Terapia transdiagnóstica y transteórica para el trastorno de personalidad

Autores/as

DOI:

https://doi.org/10.33898/rdp.v29i110.249

Palabras clave:

trastorno de personalidad, terapia transdiagnóstica, terapia transteórica, tratamiento psicológico

Resumen

Este artículo sostiene que la evidencia de la limitada eficacia de las terapias especializadas en el trastorno de personalidad apunta a la necesidad de modelos de tratamiento transdiagnósticos y transteóricos. Las terapias actuales adoptan para el desarrollo de la terapia, en gran medida, un enfoque de escuela terapéutica y diagnóstico específico; cada corriente de pensamiento principal tiende a desarrollar su propio modelo de tratamiento para diagnósticos específicos. La relevancia de un enfoque de diagnóstico específico para el tratamiento se ve cuestionada dados los problemas consolidados reflejados en los diagnósticos actuales y el creciente reconocimiento de que las características generales del trastorno de personalidad y su gravedad son más provechosas para comprender el pronóstico que los diagnósticos específicos. Estos avances sugieren el empleo de un modelo de tratamiento transdiagnóstico. De forma similar, se cuestiona el enfoque de las escuelas de tratamiento, ya que no se han demostrado diferencias en la eficacia entre los modelos terapéuticos, ni la evidencia de que estas terapias arrojen mejores resultados que la terapia de apoyo o la atención médica general. Estos hallazgos indican la necesidad de un enfoque más integrado. La implementación del tratamiento transdiagnóstico y transteórico requiere una valoración más detallada sobre la patología de la personalidad, que la proporcionada por los diagnósticos actuales, para identificar las deficiencias que conforman los objetivos de cambio, y un esquema para organizar la terapia y coordinar la aplicación de una matriz ecléctica de intervenciones. El artículo describe una forma práctica de conceptualizar la valoración con fines de tratamiento y un marco para organizar y administrar la terapia.

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Arkowitz, H. (1989). The role of theory in psychotherapy integration. Journal of Integrative and Eclectic Psychotherapy, 8, 8-16.

Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P. y, Arntz, A. (2014). The results of a multicenter randomized controlled trial on the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322.

Bartak, A., Soeteman, D. I., Verheul, R. y Busschbach, J. J. V. (2007). Strengthening the status of psychotherapy for personality disorders: An integrated perspective on effects and costs. Canadian Journal of Psychiatry, 52, 803–810.

Bateman, A. y Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization-based treatment. Oxford, Reino Unido: Oxford University Press.

Bateman, A. y Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorder. Oxford, UK: Oxford University Press.

Bateman, A. y Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization-based therapy versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166, 1355–1364.

Beutler, L. E. (1991). Have all won and must all have prizes?: Revisiting Luborsky et al.’s verdict. Journal of Consulting and Clinical Psychology, 59, 226–232.

Black, D. W., Blum, (2017). Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder. New Your, NY: Oxford University Press.

Budge, S. L., Moore, J. T., Del Re, A. C., Wampold, B. E., Baardseth, T. P. y Nienhaus, J. B. (2014). The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments. Clinical Psychology Review, 34(5), 451–452.

Cameron, A.Y., Palm Reed, K. y Gaudiano, B. A. (2014). Addressing treatment motivation in borderline personality disorder: Rationale for incorporating values-based exercises into dialectical behavior therapy. Journal of Contemporary Psychotherapy, 44, 109-116.

Castonguay, L. G. y Beutler, L. E. (2006a). Common and unique principles of therapeutic change: What do we know and what do we need to know? En L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353–369). New York, NY: Oxford University Press.

Castonguay, L. G. y Beutler, L. E. (Eds.). (2006b). Principles of therapeutic change that work. New York, NY: Oxford University Press.

Chanen, A. M., Jackson, H. J., McCutcheon, L. K., Jovev, M., Dudgeon, P., Yuen, H. P., Germano, D., Nistico, H., McDougall, E., Clarkson, V. y Mcgorry, P. D. (2008). Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: Randomised controlled trial. British Journal of Psychiatry, 193, 477–484.

Clarke, S., Thomas, P. y James, K. (2013). Cognitive analytic therapy for personality disorders: A randomized controlled trial. British Journal of Psychiatry, 202, 129–134.

Clarkin, J. F., Levy, K. N., Lenzenweger, M. F. y Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164(6), 922–928.

Clarkin, J. F. y Livesley, W. J. (2015). Formulation and treatment planning. En W. J. Livesley, G. Diaggio y J. F. Clarkin (Eds.). Integrated treatment for personality disorder: A modular approach (pp. 80-100). New York, NY: Guilford Press.

Clarkin, J. F., Livesley, W. J. y Meehan, K. B. (2018). Clinical assessment. En W. J. Livesley y R. Larstone (Eds.), Handbook of Personality Disorders (pp. 367-393). New York, NY: Guilford Press.

Clarkin, J. F., Yeomans, F. E. y Kernberg, O. (1999). Psychotherapy for borderline personality disorder. New York, NY: Wiley.

Clarkin, J. F., Yeomans, F. E. y Kernberg, O. (2006). Psychotherapy for borderline personality: Focusing on object relations. Washington, DC: American Psychiatric Publishing.

Crawford, M. J., Koldobsky, N., Mulder, R. y Cottaux, P. (2011). Classifying personality disorder according to severity. Journal of Personality Disorders, 25, 321–330.

Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C. y Cuijpers, P. (2017). Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. Jama psychiatry, 74, 319-328.

Critchfield, K. L. y Benjamin, L. S. (2006). Integration of therapeutic factors in treating personality disorders. En L. G. Castonguay y L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 253–271). New York, NY: Oxford University Press.

Davidson, K. (2008). Cognitive therapy for personality disorders (2nd ed.). London, Reino Unido: Routledge.

Davidson, K. M., Tyrer, P., Gumley, A., Tata, P., Murray, H. y Palmer, S. (2006). The effectiveness of cognitive behaviour therapy for borderline personality disorder: results from the BOSCOT trial. Journal of Personality Disorders, 20; 450-429.

Davidson, K. M., Tyrer, P., Tata, P., Cooke, D., Gumley, A., Ford, I., Walker, A., Bezlvak, V., Seivwrigth, H., Robertson, H. y Crawford, M. J. (2009). Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: An exploratory randomised controlled trial. Psychological Medicine, 39, 569–578.

Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P. y Buchheim, P. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: Randomized controlled trial. British Journal of Psychiatry, 196, 389–395.

Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Tata, P., Thronton, S., Barber, K. y Thomson, S. (1999). Manual-assisted cognitive-behavioral therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29, 19–25.

Fonagy, P. y Luyten, P. (2018). Attachment, mentalizing, and the self. En W. J. Livesley y R. Larstone (Eds.), Handbook of Personality Disorders (pp. 123-140). New York, NY: Guilford Press.

Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Homer, K. L. y Tull, M.T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Behavior Research and Therapy, 65, 29-35.

Gratz, K. L., Levy, R. y Tull, M.T. (2012). Emotion regulation as a mechanism of change in an acceptance-based emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Journal of Cognitive Psychotherapy, 26, 365-380

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilberg, W., Dirksen, C., van Asselt, T., Kremer, I., Nador, M. Y Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs. transference-focused therapy. Archives of General Psychiatry, 63, 649–658.

Hyman, S. E. (2010). The diagnosis of mental disorders: the problem of reification. Annual review of clinical psychology, 6, 155-179.

Jacobs, K. L. y Krueger, R. F. (2015). The importance of structural validity. En P. Zachar, D. St.Stoyanov, M. Aragona y A. Jablensky (Eds.). Alternative perspectives on psychiatric validation (pp. 189-2000). Oxford, Reino Unido: Oxford University Press.

Jørgensen, C. R., Bøye, R., Andersen, D., Døssing Blaabjerg, A. H., Freund, C., Jordet, H. y Mortern (2014). Eighteen months post-treatment naturalistic follow-up study of mentalization-based therapy and supportive group treatment of borderline personality disorder: Clinical outcomes and functioning. Nordic Psychology, 66, 254–273.

Jørgensen, C. R., Freund, C. Bøye, R., Jordet, H., Andersen, D. y Kjolbye, M. (2013). Mentalizing-based therapy versus psychodynamic supportive therapy. Acta Psychiatrica Scandinavica, 127, 305–317.

Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friss, S., Haaseth, O., Haavaldsen, G., Irion T., Leirvag, H., Tørum, T. y Urnes, O. (2003). Day treatment of clients with personality disorders: Experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17, 243–262.

Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., Bishop, G. K., Butterflield, M. I. y Bastian, L. A. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.

Kröger, C., Harbeck, S., Armbrust, M. y Kliem, S. (2013). Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 51, 411–416.

Leichsenring, F. y Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavioural therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160, 1223–1232.

Leichsenring, F., Leibing, E., Kruse, J., New, A. S. y Lewke, F. (2011). Borderline personality disorder. Lancet, 377, 74–84.

Linehan, M. M. (1993). Cognitive-behavioural treatment of borderline personality disorder. New York, NY: Guilford Press.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K. y Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.

Livesley W. J. (2003a). Practical management of personality disorder. New York: Guilford Press.

Livesley, W. J. (1998). Suggestions for a framework for an empirically based classification of personality disorder. Canadian Journal of Psychiatry, 43, 137-147.

Livesley, W. J. (2003b). Diagnostic dilemmas in the classification of personality disorder. En K. Phillips, M. First y H. A. Pincus (Eds.), Advancing DSM: Dilemmas in psychiatric diagnosis (pp. 153–189). Arlington, VA: American Psychiatric Association Press.

Livesley, W. J. (2012). Moving beyond specialized therapies for borderline personality disorder: The importance of integrated domain-focused treatment. Psychodynamic Psychiatry, 40(1), 47–74.

Livesley, W. J. (2017). Integrated modular treatment for borderline personality disorder. Cambridge, Reino Unido: Cambridge University Press.

Livesley, W. J. (2018). Conceptual issues. En W. J. Livesley y R. Larstone (Eds.), Handbook of Personality Disorders (pp. 3-24). New York, NY: Guilford Press.

Livesley, W. J. y Clarkin, J. F. (2015). Diagnosis and assessment. En W. J. Livesley, G. Diaggio y J. F. Clarkin (eds.). Integrated treatment for personality disorder: A modular approach (pp. 51-79). New York, NY: Guilford Press.

Livesley, W. J. Diaggio, G. y Clarkin, J. F. (eds.) (2015). Integrated treatment for personality disorder: A modular approach (pp. 51-79). New York, NY: Guilford Press.

Livesley, W. J., Schroeder, M. L., Jackson, D. N. y Jang, K. L. (1994). Categorical distinctions in the study of personality disorder: Implications for classification. Journal of Abnormal Psychology, 103, 6-17.

Luborsky, L., Singer, B. y Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has one and all must have prizes”? Archives of General Psychiatry, 32, 995–1008.

McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J. y Links, P. S. (2012). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry, 169, 650-661.

McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L. Streiner, D. L. (2009). A randomized controlled trial of dialectical behavior therapy versus general psychiatry management for borderline personality disorder. American Journal of Psychiatry, 166, 1365–1374.

McMain, S., Links, P. S., Guimond, T., Wnuk, S., Eynan, R., Bergmans, Y. y Warwar, S. (2013). An exploratory study of the relationship between changes in emotion and cognitive processes and treatment outcome in borderline personality disorder. Psychotherapy Research, 23, 658–673.

Meyer, B. y Pilkonis, P. A. (2006). Developing Treatments That Bridge Personality and Psychopathology. En R. F. Krueger y J. L. Tackett (Eds). Personality and psychopathology. New York, NY: Guilford Press.

Mulder, R. y Chanen, A. M. (2013). Effectiveness of cognitive analytic therapy for personality disorders. British Journal of Psychiatry, 202, 89–90.

Norcross, J. C. yGrencavage, L. M. (1989). Eclecticism and integration in counselling and psychotherapy: Major themes and obstacles. British Journal of Guidance and Counselling, 17, 117–247.

Norcross, J. C. y Newman, J. C. (1992). Psychotherapy integration: Setting the context. En J. C. Norcross y M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 3–45). New York, NY: Basic Books.

Piper, W. E. y Joyce, A. S. (2001). Psychosocial treatment outcome. In W. J. Livesley (Ed.), Handbook of personality disorders: Theory, research, and treatment. New York, NY: Guilford Press.

Ryle, A. (1997). Cognitive analytic therapy and borderline personality disorder. Chichester, UKReino Unido: Wiley.

Ryle A y Kerr I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester, Reino Unido: Wiley.

Safran, J. D., Muran, J. C. y Samstag, L. N. (1994). Resolving therapeutic alliance ruptures: A task analytic investigation. En A. O. Horvath y L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 225-255). New York, NY: John Wiley & Sons.

Sanderson, C. y Clarkin, J. F. (2013). Further use of the NEO-PI-R personality dimensions in differential treatment planning. En T.A. Widiger y P.T. Costa (Eds.), Personality disorders and the five factor model of personality (3rd ed., pp. 325–348). Washington, DC: American Psychological Association.

Smith, T. L., Barrett, M. S., Benjamin, L. S. y Barber, J. P. (2006). Relationship factors in treating personality disorders. En L. G. Castonguay y L. E. Beutler (eds.). Principles of therapeutic change that work (pp.219-238). New York, NY: Oxford University Press.

Stricker, G. (2010). A second look at psychotherapy integration. Journal of Psychotherapy Integration. 20, 397-405.

Tickle, J. J., Heatherton, T. F. y Wittenberg, L.G. (2001). Can personality change? En W. J. Livesley (Ed.), Handbook of personality disorders. New York, NY: Guilford Press.

Tufekcioglu, S. y Muran, J. C. (2015). A relational approach to personality disorder and alliance rupture. En W. J. Livesley, G. Dimaggio y J. F. Clarkin (eds.). Integrated treatment for personality disorder: A modular approach (pp.123-147). New York, NY: Guilford Press.

Verheul, R. y Widiger, T. A. (2004). A meta-analysis of the prevalence and usage of personality disorder not otherwise specified (PDNOS). Journal of Personality Disorders, 18, 309-319.

Yeomans, F. (2007). Questions concerning the randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 64, 609–610.

Young, J. E., Klosko, J. S., y Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York, NY: Guilford Press.

Publicado

2018-07-01

Cómo citar

Livesley, W. J. (2018). Terapia transdiagnóstica y transteórica para el trastorno de personalidad. Revista De Psicoterapia, 29(110), 89–110. https://doi.org/10.33898/rdp.v29i110.249