Alden’s Cognitive-interpersonal Therapy For Avoidance Disorder

Avoidant personality disorder is found in DSM-5, framed within Cluster B of personality disorders. According to their criteria, avoidance disorder is characterized by a dominant pattern of social inhibition.

It is also easy to identify feelings of incompetence and oversensitivity to negative evaluation, which begins in early adulthood, is present in a variety of contexts, and is manifested by four (or more) of the following facts:

• Avoid work activities that involve significant interpersonal contact for fear of criticism, disapproval, or rejection.
• You are reluctant to establish relationships with others unless you are sure you are appreciated.
• He is withdrawn in close relationships because he fears that he will be embarrassed or ridiculed.

• You worry about being criticized or rejected in social situations.
• He is inhibited in new interpersonal situations due to the feeling of lack of adaptation.
• You see yourself as socially inept, unattractive or inferior to others.
• You are extremely reluctant to take personal risks or get involved in new activities because they can be embarrassing.

Therefore, a person with avoidant personality disorder perceives social relationships of any kind as a threat in which they can be criticized, rejected or embarrassed. All this without evidence to support their beliefs.

Alden’s cognitive-interpersonal therapy aims to encourage patients to objectively examine their social behavior, to identify inappropriate or outdated beliefs about themselves and about the reactions of others to them.

Why do I still have avoidance disorder?

How we relate to other people largely predicts how they will react to us. This happens because when beliefs are deeply ingrained, as is often the case in personality disorders, my behaviors will be consistent with them.

Ultimately, examining inappropriate beliefs about social relationships and others, as well as ineffective behavior patterns, can be helpful in beginning to reverse avoidant personality disorder.

Alden’s cognitive-interpersonal therapy proposes that the patient experiment with new behavioral strategies in social interactions. The objective is to observe how changes in their behavior also have different social consequences.

This prototypical process of Alden’s cognitive-interpersonal therapy often leads to discussions regarding deeper beliefs about themselves and their interpersonal patterns, something that is beneficial to identify and discuss.

Alden’s Cognitive-Interpersonal Therapy Strategies

From Alden’s cognitive-interpersonal therapy, different strategies are used to achieve the goals set. These are the following:

• Self-registrations. Its objective is for the patient to observe the social situations they face from an objective perspective and to carry out a rational analysis of what happened. The events should be described in detail so that the therapist and the patient can analyze the situation during the session.
• First level strategies: Cognitive modification. As you review the self-records, you begin to do some cognitive preliminaries. The objective of these early-stage strategies is to lay the evidence base for later and deeper cognitive work. Therefore, these strategies would focus on very specific situations and not so much on global patterns.

• Behavioral activation. It is about the patient with avoidant personality disorder, increase their activities. If the disorder is moderate to severe, start with physical activities and interests that require little social contact. The ultimate goal is to get the subject out of their routines and reduce fears of unfamiliar situations.
• Exposure to fear-provoking behaviors and situations. Patients are encouraged to expose themselves to the social situations they fear and to engage in the kinds of behaviors that make them anxious.
• Behavior test. It is used to support the patient’s self-confidence and thereby increase the likelihood of becoming involved in the situation and experiencing a positive outcome.
• Second level strategies.  Cognitive modification. The therapist moves to mid-stage strategies that focus on more general cognitive patterns, such as negative perceptual biases and emotion-based reasoning, that often characterize patients with avoidance disorder.

• Third level strategies. Cognitive modification. Finally, deeper issues are addressed, related to the sense of self and the pattern of their relationships with others. Here the therapist would work primarily with the person’s core beliefs about himself and others.

As can be deduced, Alden’s cognitive-interpersonal therapy places great emphasis on the more cognitive part. Thus, although it does not rule out exposure to risky situations and the activation of the patient in different activities, it considers that the change of beliefs and underlying schemes is the fundamental part.

This is somewhat contrary to the standard treatment of patients with social phobia – who have many characteristics in common with avoidants. In social phobia, the crucial element of treatment lies in the exposure and not so much in the change of cognitions. This difference is interesting in order to make a good diagnosis and, based on it, choose the most effective and efficient strategies for the type of patient we are treating.