Cognitive Therapy of Personality Disorders
Chapter 1
Overview of cognitive-behavioural therapy of personality disorders

Introduction

According to the Big Five model, human personality is composed of five factors: openness, conscientiousness, extraversion, agreeableness and neuroticism.

Each factor includes a variety of more specific personality traits.

The cognitive-behavioural approach to personality disorders

The cognitive-behavioural therapy (CBT) framework/paradigm has a set of interrelated theoretical principles.

Among CBT psychological treatments there are 1) acceptance and commitment therapy 2) dialectic behaviour therapy 3) schema therapy 4) cognitive therapy 5) rational-emotive behaviour therapy.

CBT theoretical foundations

CBT doesn’t treat personality disorder symptoms as an expression of an underlying illness, but as learned human responses to specific or general stimuli. The cognitive component is often prompted as a preliminary ‘cause’ of the disorder. This doesn’t mean that the causality is unidirectional. Al types of responses are strongly interrelated, forming a multidimensional interactive psychological structure.

The general ABC model of CBT is: 1) A, activating event, whether external and/or internal   2) B, beliefs 3) C, consequences: emotional, behavioural and psychophysiological.

Once generated, a consequence can become a new activating event, thus further priming metabeliefs/secondary beliefs that generate metaconsequences/secondary consequences.

Cold cognitions are descriptions of reality and the individual’s interpretations/inferences. Hot cognitions refer to how we evaluate/appraise these descriptions and inferences about reality. Both can be more surface beliefs or core beliefs.

The sequence of CT typically focuses first on automatic thoughts and later on core beliefs. At some point, CT focuses on activating events by problem-solving strategies and/or on the consequences of the beliefs by behavioural and/or coping techniques. The interactive nature of the core elements is different for each individual.

REBT focuses on altering dysfunctional consequences by changing irrational beliefs first and then, on changing cold cognitions. The process is first focuses on the surface beliefs in forms of specific irrational self-statements and later on general irrational core beliefs. After the cognitive restructuring process, REBT would focus on the other components.

Integrative multimodal CBT framework

According to the integrative and multimodal CBT framework, there are two types of core beliefs 1) Related to core cognitions, the general core beliefs coded in the human mind as general schemas 2) Hot cognitions, general irrational core beliefs coded in the mind as evaluative schemas.

These cold