Behavioral change that supports those values. Gratz and Gunderson (57) conducted a small RCT among women with BPD and a recent history of non-suicidal self-injury. Patients were randomized to receive either TAU (n = 10) or 14-weekly sessions of ERGT in addition to TAU (n = 12). Following treatment, patients in the ERGT group had significantly reduced their average frequency of nonsuicidal self-injury: 42 of the ERGT+TAU group had reduced their frequency of nonsuicidal self-injury by 75 or more, and 59 had reduced by 45 or more. Moreover, the ERGT group showed clinically significant reductions in symptoms of BPD, depression, anxiety and stress, emotion dysregulation and experiential avoidance, whereas patients in TAU failed to show improvements in any of the outcomes of interest. Given the small sample size and absence of follow-up data, findings should be considered preliminary; however, this is one of the first studies to show that a brief, skills-based intervention can produce clinically significant reductions in non-suicidal self-injury and BPD symptom severity. Avoidant Personality Disorders There are a total of seven studies that evaluate CBT for avoidant PD (AVPD), including one RCT and two open-trials of cognitive behavioral group therapy (CBGT), and one RCT, one open trial, and two case studies of individual CBT. Notably, given the high rates of comorbidity between AVPD and social phobia (approximately 30 of those with social phobia also meet diagnostic criteria for AVPD; 58), there is a substantial body of researchPsychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewicz et al.Pagethat examines the efficacy of XR9576 web treatment for social phobia among patients with co-occurring AVPD (59, 60). However, this GGTI298 molecular weight review is limited to treatment outcome studies in which AVPD was targeted specifically (i.e., patients were selected on the basis of their AVPD diagnosis, and/or AVPD was considered the primary diagnosis.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptCognitive Behavioral Group Therapy (CBGT)CBGT interventions for AVPD draw upon strategies that have been shown to be effective in treating social phobia and patients with interpersonal problems, including graduated exposure, cognitive restructuring and social skills training (62, 63). The core of CBGT treatments for AVPD is graduated exposure, in which patients are encouraged to approach situations that are feared or avoided. Group sessions are used to prepare for upcoming exposure exercises, and to review previous exposures, while also providing a real-world opportunity for sustained exposure to a social situation (52, 63). Another element of CBGT interventions is cognitive restructuring, which in this treatment, is used primarily facilitate willingness to participate in exposure exercises. Finally, some CBGT approaches include an interpersonal skills training component, based on the assumption that individuals with AVPD lack the social skills necessary to interact effectively or appropriately (62, 64). Although CBGT interventions for AVPD include multiple treatment elements, findings suggest that multi-component treatments do not necessarily produce better outcomes. For example, Stravynski and colleagues (65) randomized 22 participants with AVPD and generalized social phobia either to a treatment that included exposure, skills training and cognitive restructuring (n = 11), or to a treatment that included only exposure and.Behavioral change that supports those values. Gratz and Gunderson (57) conducted a small RCT among women with BPD and a recent history of non-suicidal self-injury. Patients were randomized to receive either TAU (n = 10) or 14-weekly sessions of ERGT in addition to TAU (n = 12). Following treatment, patients in the ERGT group had significantly reduced their average frequency of nonsuicidal self-injury: 42 of the ERGT+TAU group had reduced their frequency of nonsuicidal self-injury by 75 or more, and 59 had reduced by 45 or more. Moreover, the ERGT group showed clinically significant reductions in symptoms of BPD, depression, anxiety and stress, emotion dysregulation and experiential avoidance, whereas patients in TAU failed to show improvements in any of the outcomes of interest. Given the small sample size and absence of follow-up data, findings should be considered preliminary; however, this is one of the first studies to show that a brief, skills-based intervention can produce clinically significant reductions in non-suicidal self-injury and BPD symptom severity. Avoidant Personality Disorders There are a total of seven studies that evaluate CBT for avoidant PD (AVPD), including one RCT and two open-trials of cognitive behavioral group therapy (CBGT), and one RCT, one open trial, and two case studies of individual CBT. Notably, given the high rates of comorbidity between AVPD and social phobia (approximately 30 of those with social phobia also meet diagnostic criteria for AVPD; 58), there is a substantial body of researchPsychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.Matusiewicz et al.Pagethat examines the efficacy of treatment for social phobia among patients with co-occurring AVPD (59, 60). However, this review is limited to treatment outcome studies in which AVPD was targeted specifically (i.e., patients were selected on the basis of their AVPD diagnosis, and/or AVPD was considered the primary diagnosis.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptCognitive Behavioral Group Therapy (CBGT)CBGT interventions for AVPD draw upon strategies that have been shown to be effective in treating social phobia and patients with interpersonal problems, including graduated exposure, cognitive restructuring and social skills training (62, 63). The core of CBGT treatments for AVPD is graduated exposure, in which patients are encouraged to approach situations that are feared or avoided. Group sessions are used to prepare for upcoming exposure exercises, and to review previous exposures, while also providing a real-world opportunity for sustained exposure to a social situation (52, 63). Another element of CBGT interventions is cognitive restructuring, which in this treatment, is used primarily facilitate willingness to participate in exposure exercises. Finally, some CBGT approaches include an interpersonal skills training component, based on the assumption that individuals with AVPD lack the social skills necessary to interact effectively or appropriately (62, 64). Although CBGT interventions for AVPD include multiple treatment elements, findings suggest that multi-component treatments do not necessarily produce better outcomes. For example, Stravynski and colleagues (65) randomized 22 participants with AVPD and generalized social phobia either to a treatment that included exposure, skills training and cognitive restructuring (n = 11), or to a treatment that included only exposure and.
