Just concluded the first edition of a retreat for mental health professionals interested in applying Compassion Focused Therapy (CFT) in personality disorders.
Despite CFT is genuinely transdiagnostic and usuful in targeting maladpative interpersonal schemas, little is known about its application in treating those struggling with personality disorders.
Thus, I organized this retreat where to present an evolutionary model of conceptualization of personality disorders and those tecniques that I found extremely useful when working with personality disorders. I also presented my work in this field with a specific focus on schizotypal, perfectionistic, narcisistic and borderline traits.
The retreat was located in an amazing center near Florence, surrounded by woods and vineyards! For two days, about 30 partecipants worked on mindful compassion, chairwork imagery, and so on.
In a cases series with five adolescents we tested a treatment for adolescents with schizotypal traits. The intervention was previously designed and tested with adults, namely Evolutionary Systems Therapy for Schizotypy (ESTS).
ESTS is an integrative form of psychotherapy that comprises an evolutionarily based conceptualization with compassion focused and metacognitvely oritented approaches. We recently published the findings of a randomized controlled trial where we showed promising results. 75% of patients remitted from diagnosis and drop-out rates was below 10%.
In this new cases series we suggest how ESTS may be a feasible treatment for adolescents with schizotypal traits. All the partecipants concluded the study and the rate of missing sessions was below 10%. Moreover, 4 out of 5 patients remitted from diagnosis at the end of the schedule 6-month treatment, 1 out of 5 after an extended 9-month intervention.
A post-hoc interview showed how the adolescents described the intervention as effective, substainable and consistent with their goals. By considering how limited informat we have about effective treatments for adolescents with personality pathology (almost nothing for those struggling with schizotypal traits), we are really excited by these findings. Despite the preliminary nature of the study, the proposed model is elegible for larger sample size studies.
Simone Cheli, Gil Goldzweig, Paul H. Lysaker, Francesca Chiarello, Courtney Wiesepape & Veronica Cavalletti (2023) An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series, Psychosis, DOI: 10.1080/17522439.2023.2199325
Last week I posted about Roz Shafran’s paper on perfectionism, now I’m again here talking about the same topic! Another interesting news, so I hope I won’t bore you! Clinicaltrial.gov (the worldwide database of funded clinical studies) has reviewed and published today our protocol of the new randomized controlled trial (RCT) on Mindful Compassion for Perfectionism (MCP).
As Shafran suggested, there are only three interventions specifically tailored on perfectionistic traits: cognitive behavioral therapy for perfectionism (Shafran et al., 2023), dynamic relational therapy (Hewitt et al., 2019), and MCP (Cheli et al., 2022). MCP is a form of group psychotherapy that integrates the conceptualization model of dynamic relational therapy with experiential techniques informed by or directly derived from Compassion Focused Therapy (Gilbert et al., 2014). Veronica Cavalletti and I developed this integrative intervention with the scientific support of Paul Hewitt.
To date, some case series have confirmed the feasibility of the MCP. This new RCT is aimed at pilot-testing the effectiveness of the proposed intervention. The study is a waiting-list controlled trial. We are going to start recruiting by nex Monday and have the first group as soon as possible!
Roz Shafran and colleagues just published an overview of existing effective treatments for perfectionism. They presented their own model and then discussed the existing alternatives.
I was very surprised and happy to see how our protocol was one of the three interventions specifically tailored on perfectionistic traits! In short, Shafran was summarizing evidence and roots of the model with strongest evidence: that is, Cognitive Behavioral Therapy for Perfectionism. This is a tailored form of CBT targeting maladpative beliefs and biases in those struggling with perfectionism. The second model reviewed was the Dynamic Relational Therapy developed by Paul Hewitt and colleagues. Hewitt suggests to consider perfectionism as a set of interpersonal styles comprising of spefici traits, interpersonal and intrapersonal components. Finally, Shafran presented our Mindful Compassion for Perfectionism that integrates the Dynamic Relational Therapy with Compassion Focused Therapy.
As I anticipated, our model is far from being considered evidence-based. We published two cases series (see pubblications) where reporting preliminary evidence for the feasibility of the model, and we are now outlining a randomized controlled trial to better understand its clinical utility. Cavalletti, Hewitt, Flett and I published a first paper introducing the group format and its rationale, and then a second cases series about.
I appreciated Shafran’s recognition, which confirms the importance of specific interventions for specific traits or psychopathological manifestations.
Shafran, R., Egan, S.J., & Wade, T.D: (2023). Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism, Behaviour Research and Therapy, 104258. https://doi.org/10.1016/j.brat.2023.104258
The Journal of Contemporary Psychotherapy published a paper where we present a psychotherapy for schizoid personality disorder. This personality is a highly understudied area: Despite early conceptualizations were prosed one century ago, clinicians do not have guidelines to rely upon. Indeed, an early formulazion of schizoid mechanisms can be traced back to Eugen Bleuler and then to the emergence of psychoanalisis (see Fairbairn and Klein).
In a two cases series we discussed how an integration of evolutionary psychopathology, metacognitively oriented psychotherapy, and compassion focused therapy may be useful in targeting severe forms of emotional and social detachment. The paper is an attempt to apply Evolutionary Systems Therapy for Schizotypy (ESTS) to this complex and understudied pattern of personality.
The prosed intervention was a 10-month individual psychotherapy that resulted in a remission from diagnosis and reliable changes in personality pathology and general symptomatology. The focus of psychotherapy was an evolutionary conceptualization of maladative traits and then a progressive focus on critical beliefs about self (e.g. I’m not adequate enough to properly live in the society) and others (e.g. my peers constantly judge me as weird and bizzare).
Cheli, S., Chiarello, F., & Cavalletti, V. (2022). A Psychotherapy Oriented by Compassion and Metacognition for Schizoid Personality Disorder: A Two Cases Series. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-022-09566-3
I’ve attended at the 6th International Congress of the European Society (10-12 October) for the Study of Personality Disorders (ESSPD). Several very interesting keynotes and symposia were presented.
I was impressed by two relevant, innovative and recurring themes. First, something has finally changed in the way we discussed personality disorders. Even if this change has been long waited, many studies were focused on the search for a positive outcome, a recovery and personal growing rather than just discussing about reduction in symptoms or remission from a categorical diagnosis. This was evident since the first two keynotes on positive psychology (Meike Bartels) and borderline personality (Mary Zanarini). Second, there were three symposia exclusively dedicated to adolescence and early onset of personality disoders. Carla Sharp was present almost in all of them, as a leading expert in the field. I was very happy to see this new interest in adolescence, and I hope for more and more studies especially on clinical applications of a personality-informed approach.