How Can Antisocial Personality Disorder Behavior Therapy Help Me?

Personality disorders may be some of the most difficult mental health conditions to recognize, diagnose, and treat. Within the spectrum of personality disorders, cluster B personality disorders (those that typically include symptoms of emotional dysregulation and unpredictable thoughts and behaviors) may be especially complex. These disorders include narcissistic personality disorder, antisocial personality disorder, borderline personality disorder, and histrionic personality disorder.

However, treatment options exist for these mental health conditions, and studies demonstrate that treatment through talk therapy and other forms of therapeutic intervention can make a difference. Let’s take a closer look at one of these conditions, particularly antisocial personality disorder (ASPD), which is often characterized by destructive and harmful behavior toward others. Psychological interventions focused on behavioral adjustment have shown promise in reducing antisocial personality disorder symptoms. In this article, we’ll explore these treatment approaches and discuss how they may assist someone living with ASPD.

What is antisocial personality disorder (ASPD)?

Contrary to what its name may sound like, antisocial personality disorder does not refer to people who are introverted or people who do not enjoy spending time with others. Antisocial personality disorder is the clinical term for what is sometimes colloquially referred to as sociopathy. It is a mental health condition that may result in a person not understanding or caring about what society considers right and wrong. Like some other cluster B personality disorders, ASPD may also cause a lack of empathy and regard for other people’s feelings and experiences.

Common symptoms demonstrated by people with antisocial personality disorder

• Manipulating or violating the rights of others

• Intentionally acting in a way that hurts other people (emotionally or physically)

• Destroying other people’s property, stealing, and otherwise violating the law, often out of disregard for the legal system and a belief that the law shouldn’t apply to them

• Displaying an attitude of harsh judgment or cruel indifference toward others

• Behaving impulsively, recklessly, and dangerously

• Lying and taking advantage of other people

• Substance use

• Violence, aggression, or hostility

• Disregarding work, school, or family responsibilities

• Using charm, wit, and sometimes sexual appeal for personal gain

• Understanding how to appropriately act toward other people, but only doing so when it benefits them

• A sense of superiority

• Lack of sensitivity or respect toward other people

• A lack of guilt, shame, or remorse about their actions that have harmed others

Antisocial personality disorder is a lifelong mental health condition, meaning there is no known cure. However, treating antisocial personality disorder in a therapeutic setting may result in successful symptom management and potentially even a decrease in symptoms over time.

Treatment for antisocial personality disorder can be complex. A person with the condition typically does not believe there is anything wrong with their behavior, and they generally do not seek treatment unless they are compelled to, i.e., their destructive and potentially criminal behavior results in their family members or even the legal system compelling them to see a mental health professional. 

Another way people with antisocial personality disorder may enter the mental health treatment system is to seek treatment for other mental health conditions. Having antisocial personality disorder may increase the likelihood that a person will experience substance use disorder, anxiety disorders, or mood disorders, for which some people may take mood stabilizers. While working with health care providers to address symptoms of other conditions, a patient may also become more open to taking steps to treat antisocial personality disorder. 

Behavioral therapy for antisocial personality disorder

A person with antisocial personality disorder is unlikely to see a reason to change, and, in many cases, the disordered thinking patterns central to the condition (lack of empathy/remorse, sense of superiority, etc.) are such a foundational part of the person’s personality that they might be impossible to adjust. This complex situation is why many therapies for antisocial personality disorder focus not on shifting the patient’s thoughts but on changing their behavior. 

Contingency management

Contingency management may be one of the more effective methods of treating antisocial personality disorder. Contingency management involves using a reward system to provide incentives for beneficial behavior, or as is often more impactful for patients with antisocial personality disorder, rewards for the absence of destructive behavior. People with antisocial personality disorder cannot typically find the motivation to change their behavior, even when it negatively impacts others; however, if they understand how changing their behavior may positively impact them, they may be more likely to adjust their actions. Contingency management is one method of helping people with antisocial personality disorder reframe their perceptions of their harmful behaviors. 

Contingency management has also shown promise in assisting those recovering from substance use disorders, which often co-occur alongside antisocial personality disorder. One 2010 study found that contingency management helped reduce symptoms and promote positive treatment outcomes for people who experienced both antisocial personality disorder and an addiction to cocaine. (Note: Mental health research is constantly evolving, so older sources may contain information or theories that have been reevaluated since their original publication date.)

Dialectical behavior therapy

Dialectical behavior therapy (DBT) may be another helpful option for addressing the behaviors associated with antisocial personality disorder. Like contingency management, it adopts a primarily behavioral lens, i.e., not changing the thoughts and personality traits of a person with antisocial personality disorder but working to adjust their behaviors.

DBT has four key components to behavior change: 

• Mindfulness: Mindfulness involves paying attention to the present moment and observing what is happening in one’s body and brain.

• Emotion regulation: Emotion regulation builds on those observations by linking physical and mental states to emotional changes, through which one may begin to identify patterns and triggers.

• Interpersonal effectiveness: Interpersonal effectiveness involves using that enhanced understanding to navigate relationships with others in more productive and healthy ways.

• Distress tolerance: Distress tolerance works to identify ways to build resilience under stressful or distressing conditions, ideally decreasing the possibility of destructive behaviors such as substance use or violence. 

Finding support for antisocial personality disorder

If you believe you or someone you love may be experiencing symptoms of antisocial personality disorder, it can be beneficial to seek therapeutic help sooner rather than later. Since some of the disorder’s symptoms are inherently destructive, it may be wise to connect with a therapist before the condition results in irreparable relationship damage or possible legal concerns.

People with antisocial personality disorder often struggle to develop meaningful connections with others. Online therapy can be a useful alternative in these cases, as it might create less pressure and not feel as intense as an in-person therapy appointment. Online therapy often also requires less time commitment, as you can easily get the treatment from the convenience of your own home instead of commuting to a physical therapy office. With an online platform like BetterHelp, you can speak with a therapist through video chats, phone calls, or in-app messaging and begin getting support according to your availability. Online cognitive behavioral therapy (CBT) may lead to a better understanding of your thoughts and behaviors, which may lead to greater overall well-being.

The efficacy of online therapy for personality disorders

Scientific research has demonstrated that online therapy may be just as effective as in-person therapy for treating various mental health conditions, including personality disorders. One meta-analysis looked at current research  across multiple databases, including PubMed and the Cochrane database. The analysis found that online therapy may help to alleviate the symptoms of personality disorders. Most of the studies focused on borderline personality disorder, but others looked at personality disorders in general.  Of those studies that were analyzed, 45% of them produced promising results, with all of them showing a reduction of personality disorder symptoms and an absence of adverse effects. Online talk therapy may also be more cost-effective than in-person therapy, potentially opening up treatment to a wider range of individuals.

Takeaway

Living with antisocial personality disorder, or having a loved one experience the disorder, can be challenging. However, there are several therapeutic options for addressing symptoms of the condition, with therapies that focus on behavioral change often having the most significant impact. While there may not be a cure for ASPD, it is possible to manage its symptoms with the right support. Online therapy may provide a more available treatment path for those with antisocial personality disorder. By connecting with an online therapist, individuals can find care and guidance from the comfort of their homes.