We describe two frameworks in which personality dimensions relevant to health, such as Conscientiousness, can be used to inform interventions designed to promote health aging. First, contemporary data and theory do not suggest that personality is “immutable”, but instead focus on questions of who changes, in what way, why, when, and how. In fact, the notion that personality could be changed was part and parcel of many schools of psychotherapy, which suggested that long term and meaningful change in symptoms could not be achieved without change in relevant aspects of personality. We review intervention research documenting change in personality. Based on an integrative view of personality as a complex system, we describe a “bottom-up” model of change in which interventions to change basic personality processes eventuate in changes at the trait level. A second framework leverages the descriptive and predictive power of personality to tailor individual risk prediction and treatment, as well as refine public health programs, to the relevant dispositional characteristics of the target population. These methods dovetail with and add a systematic and rigorous psychosocial dimension to the personalized medicine and patient-centeredness movements in medicine. In addition to improving health through earlier intervention and increased fit between treatments and persons, cost-effectiveness improvements can be realized by more accurate resource allocation. Numerous examples from the personality, health, and aging literature on Conscientiousness and other traits are provided throughout, and we conclude with a series of recommendations for research in these emerging areas.

Despite the small cohort size of this trial, it has demonstrated preliminary efficacy of panic-focused psychodynamic psychotherapy for panic disorder.

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The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and three-year follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.

A pilot study on the process of psychodynamic psychotherapy of borderline personality disorder at the Cornell University Medical College is designed to investigate the teaching and application of a specific model of treatment for borderline patients (Clarkin et al. 1992; Kernberg and Clarkin 1992). The project has involved teaching a group of self-selected trainees and faculty the manualized therapy (Kernberg et al. 1989); taping each of the twice-weekly therapy sessions over a period of 2 years; and rating (1) each therapist's adherence to the manual (Koenigsberg et al. 1985), (2) each therapist's skill, and (3) patient change. The patients are women with borderline personality disorder, between 20 and 40 years of age, diagnosed by DSM-III-R criteria (American Psychiatric Association 1987), SCID-II (Spitzer et al. 1987), and a self-report questionnaire for level of personality organization. At regular intervals, the patients are evaluated for symptom status, change in BPD criteria, and functioning. The therapists are evaluated for adherence to the manual and level of therapeutic skill. In teaching and carrying out the manualized therapy, it became clear that a critical moment in the treatment was the setting up of the treatment contract. A study was organized to look systematically at the adherence of the therapists to the model of treatment with regard to this initial phase of the therapy.

The authors provide a critical review of the evidence from psychotherapy outcome research for and against the assumption that specific techniques produce specific effects. They describe the refinement in research and methodology that will be necessary to document specific effects.

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