Avoidant personality disorder treatment.
The majority of the people suffering from avoidant personality disorder (AVPD or Avoidant PD) report feeling inadequate (socially), inept, are preoccupied with rejection, and feel the need to be liked before making social contacts . The preoccupation with rejection causes people with avoidant PD to distrust anyone, also the therapist in the beginning of the avoidant personality disorder treatment. Therefore, it’s possible for therapy to move slowly in the beginning. Once the patient-therapist relationship is strong, the focus of avoidant personality disorder treatment shifts to the painful inner experience to build relationships based on trust.
Other focus points of avoidant PD treatments are improving the patient’s functioning in (1) social situations, (2) intimate relationship, (3) (re)processing traumatic events, and (4) improving self-esteem. This page discusses the evidence based avoidant personality disorder treatment options and also discusses effective medication that reduces the impact of typical avoidant PD symptoms.
At Barends Psychology Practice, we offer (online) therapy for avoidant personality disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).
Avoidant personality disorder treatment – Cognitive Behavioural Therapy (CBT)
How does it work? The theory behind cognitive behavioural therapy (CBT) is based on the assumption that avoidance and anxiety are related to the maladapted beliefs and thought processes of the patient. Through collaborative interactions between therapist and patient and by applying cognitive behavioural techniques the severity of the avoidant PD symptoms reduces significantly. Examples of CBT techniques are: the Socratic dialogue, analysing advantages and disadvantages of avoidance, monitoring of beliefs, activity monitoring and scheduling, role-play, graded exposure assignments, and behavioural experiments .
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Effectiveness: CBT significantly reduces the effect of the avoidant PD symptoms , . Also, CBT improves interpersonal problems and personality functioning in 40% of the people. This effect was still significant two years after treatment . According to study  only 9% still met criteria for avoidant PD after a 6 month follow-up. In other words: 91% of the patients with avoidant PD who received CBT did not meet the criteria for avoidant PD 6 months after treatment . NOTE: the results of both studies  and  need to be replicated to be able to give more body to the evidence of CBT as a way of treating AVPD.
Cognitive behavioural therapy in combination with medication is the most effective avoidant personality disorder treatment type, because medication can help a patient to manage his or her anxiety levels, which make it easier for the patient to conduct behavioural experiments and practice with new behaviour.
Avoidant personality disorder treatment – short-term dynamic psychotherapy
How does it work? The theory behind psychotherapy is based on on the assumption that avoidance and anxiety are related to the unconscious psychodynamic conflicts inside someone. Shame plays a big part in these unconscious conflicts. Short-term dynamic psychotherapy treatment focuses on defense and affect restructuring. Using expressive techniques such as clarification, confrontation, and interpretation, the therapist reduces the AVPD symptoms .
Effectiveness: According to study  and similar to CBT, short-term dynamic psychotherapy significantly reduces the effect of the avoidant PD symptoms. Psychotherapy also improves interpersonal problems and personality functioning in 40% of the people. This effect was still significant two years after treatment . However, study  reports no significant difference between a waiting list and short-term dynamic psychotherapy. In other words, according to study  short-term dynamic psychotherapy is not effective in treating AvPD.
Avoidant personality disorder treatment – time-limited supportive expressive therapy
How does it work? Treatment focuses on the operationalization of core conflict and includes the patient’s main wishes, how the patient view or anticipates other people responding to him or her. Treatment also focuses on how the patient feels, thinks or behaves .
Effectiveness: After 52 weekly sessions 38,5% of the patients with AVPD still met the criteria for AvPD. In other words: time-limited supportive expressive therapy is effective in 61,5% of the AVPD patients . NOTE: this was a 1997 pilot study, so be very cautious when interpreting its results. The author of this website is not aware of any follow-up studies that were able to replicate its findings.
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Avoidant personality disorder treatment – Medication
There is no medication that cures avoidant personality disorder. However, there is medication that can reduce avoidant PD symptoms, such as anti-anxiety tablets and/or antidepressants. Unfortunately, medication is only effective for as long as someone takes the medication. Once the patient stops taking medication, the avoidant PD symptoms will return. For more information about anti-anxiety medication of antidepressants, click on: anti-anxiety medication and on antidepressants.
Medication in combination with cognitive behavioural therapy is the most effective avoidant personality disorder treatment type, because the medication can help a patient control his or her anxiety when performing behavioural experiments.
Literature used for this page
-  McGlashan, T. H., Grilo, C. M., Sanislow, C. A., Ralevski, E., Morey, L. C., Gunderson, J. G., … Pagano, M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. The American Journal of Psychiatry, 162, 883–889.
-  Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. American journal of Psychiatry, 161, 810-817.
-  Emmelkamp, P. M., Benner, A., Kuipers, A., Feiertag, G. A., Koster, H. C., & Van Apeldoorn, F. J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. The British Journal of Psychiatry, 189, 60-64.
-  Barber, J. P., Morse, J. Q., Krakauer, I. D., Chittams, J., & Crits-Christoph, K. (1997). Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy: Theory, Research, Practice, Training, 34(2), 133.