Review of Empirical Literature Studies

Very few systematic studies of treatment for avoidant personality disorder have been performed, and most of these were in the area of nonpharmacological therapy. Various therapies have been used, including psychodynamic, exposure, rational-emotive, cognitive, and interpersonal therapies, as well as social skills training. Therapy has been carried out in both individual and group formats, and several studies of treatment for social phobia have shown improvement in avoidant personality features as well.

In early studies of avoidant personality disorder, patients receiving behavioral treatments improved significantly more than waiting-list control groups. Treatments used were graduated exposure, social skills training, and systematic desensitization. In another study, Stravynski and colleagues reported significant improvement on most measures for groups treated with social skills training alone or in combination with cognitive modification. Although specific results for avoidant personality disorder were not reported, researchers found that two forms of short-term psychodynamic therapy, when applied for an average of 40 weeks, resulted in significant improvement in patients with DSM-III-R Cluster C personality disorders. In an open clinical trial, 24 patients with avoidant personality disorder received a series of 52 sessions of time-limited supportive-expressive dynamic psychotherapy. At the end of treatment, only 39% still met the criteria for avoidant personality disorder.

The cognitive theory of personality disorders has become one of the main theoretical orientations in the personality disorder literature. Cognitive-behavioral therapy (CBT), which has become a mainstay of treatment in anxiety disorders, has been shown in several studies to be effective in decreasing social phobia as well as avoidant personality traits. However, many patients do not benefit sufficiently from CBT. Turner and colleagues (1996) estimated that about 52% of socially phobic patients benefit from this treatment. Chambless and colleagues, in a 6-month follow-up study, reported that one of the predictors of greater improvement with cognitive-behavioral group therapy in social phobia was a lower level of avoidant personality traits. Scholing and Emmelkamp attempted to (partially) replicate the above study in an 18-month follow-up study and found that the presence of avoidant personality traits showed no predictive value for the group of 50 subjects who completed the study. However, for the subgroup with generalized social phobia, avoidant traits did predict less favorable results, whereas for the discrete social phobia group, these traits predicted better results. Two meta-analyses of treatment results in CBT for social phobia indicated that exposure in vivo results in significant improvement in self-reported social anxiety with no enhanced benefit from cognitive interventions.