Personal Ment Health. 2026 Aug;20(3):e70091. doi: 10.1002/pmh.70091.
ABSTRACT
We critically appraise the study by de Bruin et al., which examined whether avoidant personality traits and avoidant coping predict differential outcomes of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) in adult depression. Although the authors address an important clinical question regarding dimensional personality assessment in treatment selection, several methodological issues may limit the strength of their conclusions. First, avoidant personality traits were operationalized using a composite score derived from subtracting extraversion from neuroticism on the NEO-FFI. Although dimensional models are increasingly encouraged, this approach may not adequately capture the multifaceted construct of avoidant personality pathology, which includes features such as rejection sensitivity, shame, social inhibition, and feelings of inadequacy, and may instead reflect broader negative affectivity or introversion. Second, the study may have been underpowered to detect moderation effects, which typically require larger samples than main effect analyses. Attrition and participant exclusion may have further reduced statistical power, limiting the ability to identify meaningful treatment interactions. Therefore, the absence of significant moderation effects should be interpreted cautiously and not taken as definitive evidence of equivalent treatment efficacy across levels of avoidant pathology. Despite these limitations, the study contributes to growing research on dimensional personality approaches in depression treatment, and further well-powered studies using validated measures are warranted.
PMID:42363611 | DOI:10.1002/pmh.70091
