Rep36 Understanding Personality Disorder

2.1.4 Cognitive approaches
CBT approaches emphasise a molecular level of
behaviour analysis and avoid broader concepts of
personality traits. Beck and colleagues note that
the presence of a personality disorder reduces
the effectiveness of treatment focusing on skills
training alone (Beck 
et al
., 1990). They argue for
a broader approach to problem behaviours that
incorporates a theory of normal and abnormal
personality. Taking an evolutionary perspective,
they suggest that personality patterns or traits are
genetically determined ‘strategies’ favoured by
natural selection. Behaviours such as attacking,
freezing, avoiding, seeking help, being
suspicious, or seeking attention may all have had
survival value in some situations but not others.
Personality strategies are overt expressions of
tacit or deep cognitive schemas (core beliefs)
resulting from genetic-environmental interaction.
Personality disorders reflect dysfunctional
beliefs and maladaptive strategies that are over-
generalised, inflexible, imperative, and resistant
to change. Each disorder is characterised by a
distinct cognitive profile, a composite of beliefs,
attitudes, and emotions organised around a
general theme of the nature of self and others
that dictates a generalised behaviour strategy.
For example, the cognitive profile of antisocial
personalities embodies a concept of others as
vulnerable and exploitative and of self as
autonomous, strong, and entitled to break rules.
This dictates a behavioural strategy of exploiting
and attacking others.
Cognitive therapy originates in Beck’s earlier
theory that emotional disorders reflect biased
information processing resulting from
dysfunctional cognitive schemas. In the case of
personality disorders, cognitive therapists place a
greater emphasis on developmental issues, the
therapist-client relationship, and the need for a
longer duration of treatment. Therapy modifies
the cognitive profile through guided discussion,
structured cognitive exercises, and behavioural
experiences. The goal is not to replace schemata,
but to modify beliefs or make more adaptive use
of strategies. For example, an individual with
antisocial personality traits would be guided by
the therapist from a strategy of unqualified self-
interest to one of qualified self-interest that takes
account of the needs of others. 
Schema-focused therapy is a related cognitive
approach developed by Young (1994). It is not
based on a comprehensive theory of personality,
but rather focuses on early maladaptive schemas
(EMS) held to be common in emotional and
personality disorders. EMS are broad and
pervasive themes about oneself and relationships
with others that originate during childhood and
provide templates for processing later
experiences. They are the cumulative result of
dysfunctional early experiences rather than
specific traumas.
EMS are activated by schema-relevant events
and generate disruptive emotions that interfere
with core needs for self-expression, autonomy,
interpersonal relatedness, social validation, and
social integration that are central to the sense of
self. Young identifies a number of EMS, such as
expectations of abandonment, failure, or
subjugation to others. These EMS fall into broad
domains of disconnection and rejection,
impaired autonomy and performance, impaired
limits, other-directedness, over-vigilance and
inhibition, each of these being associated with a