Explaining the willingness of clinicians to work with patients with antisocial personality disorder using the theory of planned behaviour and emotional reactions

Abstract

Many clinicians seem to experience negative emotions towards patients with antisocial personality disorder (ASPD), resulting in the exclusion of patients in many treatment programmes. The behaviour of individuals with ASPD has a significant impact on society, which affects ASPD patients and their environment, and therefore, the exclusion from programmes is a serious concern. Relatively, little is known about why some clinicians are willing to work with ASPD patients and others are not and what factors contribute to an increase in the motivation to do so. In this study, clinicians (n = 130) working in a regular and forensic mental health service in the Netherlands completed a questionnaire based on the theory of planned behaviour (TPB) and the Feeling Word Checklist and questions about the relevant experience gained and education received. The current study confirms the limited willingness to work with ASPD patients, especially in regular mental health care. Experience working with ASPD patients, education on cluster B personality disorders and having experienced verbal and/or physical violence in clinical practice did not fully explain whether or not clinicians were motivated to provide treatment to ASPD patients.TPB appeared to predict the intention to provide psychological therapy to ASPD patients adequately. The impact of positive emotions towards ASPD patients on providing treatment appeared to be stronger than negative emotions. This study provides more insight into why so few clinicians are willing to work with ASPD patients and what may increase motivation to include this group in treatment programmes.

Applying Theory of Planned Behaviour to Understand Interinstitutional Collaboration in Chronic Disease Management: A Cross-Sectional Study from Fujian Province, China

“…The TPB has been widely applied in numerous studies, including behavioural changes among physicians [16,17]. This study suggests that TPB can provide a theoretical framework for the behavioural changes of health care personnel involved in chronic disease management.…”

Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions

“…However, instead of labelling this population as untreatable, a thorough understanding of the underlying dynamics can provide valuable information for adapting treatments to the special needs of these individuals. This is also important because research indicates that specific knowledge about applying therapeutic interventions to ASPD patients enhances the motivation of clinicians to work with this population ( Van Dam et al, 2022 ).…”

“…Moreover, in clinical practice progression is needed to support therapists in making substantiated choices about which intervention can be used for a specific patient exhibiting ASB. Uncertainty about treatment choices has a negative effect on clinicians’ motivation to treat clients with ASB ( Van Dam et al, 2022 ). The model proposed by Brazil et al (2018) makes an important contribution to the demand for a clinically relevant model.…”

Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance

“…The lack of evidence-based guidelines for building an effective TA with these patients is believed to be one of the reasons for the therapists' reluctance. The availability of more knowledge on how to build and maintain a good TA can contribute significantly to a better sense of therapist competence and treatment quality (Van Dam et al, 2022). Providing high quality treatment for these patients is important, given that ASPD can cause significant emotional burden and costs for society, the social environment, and the patients themselves (Rijckmans et al, 2020;Van den Bosch et al, 2018).…”