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Avoidant personality disorder (AVPD) is among the above-mentioned Cluster C personality disorders. In a recent RCT, Emmelkamp et al. (2006) compared CBT to PDT and a waiting-list condition in the treatment of AVPD. The authors reported CBT as more effective than waiting-list control and PDT. However, the study suffers from several methodological shortcomings (Leichsenring & Leibing, 2007). In contrast to CBT, for example, no disorder-specific manual was used for PDT. Some outcome measures applied by Emmelkamp et al. (2006) were specifically tailored to effects for CBT (e.g., to beliefs). Furthermore, an arbitrary level of significance ( p ¼ 0.10) was set by the authors so that a usually not significant difference ( p ¼ 0.09) achieved significance in favor of CBT. At follow-up, no differences between CBT and PDT were found in primary outcome measures. In addition, Emmelkamp et al. (2006) reported that PDT was not superior to the waiting-list group. This was true, but may be attributed to the small sample size and low power of the study. Furthermore, CBT was superior to the waiting-list group in only two of six measures (Leichsenring & Leibing, 2007). Thus, design, statistical analyses and reporting of results raise serious concerns about an investigator allegiance effect (Luborsky et al., 1999). H0(0%)D0*0)B6!6291<06!):!12($0*(6!Z$(#!10%6)*2<$(4!&$6)%&0%6!! Winston et al. (1994) compared PDT with brief adaptive psychotherapy or waiting-list patients in a heterogeneous group of patients with personality disorders. Most of the patients showed a Cluster C personality disorder. Patients with paranoid, schizoid, schizotypal, borderline, and narcissistic personality disorders were excluded. Mean treatment duration was 40 weeks. In both treatment groups, patients showed significantly more improvements than the patients on the waiting list. No differences in outcome were found between the two forms of psychotherapy. Hellerstein et al. (1998) compared PDT to brief supportive therapy in a heterogeneous sample of patients with personality disorders. Again, most of the patients showed a Cluster C personality disorder. The authors reported similar degrees of improvement both at termination and at six-month follow-up. However, the studies by Winston et al. (1994) and Hellerstein et al. (1998) were not sufficiently powered to detect possible differences (see Table 1 for sample sizes). Abbass, Sheldon, Gyra, and Kalpin (2008) compared PDT (intensive short term dynamic psychotherapy, ISTDP) with a minimal contact group in a heterogeneous group of patients with personality disorders. The most common Axis II diagnoses were borderline (44%), obsessive compulsive (37%), and AVPD (33%). Average treatment duration was 27.7 sessions. PDT was significantly superior to the control condition in all primary outcome measures. When control patients were treated, they experienced benefits similar to the initial treatment group. In the long-term follow- up, two years after the end of treatment, the whole group maintained their gains and had an 83% reduction of personality disorder diagnoses. In addition, treatment costs were thrice offset by reductions in medication and disability payments. This preliminary study of ISTDP suggests that it is efficacious and cost-effective in the treatment of personality disorders. At present, two meta-analyses on the effects of PDT in personality disorders are available (Leichsenring & Leibing, 2003; Town, Abbass, & Hardy, 2011). A meta-analysis addressing the effects of PDT and CBT in personality disorders reported that PDT yielded large effects sizes not only for comorbid symptoms, but also for core personality pathology (Leichsenring & Leibing, 2003). This was true especially for BPD. A more recent meta-analysis by Town et al. (2011) included seven RCTs on STPP in personality disorders. The authors drew the preliminary conclusion that PDT may be considered an efficacious empirically supported treatment option for a wide range of personality disorders, producing significant and medium to long-term improvements for a large percentage of patients.
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