Research portfolio: psychological factors and psychological treatment for Cluster C personality disorders
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Background: There is a paucity of research into Cluster C personality disorders, however there is increasing recognition that they are highly prevalent, associated with significant distress and frequently present alongside co-occurring axis I disorders. Research has led to significant progress in the understanding of the psychological mechanisms and has guided the development of evidence based treatment for borderline personality disorder and therefore it is likely that increased focus on Cluster C personality disorders may lead to similar developments. This thesis aimed to examine and evaluate current research on psychological interventions for the treatment of Cluster C personality disorders. It also sought to explore psychological factors involved in the development and maintenance of cluster C personality disorder. Method: A systematic literature review examining the effectiveness of psychological treatments for cluster C personality disorder identified 16 studies. The empirical study recruited individuals identified by clinicians as meeting criteria for Cluster C personality disorders. Participants completed a range of self-report measures of personality psychopathology, interpersonal problems and axis I disorders and a series of interviews exploring adult attachment style, reflective function, autobiographical memories. These were completed at 2 time points, 4 months apart. Participants also provided responses to a semi-structured qualitative interview to gain insight into their beliefs about their difficulties. Additional information was also gained through participants’ psychiatric notes. Results: The systematic review results indicate that psychological interventions are effective in the treatment of cluster C personality disorders however studies generally focused on cognitive behavioural or psychodynamic approaches. There is a lack of clarity over which treatment components are most effective in treating particular features of cluster C personality disorders. The empirical paper identifies no significant changes in personality psychopathology, anxiety and depressive symptoms, interpersonal problems, reflective function and autobiographical memory across time. Participants demonstrated insecure adult attachment styles. Conclusions: Results from the systematic review and empirical study identify a need for more research to explore the complexity of personality psychopathology and co-occurring axis I and axis II disorders. It is also necessary for research to identify psychological factors involved in the development and maintenance of Cluster C personality disorders in order to guide evidence based treatments. The systematic review highlights the need for research to identify the most effective psychological treatments for cluster C personality disorders and to establish which components of treatment are most effective in targeting particular symptoms associated with cluster C personality disorder.