On, both the clinician and the patient noted improvements in symptomatic behavior and social functioning. Lynch and Cheavens (74) reported similarly encouraging outcomes for a patient with PPD, OCPD and MDD, who was treated with a modified DBT-based treatment. Specifically, whereas DBT for BPD AZD-8835 chemical information targets emotional dysregulation and impulsive behavior, modified DBT for PDs focuses on reducing features which generally characterize Cluster C PDs such as emotional over-control, cognitive rigidity and risk aversion, The 28-week skills group includes modules on mindfulness, AZD-8835MedChemExpress AZD-8835 distress tolerance, and radical openness, in addition to a new module that provides skills for forgiveness and expressing loving kindness (74). The client received nine months of treatment: the first three months of treatment consisted of individual weekly DBT, and the last six months consisted of weekly individual DBT and weekly DBT skills training group (using the modified material). Individual treatment goals were to decrease fear and hostility in relationships, to tolerate criticism and to make decisions in ambiguous situations. Individual sessions involved exposure exercises, and skills included modules on mindfulness, distress tolerance and radical openness. At the endPsychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptMatusiewicz et al.Pageof treatment, the patient was in remission from PPD, OCPD and MDD, and demonstrated improvements in interpersonal functioning and emotional well-being. Taken together, these studies highlight the potential utility of both CBT and DBT for PPD. These approaches led to distinct case conceptualizations, and different therapeutic strategies were emphasized in each treatment, however, both patients showed symptomatic and functional recovery across multiple symptom domains. Two single-case designs have been used to describe Functional Analytic Psychotherapy (FAP) for histrionic PD (HPD). FAP is a radical behavioral approach in which the therapist uses principles of reinforcement to modify the patient’s behavior (12). FAP cases are conceptualized in terms of problematic clinically-relevant behaviors and desirable clinicallyrelevant behaviors (i.e., adaptive alternatives). As target behaviors occur in session, the therapist blocks or reinforces them using natural contingencies (e.g., sharing feelings that the patient has evoked in the therapist), with the goal of creating behavioral change that generalizes to daily life (12; 75). Given its interpersonal emphasis, FAP may be well-suited to the needs of patients with interpersonal difficulties (76), including patients with PDs. For example, Callaghan and colleagues (77) described treatment of a patient with features of histrionic and narcissistic PDs. The patient’s difficulties were characterized as involving problems identifying personal needs and values and identifying and responding to feedback from others. Over the course of 23-sessions, the patient displayed less dramatic behavior in session, was better able to identify and express his emotional experiences, demonstrated greater skill at noticing his impact on others, and became more successful in social interactions. Busch and colleagues (78) reported similarly encouraging findings using a FAP-CBT integration to treat a patient with HPD. Traditional CBT techniques were used in the first 11 sessions, and the final nine sessions used FAP tech.On, both the clinician and the patient noted improvements in symptomatic behavior and social functioning. Lynch and Cheavens (74) reported similarly encouraging outcomes for a patient with PPD, OCPD and MDD, who was treated with a modified DBT-based treatment. Specifically, whereas DBT for BPD targets emotional dysregulation and impulsive behavior, modified DBT for PDs focuses on reducing features which generally characterize Cluster C PDs such as emotional over-control, cognitive rigidity and risk aversion, The 28-week skills group includes modules on mindfulness, distress tolerance, and radical openness, in addition to a new module that provides skills for forgiveness and expressing loving kindness (74). The client received nine months of treatment: the first three months of treatment consisted of individual weekly DBT, and the last six months consisted of weekly individual DBT and weekly DBT skills training group (using the modified material). Individual treatment goals were to decrease fear and hostility in relationships, to tolerate criticism and to make decisions in ambiguous situations. Individual sessions involved exposure exercises, and skills included modules on mindfulness, distress tolerance and radical openness. At the endPsychiatr Clin North Am. Author manuscript; available in PMC 2011 September 1.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptMatusiewicz et al.Pageof treatment, the patient was in remission from PPD, OCPD and MDD, and demonstrated improvements in interpersonal functioning and emotional well-being. Taken together, these studies highlight the potential utility of both CBT and DBT for PPD. These approaches led to distinct case conceptualizations, and different therapeutic strategies were emphasized in each treatment, however, both patients showed symptomatic and functional recovery across multiple symptom domains. Two single-case designs have been used to describe Functional Analytic Psychotherapy (FAP) for histrionic PD (HPD). FAP is a radical behavioral approach in which the therapist uses principles of reinforcement to modify the patient’s behavior (12). FAP cases are conceptualized in terms of problematic clinically-relevant behaviors and desirable clinicallyrelevant behaviors (i.e., adaptive alternatives). As target behaviors occur in session, the therapist blocks or reinforces them using natural contingencies (e.g., sharing feelings that the patient has evoked in the therapist), with the goal of creating behavioral change that generalizes to daily life (12; 75). Given its interpersonal emphasis, FAP may be well-suited to the needs of patients with interpersonal difficulties (76), including patients with PDs. For example, Callaghan and colleagues (77) described treatment of a patient with features of histrionic and narcissistic PDs. The patient’s difficulties were characterized as involving problems identifying personal needs and values and identifying and responding to feedback from others. Over the course of 23-sessions, the patient displayed less dramatic behavior in session, was better able to identify and express his emotional experiences, demonstrated greater skill at noticing his impact on others, and became more successful in social interactions. Busch and colleagues (78) reported similarly encouraging findings using a FAP-CBT integration to treat a patient with HPD. Traditional CBT techniques were used in the first 11 sessions, and the final nine sessions used FAP tech.
