Mindfulness For Antisocial Personality Disorder

Buddha in FallI’ve been regularly practicing mindfulness meditation since the summer of 2014 and I can tell you that I’ve noticed a subtle but definite difference in the way I respond to stress in my role as a general hospital psychiatrist. More often nowadays, I’m a little more likely to be aware of tension in my body when I’m hurrying on my way to a potentially explosive violent situation (what we call a “Code Green” here) somewhere in the hospital. It still takes me a while to calm down afterward, but I’m also more aware of that.

I’m not ready to claim that mindfulness has fundamentally changed my personality or my temperament. That would be too much to ask. However, the medical literature is starting to see an ever-widening array of indications for applying mindfulness (moment to moment non-judgmental awareness), including a variety of psychiatric disorders. It may even be helpful for those with personality disorders.

This is an important development and, while most the early research evidence focuses on Borderline Personality Disorder, there is a small body of work supporting the use of mindfulness for other personality disorders, including Antisocial Personality Disorder (ASPD) [1]. This may come as a surprise to some, because many believe ASPD is untreatable. In fact there is evidence for response to cognitive behavioral approaches [2].

There are a couple of studies on ASPD which show that mindfulness might be an effective treatment adjunct, particularly in correctional settings. Authors point out that “Questionnaire data collected from an offender sample revealed that deficits in mindfulness, particularly in acting with awareness, were associated with increased antisocial personality disorder traits.” Mindfulness also seemed to moderate the relationship between ASPD traits and aggression, “…suggesting that mindfulness may be a potential treatment target in interventions.”

The authors continue by suggesting that helping people with ASPD (both men and women may have the disorder, although it’s more common in men) could promote awareness about how internal thoughts and feelings lead to aggression and may then help them adopt alternative responses. Some experts speculate that mindfulness practice may even change the brain, enhancing inhibitory control and fostering empathy, both of which have been documented as lacking in ASPD. Eventually this could promote better emotion regulation, and enhanced ability to control impulsivity and violence.

In my role as a psychiatric consultant, I see many people suffering from a variety of persistent maladaptive coping and interpersonal styles, including those with ASPD. The challenge I see is how to encourage psychiatrists as a group to learn more about mindfulness and integrate it into their practices.

One resource I’ve recently found is an article in the March 2016 issue of Psychiatric Times, Incorporating Meditation Training Into an Outpatient Psychiatry Practice, by Greg Sazima, MD. He comes right out and says that “…psychiatrists have not caught on. Some mistrust the validity of a practice that entrains observation of a subjective, hard-to-assess interior experience. Others may misunderstand it as uncomfortably associated with religiosity. There is also the practical obstacle of squeezing even basic meditation skills training into the psychiatrist’s already over-subscribed treatment visits. Regardless of our possible reasons for stiff-arming it, meditation training remains a valuable, thoroughly secular tool for psychiatrists to incorporate into our patient practices—and our own personal self-care routines. – See more at: http://www.psychiatrictimes.com/integrative-psychiatry/incorporating-meditation-training-outpatient-psychiatry-practice#sthash.5doaTbx6.dpu”f

Dr. Sazima has a handy reminder card about how to begin meditation:

Basic Awareness Meditation by Greg Sazima MD Psychiatric TImes March 2016

Basic Awareness Meditation by Greg Sazima MD Psychiatric TImes March 2016

Or if you live in Iowa City, you can enroll in one of the University of Hospital and Clinic mindfulness classes, of which there are many, led by Director Bev Klug, MA, LMFT. Tell Bev I sent you.

It’s important to restore hope to those who suffer from any psychiatric illness, especially those struggling with personality disorders. It’s also important to remember that a motivational interviewing style may be more helpful than begging, preaching, cajoling, or threatening in order to connect with them, especially since they may be anywhere on the readiness to change ladder. If they happen to be on the precontemplation step, they may just think everyone else is the problem.

References:

  1. Sng, A. A. and A. Janca (2016). “Mindfulness for personality disorders.” Curr Opin Psychiatry 29(1): 70-76.
    PURPOSE OF REVIEW: Third-wave cognitive-behaviour therapies such as dialectical behaviour therapy have demonstrated effectiveness in the treatment of personality disorders, which are considered difficult to treat. These therapies typically incorporate some component of mindfulness practice. The current study examines current applications and effectiveness of mindfulness to the treatment of personality disorders. RECENT FINDINGS: The majority of evidence available focuses on borderline personality disorder, and highlights positive associations between mindfulness practice and reduced psychiatric and clinical symptoms, less emotional reactivity, and less impulsivity. Fewer studies examine the other personality disorders, though emerging case studies have applied mindfulness techniques to treatment with antisocial, avoidant, paranoid, and obsessive-compulsive personality disorders. SUMMARY: Mindfulness is a promising clinical tool for the treatment of personality disorders, and appears to be adaptable to the unique features of different types of personality disorders. However, further empirical research with greater methodological rigour is required to clarify the effectiveness of mindfulness as a specific skill component, and to identify the underlying mechanisms that contribute to therapeutic change.

2. Black, D. W. (2013). Bad boys, bad men : confronting antisocial personality disorder. New York, Oxford University Press.

Advertisements
%d bloggers like this: