels of thinking

Structural level

AutomaGc thoughts AssumpGons &

Core beliefs

Treatment technique Thought records Behavioural experiments ConGnuum Historical test of schema Notebook to strengthen more adapGve beliefs

Continuum for core beliefs

New belief

I am able cope on my own 0% x 100%

Historical test of belief (5 to 10 years)

Old belief: I am not worthy of love

New belief: Others may like me & I can be loved

Evidence for the old belief

  my mother cri@cised me a

lot

  I was bullied at school

  The teachers never said I

was good at anything

Evidence for my new belief   my aunt cuddled me

  my mother was unhappy because my father was

oKen drunk, not because of

me

  Susie liked me

Ending

&

the final phase of CBTpd


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Review of progress and new

learning

•  Discuss progress with problems

•  Note pattern of problems. ( For example, stress/ alcohol use etc and how this has an effect on self-harm, relationships etc)

•  Discuss how the patient’s response (behaviour) has changed over time of therapy. What more adaptive strategies have been acquired? How did they developed these new strategies?

•  Discuss how old and new core beliefs influence behaviour


Deal with separation issues

•  Be clear that therapy is structured, has finite number of sessions.

•  Increase frequency of sessions to weekly at end (if

necessary).

•  Discuss how the patient will cope without therapy and

what supports and new ways of behaving are available

to them.

•  Acknowledge the quality and meaning of the

relationship.


What if there is a crisis?

Try to deal with crisis within time

frame outlined to patient.

Review patient’s new ways of coping (from previous

sessions)

Discuss patient’s anxieties about end

of therapy.


Helping families / staff groups work with PD

Professor Kate Davidson CBTpd January 2016

AssumpGons that may help

Marsha Linehan

It may be hard to understand this but… •  They are doing the best they can

Professor Kate Davidson CBTpd 2016

PotenGal Trap

Professor Kate Davidson CBTpd 2016

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Tips for families and staff

①  If you need to set a limit, then prepare to do so. ②  Be clear about the aim of sekng limit. ③  Why limit would be useful/ a good thing to do for the

individual concerned and for you. ④  What are the benefits and costs. ⑤  Seek consensus for carrying it out ⑥  Keep the benefits of the limits in mind when the going gets

hard ⑦  Prepare mentally. Don’t be stuck -‐ explore fears. Be ready

and anGcipate. ⑧  Reinforce the right behaviours (Adapted from Randi Kreger: Stop walking on Eggshells)

Professor Kate Davidson CBTpd August 2017

hcp://www.ucl.ac.uk/clinical-‐psychology/competency-‐maps/pd-‐map.html

Generic therapeuGc competences

Assessment &

formulaGon

General clinical care

Specific

Ψ

therapies

Meta-‐competences

Conclusions •  PD a complex disorder originaGng in childhood •  EmoGonal hypersensiGvity & social dysfuncGon may be

central problem in BPD

•  Psychological therapies help – emphasis on validaGon, helpful trusGng relaGonship & coping skills

•  CBTpd for BPD – least intensive of all therapies for BPD: effecGve, gains maintained at follow up of 6 years, cost efficient

•  CBTpd for ASPD – only RCT to date, promising, used in community & forensic sekngs


References

Davidson KM (2007) (2nd EdiGon) Cogni@ve therapy for personality disorders: a guide for

clinicians. Routledge, Hove.

Thank you

Professor Kate Davidson [email protected]

Documents

Handout day 2 Copenhagen 21.8.17 - Wattar Gruppen