Our Approach
Why target personality features instead of symptoms?
Over the past decade, mental health researchers and clinicians have grown disillusioned with the DSM system of understanding psychological disorders. Specifically, the DSM system assumes that each diagnosis represents a discrete entity, each requiring a different treatment protocol. Learning a different treatment for each DSM disorder creates a large training burden for clinicians. Moreover, treatment tied to a single diagnosis cannot adequately support patients with more than one condition – the rule, not the exception.
There is emerging evidence that similarities across DSM disorders outweighs differences between them. There appears to be a limited number of personality features that underlie most, if not all, mental disorders. Developing treatment modules to target 5 or 6 personality features (versus countless DSM symptoms) represents a more parsimonious approach to addressing comorbid symptoms for both patients and clinicians. Moreover, targeting the core dysfunction maintaining symptoms is more potent. Finally, personality-focused treatment modules can be selected based on patient presentation (only relevant modules need be delivered), making this approach personalizable.
What are the personality features we target with Compass?
The Five Factor Model (FFM) of personality is, perhaps, the most well-known conception of individual differences. This model supposes that all differences between people can be summarized on five dimensions: Neuroticism (vs emotional stability), Agreeableness (vs antagonism), Extraverson (vs introversion), Conscientiousness (vs. Disinhibition), and Openness (vs closedness) to Experience.
Recently, models of psychopathology have emerged that lean heavily on the FFM. For example, the “trait model” of DSM-5’s Alternative Model of Personality Disorders (located in the section of Emerging Models and Measures) characterizes personality disorders by describing their elevations and deficits on FFM domains. Borderline personality disorder, for example, is described as high neuroticism (negative affectivity), low agreeableness (antagonism), low conscientiousness (disinhibition). Similarly, the Hierarchical Taxonomy of Psychopathology (HiTOP) locates almost all DSM disorders beneath 6 higher-order targets that largely resemble the FFM personality domains.
Currently, we have developed Compass modules to address neuroticism, (low) agreeableness, and (low) conscientiousness because these traits account for the most variance in psychopathological symptoms. We have largely tested these modules in the context of patients with borderline personality disorder, however they treatment components apply to wide range of psychopathology. We plan to expand Compass to address low Extraversion (detachment) and high Openness (psychoticism) in the future.
How does Compass address personality?
Neuroticism
(Low) Agreeableness / Antagonism
(Low) Conscientiousness / Disinhibition.
What skills are included in Compass?
Values Identification
We begin treatment by helping clients identify their values across 11 life domains. This information is used to address identity disturbance (with our BPD clients) and to serve as a motivator - clients evaluate the degree to which their current actions line up with their valued life directions.
Skills for Thinking
Clients apply cognitive flexibility to emotional situations, interpersonal difficulties, and triggers for impulsive action. Core beliefs, dimensions of trust, and identifying the thoughts that underlie urges.
Skills for Doing
Classic behavior change skills (alternative actions, exposure) are employed to approach emotions, move toward goals in relationships, and keep one's long-term goals in mind when faced with urges for impulsive actions.
Skills for Being
Mindful awareness (a nonjudgmental, present-focused stance) is applied to emotional experience, interpersonal conflicts, and urge surfing.
Compass Developers
Shannon Sauer-Zavala, PhD
Matt Southward, PhD
Caitlyn Hood, PhD
Julianne Wilner-Tirpak, PhD
BPD Compass
BPD Compass is an evidence-based treatment for borderline personality disorder developed by experts who specialize in studying & treating this condition. Manualized and short-term (delivered across 18 or fewer sessions), BPD Compass was developed with clinicians in mind. Given that at least 10% of people seeking outpatient therapy have BPD, we sought to create an easy-to-learn (yet effective) intervention that could be delivered in generalist settings (e.g., private practice, community mental health, academic medical centers, college counseling centers).
BPD Compass uses cognitive behavioral skills to directly target the personality features that underlie BPD symptoms: (1) the tendency to experience strong emotions, (2) difficulty feeling secure in relationships, & (3) impulsivity. People with BPD can exhibit any combination of these personality, so BPD Compass is modular. In other words, clinicians can personalized the elements (i.e., modules) delivered based on patient presentation. The treatment also includes values exploration to address the identity disturbance common in BPD.
BPD Compass has been tested in a clinical trial with nearly 100 people with BPD. Results suggest that, on average, patients experience large reductions in BPD symptoms. They also experience decreases in comorbid symptoms (e.g., PTSD) and improvements in quality of life.
Why CBT?
An important consideration for maximizing widespread dissemination of an intervention is the burden placed on clinicians to deliver it. Compass is a manualized cognitive-behavioral treatment (CBT) with a patient workbook and therapist guide (coming soon to the public). By providing clear guidance on the application of this treatment for clinicians in a familiar format (i.e., workbook chapters corresponding to session-by-session material), any mental health provider that is inclined to work through Compass with their patients will be able to more quickly learn and apply it. We do offer consultation/training service, we explicitly view these offerings as enriching one’s practice, rather than necessary to provide the treatment. Finally, we elected to use a cognitive-behavioral approach given that CBT is reported as the primary theoretical orientation by most providers in typical mental health service settings (Wolitzky-Taylor et al., 2019) and most training programs for clinical psychology focus on developing student competencies in delivering CBT (Heatherington et al., 2012). Although we believe that adopting a manualized, CBT approach increases the disseminablility of Compass, it is important to note that the eclectic use of other theoretical orientations is not precluded; indeed, psychodynamic or interpersonal techniques that use the patient’s relationship with their therapist as a vehicle for new learning can be integrated within structured CBT exercises (Westen, 2000).
