OCPD

[MiniLop]

Does anyone have any recommendations for treatment resources (books, articles, whatever you got) for clients with OCPD? Obviously google scholar is my friend, but curious what folks have found to be effective/useful.

Or feel free to share your experience of and/or advice for working with clients with OCPD.

---

Members don't see this ad.

 

[LadyHalcyon]

There are two books by Grossman and Millon. One is called moderating severe personality disorders and the other is called overcoming resistant personality disorders. Has a lot of information on PD's and treatment approaches.

 

[Indiana_Jane]

You might check out Radically-Open DBT. I barely touched the surface as I waived out of practicum - I am not sure about the research evidence, but it seemed promising.

 

[summerbabe]

You might check out Radically-Open DBT.

I went to a 1-day training on RO-DBT and would agree that it seems promising for this very challenging concern.

 

[DynamicDidactic]

You might check out Radically-Open DBT. I barely touched the surface as I waived out of practicum - I am not sure about the research evidence, but it seemed promising.

I went to a 1-day training on RO-DBT and would agree that it seems promising for this very challenging concern.

How does RO-DBT have such a recognizable name without a published RCT (last I checked)? Is it the association with DBT (which Lynch has separated from)?

I'll wait for some higher quality evidence before recommending the treatment.

 

[IWillSurvive]

In the context of limited options for this form of PD, I also thought RO-DBT seemed promising. And Schema Therapy..

 

[DynamicDidactic]

In the context of limited options for this form of PD, I also thought RO-DBT seemed promising. And Schema Therapy..

I do not get the rationale. When options are limited I would look for a treatment that has been examined with some other PD rather than one that has no RCTs at all.

 

[clausewitz2]

How does RO-DBT have such a recognizable name without a published RCT (last I checked)? Is it the association with DBT (which Lynch has separated from)?

I'll wait for some higher quality evidence before recommending the treatment.

There is at least one (under-powered) RCT from the UK looking at it for 'refractory depression':

Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT - NCBI Bookshelf

It did not separate from TAU at 12 months but did at 7 months; they concluded it did not meet NICE cost-effectiveness criteria.

It does seem to have become incredibly popular in this neck of the woods without a huge amount of evidence as you point out. Possibly due to despair at exactly how to come at some folks who seem over-controlled? Anecdotally I have tried using some of the techniques with a handful of Cluster C clients; they mostly found it helpful and seemed to like it and one found it so patronizing or simplistic that they bolted from treatment after two sessions. As someone operating in a role and setting where I am mostly not doing the standard therapy hour and need approaches that can be modularized a bit more it seemed promising.

For OCPD specifically there certainly is not an evidence base per se, but I think it's pretty rare to encounter people meeting criteria who are seeking help who aren't also dealing with something like persistent depression that is complicated by their rigidity. How much this resembles successful evidence for treating a PD depends on whether you think of PDD as a personality issue, which I tend to, pace DSM.

 

[DynamicDidactic]

There is at least one (under-powered) RCT from the UK looking at it for 'refractory depression':

Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT - NCBI Bookshelf

It did not separate from TAU at 12 months but did at 7 months; they concluded it did not meet NICE cost-effectiveness criteria.

It does seem to have become incredibly popular in this neck of the woods without a huge amount of evidence as you point out. Possibly due to despair at exactly how to come at some folks who seem over-controlled? Anecdotally I have tried using some of the techniques with a handful of Cluster C clients; they mostly found it helpful and seemed to like it and one found it so patronizing or simplistic that they bolted from treatment after two sessions. As someone operating in a role and setting where I am mostly not doing the standard therapy hour and need approaches that can be modularized a bit more it seemed promising.

Thank you for the update. At least there is one RCT (not that RCTs are the end-all-and-be-all of treatment research).

Side topic: I am interested in this journal, Efficacy and Mechanism Evaluation. It appears to be an non-traditional journal.

Efficacy and Mechanism Evaluation (EME) was launched in 2014 and is indexed by NHS Evidence, Europe PMC and NCBI Bookshelf.
Remit
Evaluations of new treatments, including those intended to prevent disease, covering:

• therapeutics (small molecule and biologic)
• psychological interventions
• public health
• diagnostics
• medical devices

Publication criteria

Reports are published in the journal if

1. they have resulted from work for the Efficacy and Mechanism Evaluation (EME) Programme, and
2. they are of a sufficiently high scientific quality as assessed by the external reviewers and journal editors.

For OCPD specifically there certainly is not an evidence base per se, but I think it's pretty rare to encounter people meeting criteria who are seeking help who aren't also dealing with something like persistent depression that is complicated by their rigidity. How much this resembles successful evidence for treating a PD depends on whether you think of PDD as a personality issue, which I tend to, pace DSM.

Perhaps we need a whole thread about the topic

 

[clausewitz2]

Side topic: I am interested in this journal, Efficacy and Mechanism Evaluation. It appears to be an non-traditional journal.

It seems to be a publication of a joint venture of two UK government health agencies that would be roughly equivalent to CMS and NIH running a joint translational program focusing entirely on medium to long term outcomes research.

That'd be pretty sweet, actually.

 

[IWillSurvive]

I do not get the rationale. When options are limited I would look for a treatment that has been examined with some other PD rather than one that has no RCTs at all.

So can you give us some information on RTC's for other PD's? I only know of DBT having support and I see that as a fundamentally different disorder than OCPD but I'm not really in the loop on the PD research

 

[DynamicDidactic]

I only know of DBT having support and I see that as a fundamentally different disorder than OCPD but I'm not really in the loop on the PD research

I’m assuming you mean borderline personality disorder?

It’s a common misconception. BPD is often associated with DBT and is a commonly used in RCTs. But the original intention was simply people that had lots of severe problems including suicidality.

The empirical research on DBT is pretty transdiagnostic and includes numerous PDs. Here is a worthwhile resource:

Core Evidence & Research - Behaviorial Tech Institute

There is a wealth of evidence supporting the effectiveness of DBT. The first randomized controlled trial (RCT) of DBT was published in 1991, in which Dr.

behavioraltech.org

RCTs include Cluster B and PD in general. Non-controlled trial for mixed BPD and antisocial PD.

I’m not a PD person but I’d love to see other studies. I’m a skeptic of RO-DBT. I dont buy the concept that overcontrol is a different construct that emotional dysregulation.