Personality Pathology: Assessment and

Transcription

Personality Pathology:
Assessment and prediction
of change following
group psychotherapy
Sebastian Simonsen
PhD Thesis
Department of Psychology,
Faculty of Social Sciences,
University of Copenhagen
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Types of variance in genetic twin studies of personality: 1) Additive genetic variance: that proportion of phenotypic variance which is
due to the addictive effect of genes (i.e., the summed effect of multiple genetic loci). Additive genetic effects can also be thought of
as genetic effects passed directly from parents to offspring. This is indicated when the correlation for monozygotic twins is greater
than that for the dizygotic twins because of the twofold greater similarity of monozygotic twins compared to dizygotic twins. 2) Nonadditive variance: that proportion of phenotypic variance which is due to dominance or epistatic interactions (the masking of the
effects of a gene by one at a different locus, gene-gene interactions). This is indicated when the correlation is greater than twice the
size of the correlation for dizygotic twins. 3) Shared environmental variance: that proportion of phenotypic variance which is due to
the shared experiences of a twin pair e.g., social class. This is indicated by a low correlation of scores between dizygotic twin pairs.
4) Non-shared environmental variance: that proportion of phenotypic variance which is due to non-shared factors such as birth
order. This is not measured directly but is estimated as the residual variance which also includes error variance.
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Table 1. Socio-demographic and symptom characteristics of the clinical sample (N=76)
Characteristics
Clinical
%
Mean
SD
36.3
11.0
49.6
5.5
1.7
.94
(N=76)
Gender (female)
82.9
Age
Education (highest level achieved) (N=67)
Comprehensive school, only
30
30
9
13
+ 2-3 years education
22
33
+ 3-4 years education
13
19
3
4
40
60
High school
+ 5 years education (college)
Living arrangement (N=67)
Living with partner and children
Living alone with children
8
12
11
16
8
12
2
3
0-6 months
40
60
>12 months
5
7
>24 months
9
13
Living alone
Living with parents or others
Work functioning (number of months since last working period) (N=67)
Never worked (>20 hrs.)
Previous psychiatric hospitalization (N=67)
29
43
Previous psychiatric treatment (N=67)
42
63
Receiving psychotropic drugs (N=67)
52
78
GAF (N=67)
SCL-90-R (N=67)
Somatization
Obsessive-Compulsive
2.0
.78
Interpersonal Sensitivity
1.9
.81
Depression
2.4
.84
Anxiety
1.9
.90
Hostility
1.4
1.0
Phobic Anxiety
1.4
1.0
Paranoid Ideation
1.3
.93
Psychoticism
1.0
.70
GSI
1.8
.70
Note. GAF = Global Assessment Functioning; GSI = Global Severity Index
Table 2. Diagnostic characteristics of the clinical sample (N=76)
Diagnosis
Clinical
%
(N=76)
Axis I Diagnosis (N=64)
Mood Disorders
Major Depression
Dysthymic Disorder
31
48
9
14
Anxiety Disorders
Panic Without Agoraphobia
5
8
Panic With Agoraphobia
17
27
Social Phobia
19
30
Obsessive-Compulsive Disorder
4
6
Generalized Anxiety Disorder
8
13
Post Traumatic Disorder
5
8
Other Anxiety Disorders
13
20
Alcohol Dependence/Abuse
5
8
Drug Dependence/Abuse
4
6
Somatoform Disorders
10
16
Eating Disorders
11
17
Mean number of diagnoses
2.2
Substance Related Disorders
Other Disorders
Axis II Diagnosis (N=59)
Schizotypal
1
2
Schizoid
0
0
Paranoid
4
7
Borderline
10
17
Antisocial
0
0
Narcissistic
1
2
Histrionic
0
0
Avoidant
25
42
Dependent
5
8
Obsessive-Compulsive
8
13
PD NOS (>5)
13
22
Depressive
10
17
5
8
11
19
Passive-Aggressive
No PD
Mean number of PDs
Note. PD NOS = Personality Disorder Not Otherwise Specified
1.4
Table 3. Means, standard deviations and Coefficient alpha for the Danish DAPP-BQ scales
Non-Clinical sample
DAPP-BQ
Clinical sample
(N=76)
M
Total Non-Clinical sample
(N=168)
SD
M
SD
Females
(N=136)
M
Males
(N=32)
SD
M
SD
Submissiveness
48.43***
10.30
.86
33.78
7.25
.84
33.65
6.90
34.31
8.71
Cognitive Distortion
43.08***
11.83
.89
26.52
7.05
.84
26.40
6.68
27.00
8.54
Identity Problems
50.75***
12.78
.92
26.86
7.11
.87
25.71
6.85
26.50
8.20
Affective Instability
50.22***
11.45
.88
34.52
8.83
.88
34.65
8.91
33.97
8.60
Stimulus Seeking
37.25
10.02
.85
35.07
7.40
.82
34.49
7.19
37.53*
7.89
Compulsivity
49.58***
13.01
.92
45.18
8.07
.84
45.19
7.98
45.16
8.58
Restricted Expression
47.78***
11.58
.88
31.98
6.66
.82
31.35
6.40
34.66*
7.16
Callousness
30.24***
7.06
.76
26.43
5.83
.77
25.82
5.33
29.03*
7.10
Oppositionality
46.30***
11.66
.88
31.95
8.34
.88
31.66
7.89
33.19
10.07
Intimacy Problems
34.58***
9.79
.86
26.01
6.62
.82
26.10
6.82
25.59
5.82
Rejection
38.05
8.76
.80
38.02
6.96
.78
37.55
6.50
40.03
8.51
Anxiousness
55.38***
12.49
.91
33.51
10.00
.92
33.38
9.56
34.09
11.84
Conduct Problems
28.47***
9.66
.85
24.31
6.39
.80
23.51
5.97
27.69***
7.12
Suspiciousness
34.08***
11.73
.93
21.68
5.73
.86
21.40
5.40
22.88
6.94
Social Avoidance
49.78***
12.67
.91
30.90
8.11
.88
30.63
7.68
32.03
9.80
Narcissism
43.29***
11.22
.89
35.92
8.45
.87
35.10
7.96
39.41**
9.65
Insecure Attachment
46.28***
14.33
.93
30.61
7.59
.85
30.53
7,48
30.94
8.19
Self-Harm
25.87***
13.35
.94
13.56
3.57
.87
13.45
3.42
14.03
4.17
Note. DAPP-BQ = Dimensional Assessment of Personality Pathology-Basic Questionnaire
p: Two-tailed probability levels associated with significant differences in means between females and males in the non-clinical sample
*(p .05) ** (p .01) ***(p .001)
Table 4. Oblimin-Rotated Principal Component structure Loadings* of the DAPP-BQ
Clinical Sample (N=76)
Dimension
Non-Clinical Sample (N=168)
ED
DB
IH
CO
ED
DB
IH
CO
Submissiveness
0.72
-0.12
0.35
0.12
0.86
0.34
0.14
0.17
Cogn. Distortion
0.80
0.37
0.13
-0.07
0.75
0.55
0.41
0.15
Identity Problems
0.88
0.21
0.30
-0.11
0.79
0.40
0.65
0.27
Affective Instability
0.82
0.48
-0.03
0.27
0.66
0.60
0.25
0.56
Stimulus Seeking
0.25
0.58
-0.43
-0.22
0.38
0.73
0.13
-0.09
Compulsivity
0.08
-0.16
0.14
0.90
0.17
0.06
0.08
0.89
Restr. Expression
0.31
-0.04
0.85
0.14
0.61
0.24
0.73
0.05
Callousness
0.13
0.81
-0.09
-0.19
0.37
0.78
0.41
-0.04
Oppositionality
0.72
0.27
-0.21
-0.50
0.80
0.46
0.31
-0.14
Intim. Problems
0.10
0.04
0.83
-0.07
0.26
0.23
0.90
0.10
Rejection
0.24
0.70
-0.30
0.38
0.31
0.81
0.03
0.34
Anxiousness
0.90
0.14
0.18
0.13
0.85
0.43
0.33
0.47
Cond. Problems
0.32
0.81
0.04
-0.14
0.36
0.72
0.24
-0.11
Suspiciousness
0.73
0.46
0.27
0.33
0.59
0.63
0.52
0.43
Social Avoidance
0.71
0.20
0.60
0.17
0.79
0.33
0.43
0.22
Narcissism
0.61
0.38
-0.12
0.17
0.69
0.67
0.04
0.33
Insec. Attachment
0.70
0.26
-0.18
0.13
0.60
0.53
0.05
0.40
% Accounted Variance
33.9
15.3
13.4
9.5
28.9
20.3
12.0
9.9
Note. DAPP-BQ = Dimensional Assessment of Personality Pathology-Basic Questionnaire;
ED = Emotional Dysregulation; DB = Dissocial Behavior; IH = Inhibitedness; CO = Compulsivity
*Highest and substantial loadings >0.40 are in boldface.
Table 5. Zero-order correlation between DAPP-BQ Higher-Order Factor Scores and SCID-II personality disorder counts (number of fulfilled criteria) and scale scores of the
Inventory of Interpersonal Problems-C
Clinical sample
ED
DB
IH
CO
Paranoid
0.49***
0.29*
0.27*
0.05
Schizotypal
0.38**
0.32*
0.01
-0.21
Schizoid
0.10
0.15
0.25
0.06
Antisocial
0.25
0.42***
0.01
-0.08
SCID-II (N=59)
Borderline
0.57***
0.41***
0.11
-0.26*
Histrionic
0.16
0.13
0.02
-0.02
Narcissistic
0.26*
0.22
-0.14
-0.13
Dependent
0.50***
0.08
0.23
-0.18
Avoidant
0.55***
0.17
0.34**
0.08
Compulsive
0.12
0.17
0.18
0.45***
PD-total score
0.67***
0.43***
0.23
-0.06
Dominering
0.51***
0.58***
-0.05
-0.12
Vindictive
0.50***
0.40**
0.20
-0.13
Cold
0.46***
0.29*
0.57***
0.03
IIP-C(N = 59)
Socially Avoidant
0.54***
0.11
0.62***
0.08
Nonassertive
0.43***
-0.12
0.45***
0.05
Exploitable
0.27*
-0.39**
0.47***
0.04
Overly Nurturant
0.25
-0.28*
0.42***
0.13
Intrusive
0.29*
0.20
0.09
-0.11
Note. DAPP-BQ = Dimensional Assessment of Personality Pathology-Basic Questionnaire;
SCID-II = Structural Clinical Interview for DSM-IV Axis II Disorders;
IIP-C = Inventory of Interpersonal Problems; ED = Emotional Dysregulation;
DB = Dissocial Behavior; IH = Inhibitedness; CO = Compulsivity; PD = Personality Disorders
***p value .001
**p value .01
*p value .05
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Table 1. Five-factor model: NEUROTICISM
Study
Evidence
Level
Main diagnoses
Treatment type & (N)
Effect size
Trait and effect on outcome in Group Therapy
Ogrodniczuk et al., 2003
A2
Major depression and personality
disorder
IGP & SGP (91)
.30
Neuroticism (high) (NEO-FFI) predicted less improvement in general symptoms in both IGP and SGP. Association corrected for baseline severity.
Zettle et al., (1992) & 1995
B
Dysthymia
IBT and GCBT (25)
p values
Neuroticism (high sociotropy) (SAS) did not predict more improvement in post depression symptoms for patients matched to either GCBT or IBT. Association corrected for
baseline severity.
Talbot et al., 2003
B
Affective disorders (sexually
abused)
WSIR in addition to TAU-PHP
(43)
Not reported
Neuroticism (NEO-FFI) was neither related to improvement in general symptoms in WSIR in addition to TAU or in TAU alone. Association corrected for baseline severity.
Spek et al., 2008
B
Sub-threshold depression
GCBT and INBT (111)
.25
Neuroticism (high) (NEO-FFI) Predicted less improvement in depression symptoms in both GCBT and IBT. Association corrected for baseline severity.
Steinmetz et al., 1983
C
Unipolar depression
PEGT (70)
Not reported
Neuroticism (EPQ) was not related to improvement in depression symptoms in PEGT. Association corrected for baseline severity.
Fisher et al., 1993
C
Major depression
SGT for sexual abuse (55)
.05-.21
Neuroticism (avoidant, passive-aggressive, schizotypal and borderline traits) (MCMI) were not related to dropout in SGT for sexual abuse.
Enns et al., 2002
C
Major depression
GCBT (65)
.24
Neuroticism (high) (self criticism) (DEQ) predicted less improvement in depression symptoms in GCBT. Association corrected for baseline severity.
Saulsman et al., 2006
C
disorder
GCBT (117)
.12
Neuroticism (depressive personality traits) (MCMI-III) was not related to improvement in depression scores for GCBT. Association corrected for baseline severity
Tasca et al., 2006
A2
Binge eating disorder
GCBT and GPIP (66)
-.36 & .48
Neuroticism (high attachment anxiety) (ASQ) was related to more improvement in days binging in GPIP and less improvement in days binging in GCBT. Conversely low
attachment anxiety was related to more improvement in days binging in GCBT and less improvement in GPIP. Association corrected for baseline severity.
Mörtberg et al., 2007
B
Social phobia and personality
disorder
IGCT (59)
.31
Neuroticism (high harm avoidance) (TCI) predicted less improvement in social anxiety in IGCT. Association corrected for baseline severity.
Clair et al., 1992
C
Agoraphobia
GCBT (30)
.12
Neuroticism (MPI) was not related to improvement in phobia in GCBT. Association corrected for baseline severity
Chambless & Tran, 1997
C
Social phobia
GCBT (59)
.25
Neuroticism (high scores on avoidant traits) (MCMI) predicted less improvement in anxiety symptoms in GCBT. Association corrected for baseline severity.
Brown et al., 1998
C
Social phobia
GCBT (28)
Not reported
Neuroticism (autonomy/ sociotropy) (PSI) was not related to improvement in anxiety in GCBT.
Erwin et al., 2003
C
Social phobia
GCBT (68)
.14-.39
Neuroticism (high trait anger/temperament/anger-in) (STAXI) related to less improvement in anxiety and depression symptoms in GCBT. Associations corrected for
baseline severity.
Tasca et al., 2004
C
Anorexia nervosa
PHP (74)
.53
Neuroticism (highly preoccupied) (ASQ) predicted treatment completion (though only for binge-purge subtype not for restricting subtype) in PHP group-based.
Franzen et al., 2004
C
Eating disorders
PHP (125)
p values
Neuroticism (high aggressiveness) (FPI-R) predicted non-completion in PHP.
AFFECTIVE DISORDERS
OTHER DISORDERS
Notes: Treatment type abbreviations: (IGP) Interpretive Group Psychotherapy, (SGP) Supportive Group Psychotherapy, (IBT) Individual Behavioural Therapy, (GCBT) Group Cognitive Behavioural Therapy, (WSIR) Womens Safety in Recovery group), (TAU) Treatment
As Usual, (PHP) Partial Hospitalization Programme, (INBT) Internet-based Treatment, (PEGT) Psychoeducational Group Treatment, (GPIP) Group Psychodynamic Interpersonal Psychotherapy, (IGCT) Intensive Group Cognitive Therapy.. Measure abbreviations: (NEOFFI) NEO-Five-Factor Inventory, (SAS) Sociotropy-Autonomy Scale, (EPQ) Eysenck Personality Inventory, (MCMI) Millon Clinical Multiaxial Inventory, (DEQ) Depressive Experience Questionnaire, (ASQ) Attachment Styles Questionnaire, (TCI) Temperament and
Character Inventory, (MPI) Maudsley Personality Inventory, (PSI) Personal Style Inventory, (STAXI) The State-Trait Anger Expression Inventory, (FPI-R) Freiburger Personality Inventory – Revised Form-
Table 2. Five-factor model: EXTRAVERSION
Study
Evidence
Level
Main diagnoses
Effect size
A2
Major depression and
personality disorder
IGP & SGP (91)
.37
Extraversion (high) (NEO-FFI) predicted more improvement in general symptoms in both SGP and IGP. Association corrected for baseline severity.
Beutler et al., 1991
B
Major Depression
GCBT (63)
GFEP
IS/SD
.17 & .48 vs.
-.60
Extraversion (high) (Low resistance potential) (MMPI) predicted more improvement in depression symptoms in GCBT and GFEP than in IS/SD.
Conversely patients with high resistance potential (Low E) responded better to IS/SD than to both GCBT and GFEP. Association corrected for
baseline severity.
Talbot et al., 2003
B
abused)
WSIR in addition to TAUPHP or TAU-PHP alone (43)
AFFECTIVE DISORDERS
.31 vs. -.20
Extraversion (low) (NEO-FFI) predicted more improvement in general symptoms in WSIR in addition to TAU but not in TAU alone. Association
corrected for baseline severity.
Spek et al., 2008
B
Sub-threshold depression
GCBT and INBT (111)
.05
Extraversion (NEO-FFI) was not related to improvement in depression symptoms in either GCBT or INBT.
C
Unipolar depression
PEGT (70)
Not reported
Extraversion (EPQ) was not related to improvement in PEGT.
Fisher et al., 1993
C
Major depression
.34
Extraversion (high) (Low scores on dependent traits) (MCMI) predicted non-completion in SGT.
Potvin et al., 2000
C
Mood disorders and
PHP (224)
.21
Extraversion (low) (Social introversion) (MMPI) predicted less improvement in general symptoms in group-based PHP. Association corrected for
baseline severity.
Lorentzen & Høglend, 2004
C
Affective disorders and
LAGP (40)
.49
Extraversion (high) (Intrusiveness) (IIP) scores predicted more improvement in interpersonal problems in LAGP. Association corrected for baseline
severity.
Tasca et al., 2006
A2
Binge eating disorder
GCBT and GPIP (95)
.47
Extraversion (low) (Higher attachment avoidance) (ASQ) was related to dropping out in GCBT but not in GPIP.
B
Social phobia and
IGCT (59)
.31
Extraversion (low) (high harm avoidance) (TCI) predicted less improvement in social anxiety in IGCT. Association corrected for baseline severity.
Clair et al., 1992
C
Agoraphobia
GCBT (30)
-.23
Extraversion (MPI) was not related to improvement in fear symptoms in GCBT.
C
Social Phobia
GCBT (59)
.25
Extraversion (low) (High scores on Avoidant traits) (MCMI) predicted less improvement in anxiety symptoms in GCBT. Association corrected for
baseline severity.
C
Eating disorders
PHP (125)
p values
Extraversion (high) (Low Inhibitedness and high Extraversion) (FPI-R) predicted non-completion in PHP.
OTHER DISORDERS
Notes: Treatment type abbreviations: (IGP) Interpretive Group Psychotherapy, (SGP) Supportive Group Psychotherapy, (IBT) Individual Behavioural Therapy, (GCBT) Group Cognitive Behavioural Therapy, (WSIR) Womens Safety in Recovery group), (TAU) Treatment
As Usual, (PHP) Partial Hospitalization Programme, (INBT) Internet-based Treatment, (PEGT) Psychoeducational Group Treatment, (GPIP) Group Psychodynamic Interpersonal Psychotherapy, (IGCT) Intensive Group Cognitive Therapy, (GFEP) Group Focused
Expressive Psychotherapy, (IS/SD) Individual Supportive/Self-directed therapy, (SGT) Specialized Group Therapy, (LAGP) Long-term Analytic Group Psychotherapy, (GPST) Group Psychotherapy Short-term, (IPGP) Intensive Psychodynamic Group Psychotherapy.
Measure abbreviations: (NEO-FFI) NEO-Five-Factor Inventory, (MMPI) Minnesota Multiphasic Personality Inventory, (EPQ) Eysenck Personality Inventory, (MCMI) Millon Clinical Multiaxial Inventory, (IIP) Inventory of Interpersonal Problems, (ASQ) Attachment Styles
Questionnaire, (TCI) Temperament and Character Inventory, (MPI) Maudsley Personality Inventory,(FPI-R) Freiburger Personality Inventory – Revised Form.
Table 3. Five-factor model: OPENNESS
Study
Evidence Level
Main diagnoses
Effect size
McCallum & Piper, 1990
A2
GPST (54)
.57
Openness (low) (low psychological mindedness) (PMAP) strongly related to dropout but not to improvement in GPST. Association not
Piper et al., 1994
A2
PHP (59)
.33
Openness (high) (high psychological mindedness) (PMAP) predicted more improvement in general symptoms in PHP, but was not related to
dropout. Association corrected for baseline severity.
A2
IGP & SGP (101)
.22
Openness (high) (NEO-FFI) predicted more improvement in target objectives and life satisfaction (but not general symptoms) in both SGP and
IGP. Association corrected for baseline severity.
McCallum et al., 2003
A2
IGP & SGP (107)
.32
Openness (low) (high Alexithymia) (TAS-20) was related to less improvement in general symptoms in SGP. Association corrected for baseline
severity.
B
Major Depression
GCBT
GFEP
IS/SD (63)
.17 & .48 vs. .60
Extraversion (high) (Low resistance potential) (MMPI) predicted more improvement in depression symptoms in GCBT and GFEP than in
IS/SD. Conversely patients with high resistance potential (Low E) responded better to IS/SD than to both GCBT and GFEP. Association
Talbot et al., 2003
B
abused)
WSIR in addition to TAU
PHP or TAU alone (43)
Not reported
Openness (NEO-FFI) was not related to improvement in general symptoms in either WSIR in addition to TAU or in TAU alone.
Spek et al., 2008
B
Subthreshold depression
GCBT and INBT (111)
.00
Openness (NEO-FFI) was not related too improvement in depressive symptoms in either GCBT or INBT. Association corrected for baseline
severity.
Yalom et al., 1967
C
Neurotic and character
disorders
IPGP (40)
Not reported
Openness (Psychological mindedness) (CPI) was not related to improvement in symptoms in IPGP.
Caine & Wijesinghe, 1976
C
Neurotic and character
disorders
GP or IBT (24)
p values
Openness (high) (More Internally directed interest and Low Conservatism) (DIQ) (the Conservatism Scale) are more responsive to GP.
Partially corrected for baseline severity.
Pearson et al., 1990
C
Primarily neurotic and
personality disorders
PGT (32)
- .02-.31
Openness (Internally directed interest and Conservatism (DIQ) (the Conservatism Scale) were not related to improvement in general
symptoms in PGT. Association corrected for baseline severity
McCallum et al., 1997
C
PHP (142)
Not reported
Openness (Psychological mindedness) (PMAP) was neither related to outcome or dropout in PHP.
Tasca et al., 1999
C
PHP (102)
.34
Openness (low) (low psychological mindedness) (PMAP) predicted non-completion in PHP.
Potvin et al., 2000
C
Mood disorders and
PHP (224)
Not reported
Openness (low) (Psychopathic deviation & Paranoia) (MMPI/MMPI-2) was not related to improvement in general symptoms in PHP
AFFECTIVE DISORDERS
Notes: Treatment type abbreviations: (GPST) Group Psychotherapy Short-term, (PHP) Partial Hospitalization Programme (IGP) Interpretive Group Psychotherapy, (SGP) Supportive Group Psychotherapy, (GCBT) Group Cognitive Behavioural Therapy, (GFEP) Group
Focused Expressive Psychotherapy, (IS/SD) Individual Supportive/Self-directed therapy (WSIR) Womens Safety in Recovery group), (TAU) Treatment As Usual, , (INBT) Internet-based Treatment, , (IPGP) Intensive Psychodynamic Group Psychotherapy, (GP) Group
Psychotherapy, (IBT) Individual Behavioural Therapy (PGT) Psychodynamic Group therapy. Measure abbreviations: (PMAP) Psychological Mindedness Assessment procedure, (NEO-FFI) NEO-Five-Factor Inventory, (TAS-20) 20-item Toronto Alexithymia Scale,
(MMPI) Minnesota Multiphasic Personality Inventory, (CPI) California Personality Inventory, (DIQ) Direction of Interest Questionnaire.
Table 4: Five-factor model: AGREEABLENESS
Study
Evidence
Level
Main diagnoses
A2
disorder
IGP & SGP (88)
Mohr et al., 1990
B
Major depression
B
Major depression
Zettle et al., (1992) & 1995
B
Dysthymia
GCBT
GFEP
IS/SD (62)
GCBT
GFEP
IS/SD (63)
IBT and GCBT (25)
Talbot et al., 2003
B
abused)
Spek et al., 2008
B
Nash et al., 1957
Effect size
-.36 vs. .13
AFFECTIVE DISORDERS
Agreeableness (high) (NEO-FFI) was related to more improvement in grief symptoms in IGP but not in SGP. Association corrected for baseline severity.
.56
Agreeableness (low) (high Level of Interpersonal problems) (IIP) was related to both more and to less improvement in depressive symptoms in all types
of treatment. Non- and negative response groups characterised as more externalizing. Association corrected for baseline severity.
-.57 vs. .53 &
-.20
Agreeableness (low) (Higher Externalizing) (MMPI) predicted more improvement in depressive symptoms in GCBT than in either IS/SD or GFEP.
Conversely nonexternalizing patients did worse in GCBT and significantly better in IS/SD. Level of externalization had little impact in GFEP. Association
Agreeableness (high sociotropy) (SAS) did not predict more improvement in depression symptoms for patients matched to either GCBT or IBT.
Association corrected for baseline severity.
Agreeableness (low) (NEO-FFI) was related to more improvement in general symptoms in WSIR in addition to TAU, but not in TAU alone. Association
p values
WSIR in addition to
TAU PHP or TAU alone
(43)
GCBT and INBT (111)
.08
C
Psychiatric outpatients
AGP (24)
p values
Budman et al., 1980
C
PGT (81)
p values
Fisher et al., 1993
C
Major depression
.30-.36
Davies-Osterkamp et al.,
1996
Rice, 2003
C
p values
C
GCBT (42)
.39
Lorentzen & Høglend, 2004
C
Neuroses and personality
disorders
disorder
SGT for sexual abuse
(55)
PAGT (194)
LAGP (40)
-.40 & -.33
Alden & Capreol, 1993
A2
GEG, STG, IFSTG, WL
(76)
B
.30, .45, .47
vs.
.28
Not reported
Avoidant personality disorder
.58 vs. -.15
Agreeableness (high altruism) (NEO-FFI)) was related to more improvement in depressive symptoms in GCBT than in INBT. Association corrected for
baseline severity.
Agreeableness (low) (Social ineffectiveness) (the Social Ineffectiveness Scale)) was related to dropping out of AGP. Patient with high social
ineffectiveness only remained in group therapy if subjective discomfort was high. No correction for baseline severity
Agreeableness (high) (Closeness) (Personal Assessment) to others was related to more improvement in major problems in PGT. No correction for
baseline severity
Agreeableness (low) (Higher Narcissistic, antisocial and paranoid traits) (MCMI) was related to dropout in SGT for sexual abuse. Association corrected
for baseline severity.
Agreeableness (low) (higher level of Interpersonal problems) (IIP) was related to more improvement in general symptoms in PAGT. No correction for
baseline severity.
Agreeableness (high) (High Need for social approval) (IIP) was related to improvement in self-esteem in GCBT. Association corrected for baseline
severity.
Agreeableness (high and low) (high Overly nurturant and coldness scores) (IIP) were related to less improvement in general symptoms and interpersonal
problems in LAGP. Association corrected for baseline severity.
OTHER DISORDERS
Agreeableness (exploitable-avoidant vs. cold-avoidant) (IIP). Exploitable-avoidant (high A) patients improved more in anxiety and other symptoms than
WL with all three types of treatment. Cold-avoidant patients (low A) improved more in anxiety and other symptoms with GEG than with WL, STG or
IFSTG. Associations corrected for baseline severity.
Agreeableness (Cooperativeness) (TCI) was not related to improvement in IGCT
Social phobia and personality
IGCT (59)
disorder
Clair et a., 1992/C
C
Agoraphobia
GCBT (30)
-.11-.41
Agreeableness (interpersonal problems scales) (FIRO-B) was not related to improvement in fear symptoms in GCBT
C
Social phobia
GCBT (59)
.09
Agreeableness (dependent traits) (MCMI) was not related to improvement in anxiety symptoms in GCBT. Association corrected for baseline severity.
Brown et al., 1998/C
C
Social phobia
GCBT (45)
Not reported
Agreeableness (sociotropy & autonomy) (PSI) were not related to improvement in GCBT
Notes: Treatment type abbreviations: (IGP) Interpretive Group Psychotherapy, (SGP) Supportive Group Psychotherapy, (GCBT) Group Cognitive Behavioural Therapy, (GFEP) Group Focused Expressive Psychotherapy, (IS/SD) Individual Supportive/Self-directed
therapy, (IBT) Individual Behavioural Therapy, (WSIR) Womens Safety in Recovery group), (TAU) Treatment As Usual, (PHP) Partial Hospitalization Programme, (INBT) Internet-based Treatment, (AGP) Analytic Group psychotherapy, (PGT) Psychodynamic Group
therapy, (SGT) Specialized Group Therapy, WL (Waiting list) (PAGT) Psychoanalytic Group Psychotherapy, (LAGP) Long-term Analytic Group Psychotherapy, (GEG) Graduated Exposure Group, (STG) Skills Training Group, (IFSTG) Intimacy Focused Skills Training
Group, (IGCT) Intensive Group Cognitive Therapy. Measure abbreviations: (NEO-FFI) NEO-Five-Factor Inventory, (IIP) Inventory of Interpersonal Problems, (SAS) Sociotropy-Autonomy Scale, (MMPI) Minnesota Multiphasic Personality Inventory, (MCMI) Millon Clinical
Multiaxial Inventory, (TCI) Temperament and Character Inventory, (FIRO-B) Fundamental Interpersonal Relations Orientation Behaviour Scale, (PSI) Personal Style Inventory.
Table 5: Five-factor model: CONSCIENTIOUSNESS
Study
Evidence
Level
Main diagnoses
Effect size
A2
IGP & SGP (90)
.29
Zettle et al.,(1992) & 1995
B
Dysthymia
Talbot et al., 2003
B
Spek et al., 2008
B
abused)
WSIR in addition to TAU
PHP or TAU alone (43)
GCBT and INBT (111)
C
Unipolar depression
PEGT (70)
.14
Hoberman et al., 1988
C
Unipolarpolar depression
PEGT (63)
.22
Fisher et al., 1993
Hazzard et al., 1993
C
C
Major depression
POGT (49)
.22
.01
B
IGCT (59)
Not reported
Bowen et al., 1994
C
GCPT (48)
-.53
C
C
Social phobia and
Panic disorder and
agoraphobia
Social phobia
Eating disorders
GCBT (59)
PHP (125)
-.07
p values
IBT and GCBT (25)
AFFECTIVE DISORDERS
Conscientiousness (NEO-FFI) was related to more improvement in general symptoms in both IGP and SGP. Association corrected for baseline
severity.
p values
Conscientiousness (High Autonomy) (SAS) did not predict more improvement in depression symptoms for patients matched to either GCBT or
IBT. Association corrected for baseline severity.
Not reported
Conscientiousness (NEO-FFI) was not related to improvement in general symptoms in either WSIR in addition to TAU-PHP or in TAU alone
.11
Conscientiousness (NEO-FFI) was not related to improvement in depressive symptoms in either GCBT or in IBT. Association corrected for
baseline severity
Conscientiousness (higher) (Perceived Mastery of control) (items) was associated with more improvement in depressive symptoms in PEGT.
Locus of control (Social Reaction Inventory) was not associated with improvement in depressive symptoms in PEGT. Associations corrected for
baseline severity.
Conscientiousness (Perceived mastery) (Mastery Scale) was related to more improvement in depressive symptoms in PEGT. Association
Conscientiousness (Compulsive traits) (MCMI) was not related to dropout in SGT for sexual abuse
Conscientiousness (Locus of control) (Locus of control scale) was not related to improvement in general symptoms in POGT
OTHER DISORDERS
Conscientiousness (Persistence) (TCI) was not related to improvement in social anxiety in IGCT.
Conscientiousness (Sense of mastery) (Pearlin Mastery Scale) was related to more improvement in anxiety and other symptoms in GCBT.
Association corrected for baseline severity.
Conscientiousness (Compulsive traits) (MCMI) was not related to improvement in anxiety symptoms in GCBT.
Conscientiousness (Achievement orientation) (FPI-R) was not related to non-completion in PHP
Notes: Treatment type abbreviations: (IGP) Interpretive Group Psychotherapy, (SGP) Supportive Group Psychotherapy, (IBT) Individual Behavioural Therapy, (GCBT) Group Cognitive Behavioural Therapy, (WSIR) Womens Safety in Recovery group), (TAU)
Treatment As Usual, (PHP) Partial Hospitalization Programme, (INBT) Internet-based Treatment, (PEGT) Psychoeducational Group Treatment, (SGT) Specialized Group Therapy, (POGT) Process-oriented Group Psychotherapy. (IGCT) Intensive Group Cognitive
Therapy. Measure abbreviations: (NEO-FFI) NEO-Five-Factor Inventory, (SAS) Sociotropy-Autonomy Scale, (MCMI) Millon Clinical Multiaxial Inventory, (TCI) Temperament and Character Inventory, (FPI-R) Freiburger Personality Inventory – Revised Form.

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