 The video you're about to watch has caused me enormous distress, cognitive dissonance, decompensation, disintegration and constipation, not necessarily in this order. And the reason is it's a hopeful video. It's a review of five studies recently published which deal with antisocial personality disorder including its most extreme form colloquially known as psychopathy or sociopathy. Psychopathy and sociopathy are not recognized clinical terms in the diagnostic and statistical manual, but they describe a manifestation or a portion of the antisocial personality disorder spectrum. And for the first time in many many years there's hope. The thing is this, I don't do hope. My video is a bleak, doom, gloom, hopelessness, helplessness and when I'm forced to follow the evidence to a path of light and hopefulness, I feel bad. I feel hopeless. And who the heck am I? My name is Sam Vaknin. I am the hopeless author of Malignancy of Love and Narcissism. Revisited the bleak former professor of psychology in Southern Federal University in Rostov-on-Don on Russia and currently on the faculty of CIAPS, Commonwealth Institute for Advanced Professional Studies, Cambridge, United Kingdom, Toronto, Canada and Outreach Campus in Lagos, Nigeria. And if this didn't drive you to despair, depression and disintegration, wait till you listen to this or watch this video. A video about hope. Hope for a diagnosis that either to was considered untreatable, incurable, hopeless, most practitioners avoid psychopaths, avoid people with antisocial personality disorder, because we don't have any treatment modality, any intervention that has even a minimal effect on psychopaths, while we can and do often modify the behaviors of narcissists. We are able to reduce abrasive and antisocial behaviors in narcissistic personality disorder. Even this minor modicum of accomplishment is denied us when we deal with psychopaths. Psychopaths are incorrigible. They are immutable. They are like rocks. You know, you need a geological time to affect any change in a psychopath. So practitioners just give up on psychopaths. In prison, psychopaths go through evaluation. They go through mock, mock therapeutic treatment, but really, you know, everyone fully expects them to relapse. Recidivism rate among criminals, for example, is extremely high. And people with antisocial personality disorder who are not criminals, which is the vast majority of the population of psychopaths, by the way, the vast majority are actually not criminals. You can find them in various settings, such as corporate structures in the army, in medicine, and so on and so forth. But they're not criminals. Even in this case, they don't change until late in life, until they're 40s and 50s. And now there's new information about this as well. So stay tuned. What are the latest breakthroughs when it comes to antisocial personality disorder and psychopathy based on the latest studies? Antisocial personality disorder. There's a debate. Is it a mental illness at all? Or is it just a lifestyle choice or a personality style? Define authority known as contumatiousness, recklessness, rejection of laws and mores and regulations or any imposition from the outside. Constant power play, goal orientation, using other people, instrumentalizing them or trampling of them on the way to obtaining the goal. These are all personality choices or personality features. But when put together, do they constitute a mental illness? Your humble servant does not think so. I don't consider antisocial personality disorder a personality disorder at all or a mental illness of any kind. I think the folks, the folks in the 19th century, got it more right, got it more accurately than we do. They called psychopathy a moral insanity, a character defect, a social insanity or social dysfunction. They didn't regard antisocials or psychopaths mentally ill and I don't think they are. The current thinking, the current emerging thinking, is that antisocial personality disorder is some kind of cognitive distortion. It is a dysfunctional thought process. Now we have a cognitive distortion in narcissism, in narcissistic personality disorder, and it's known as grandiosity. Grandiosity distorts the narcissist's ability to perceive reality properly. The narcissist deforms, reframes, reshapes and rewrites reality in order to uphold and buttress an inflated fantastic self-image. Similarly, someone with antisocial personality disorder has a cognitive distortion, a dysfunctional thought process focused on socially exploitative behavior. Typically, antisocial personality disorder is characterized by a lack of remorse for these behaviors, hurting other people, using other people, leveraging their vulnerabilities, abusing them, instrumentalizing them in order to obtain goals. All these are considered legitimate. It's a dog eat dog world. It's a jungle out there. They would have done it to you as a psychopath. The psychopathic thought process is they would have done it to me had I not done it to them first. So it's a cognitive distortion, actually. It's a misperception of reality, and we all know that antisocial personality disorder is one of the four personality disorders in the cluster B. This clustering of personality disorders has survived well into the fifth edition text revision of the Diagnostic and Statistical Manual published only two years ago. Nothing has changed. We still, the DSM is still stuck somewhere 25 years ago. The situation is much better with the competitor of the DSM, the International Classification of Diseases, published by the World Health Organization, where there is a single personality disorder with a variety of traits such as dissociality in the case of psychopaths and narcissists. But within cluster B, we have the erratic dramatic disorders. We have narcissistic, borderline, histrionic, and and antisocial. The thing is that thousands of studies over the last hundred and fifty years have linked environmental factors and adverse childhood experiences to the emergence of antisocial personality disorder and psychopathy in adulthood neglect physical abuse, even to some extent sexual abuse, although sexual abuse usually translates into borderline personality disorder. Among quite a few psychopaths, we find sexual abuse and psychopathy or antisocial personality disorder is highly comorbid with narcissistic and borderline personality disorder. In other words, within the same patient we often diagnose antisocial, narcissistic, and borderline personality disorder, the same patient. Now we know that genetic factors play a huge role in the development of antisocial personality disorder. Estimates of heritability range from 38% to a whopping 69%. It's even much more pronounced than in borderline personality disorder according to some studies. Childhood psychopathology, known as conduct disorder, also strongly correlates to the development of antisocial personality disorder. A small majority of children diagnosed with conduct disorder go on to become antisocial adults. Now, we don't know what is the prevalence of antisocial personality disorder in the general population because exactly like narcissists, psychopaths are not very keen on therapy. To put it gently, psychopaths also, like narcissists, are grandiose. They deny that anything is wrong with them. It is society that is malformed. It is other people who are responsible for the antisocial's choices, decisions, and behaviors. He is innocent, as pure, as a driven snow. So it's very difficult to estimate the prevalence of antisocial personality disorder in the general population. But we think that 6% of men, at 2% of women, suffer from antisocial personality disorder. So yes, to this very day, antisocial personality disorder is more preponderant, more common among men than among women. That is not the case in narcissistic personality disorder and borderline personality disorder, where women caught up with men. And today, half of all narcissists and half of all borderlines are women or men. So with psychopathy, still the vast majority of psychopaths, about 60, 70% of psychopaths, are men. And women's psychopaths are typically borderlines. So they are secondary psychopaths. They're not primary psychopaths. They're not what is known as factor one psychopaths. They are factor two psychopaths. Factor one and factor two are elements in the main test we have to diagnose psychopaths known as the PCLR developed by Robert Hare. It has huge deficiencies and flaws as a clinical test, but it's proven to be a valid test to a large extent. Now, one last thing. The importance of early intervention in all cluster B personality disorders cannot be overestimated. It's critical to intervene early on. We can diagnose borderline personality disorder at age 12. We can diagnose narcissistic personality disorder at about age 18 and I think maybe 16. We can diagnose conduct disorder in children as young as nine and sometimes four. So early intervention is crucial. Unfortunately, there aren't many pharmacological treatment options. Psychopharmacology of cluster B personality disorder is extremely underdeveloped and so is brain imaging and so is the genetics of, for example, narcissism. So we are still missing many critical pieces in the puzzle. One recent study aims to plug a mini-hole in the dyke or the dam of cluster B personality disorders, especially antisocial personality disorder, and that is a study of internasal oxytocin. Does it benefit patients with antisocial personality disorder? Does it reduce amygdala hyperreactivity to images of emotional faces? That was the question that posed by the study. So it was a double-blind randomized placebo controlled study and it aimed to address the question whether oxytocin normalizes levels of hyperreactivity to emotional faces in amygdala among people with antisocial personality disorder. Now you can find all the bibliography, all the references in the description and as usual, shockingly, the description is under the video. Get it? Get it? Some of you. Not all. Okay. Now we know that the amygdala is hyperreactive to emotional faces in aggression-prone individuals. Aggression-prone individuals have a problem with the amygdala in situations which involve emotions. Now when administered oxytocin, the situation has changed. The oxytocin seemed to have reduced the signal in aggression-prone individuals, reduced the hyperreactivity that is anger-related. So it seems that oxytocin somehow ameliorated or mitigated not only the anger, but the brain's reaction to anger. While in psychopaths the brain is hyperactive, goes out of control in a way, oxytocin was able to reassert control, re-establish the equivalent of impulse control. The researchers performed functional magnetic resonance imaging, fMRI, after treatment with intranasal synthetic oxytocin and placebo. There was a control group with placebo. And then what they did, after they have administered the intranasal oxytocin, they exposed the test subjects, they exposed them to an emotional classification task. They asked them. They showed them faces and they asked them, is this face angry? Is this face fearful? Is this face happy? And so on and so forth. They found that oxytocin reduced right amygdala hyperactivity to angry faces in participants with antisocial personality disorder. So in the absence of oxytocin, people with antisocial personality disorder react dramatically to anger in other people. When they confront a face with angry people, they become super violent, super aggressive. And oxytocin seemed to have somehow placed this reaction under control by reducing activity in the right side of the amygdala. And the effects were larger in women even. I mean, the effects were even larger in women. And this is a conclusion that women with antisocial personality disorder might benefit from oxytocin treatment for reactive aggression much more than men. First bit of good news, especially in borderline, actually, when borderline switch from borderline self-state to a secondary psychopathic self-state when they decompensate, they are about to act out, become aggressive or violent or reckless. So perhaps an intranasal dose of oxytocin can prevent the disaster from happening and reestablish impulse control. Now, another study tried to correlate antisocial personality disorder in young adults between the ages of 18 and 29 years and the capacity to focus on tasks, focus on an agenda, things to do. Now, this is a bit ironic because psychopathy, one of the defining features of psychopathy is that it is goal oriented. But the psychopath's problem is that while the goal remains fixed and clear and unambiguous and unequivocal, and the psychopath pursues the goal relentlessly and callously and mercilessly, trampling on people, killing people if needed, need be. On the way to obtaining the goal, the psychopath has a problem with managing tasks. He has a problem to break the goal down to a variety of steps and then pursue this algorithm to its end. It's not that psychopaths are not self-efficacious. Psychopaths are actually highly self-efficacious. It's as they have a bit of a problem in some aspects of processing tasks. Adaptive behavior requires the ability to focus on a current task and to protect it from distraction, from other intervening tasks. So adaptive behavior requires not to engage in multitasking, but to focus on a single task. And this is known as cognitive stability, but another requirement is the ability to rapidly switch to another task in light of changing circumstances. So on the one hand, you need to pursue a task without getting distracted, without losing your focus, being able to direct all your attention to obtaining the outcome, the required or desired outcome and so on. So this is cognitive stability. On the other hand, if your environment changes and presents new challenges or even threats, you need to possess the ability to switch from a given task to another task, more conducive to survival and to functioning. And this is known as cognitive flexibility. A truly a well-adopted person possesses both cognitive stability and cognitive flexibility, the ability to shift attention between task sets, between attributes of a stimulus, between responses, between perspectives, between strategies. The best description of best analysis of cognitive flexibility, you can find in the work of Miyaki and Zelazo over the last 20 years. Now, this recent study that I'm reviewing here examined issues of cognitive flexibility across a range of psychiatric disorders in young adults between the ages of 18 and 29. It used a validated computerized trans-diagnostic flexibility paradigm and we will not go into this. The specific measures of interest were total errors, total mistakes on an extra-dimensional task. So the ability to shift between sets of tasks and the shift performance that reflected the ability to move attention away from one stimulus dimension to another stimulus dimension. In short, how alert are you to the environment? When you're pursuing your task, are you then totally blind and oblivious, deaf and dumb and mute, unable to digest, unable to absorb information from the environment, to change and to react to it on the fly? If you have this problem, you have a problem with cognitive flexibility. And some people, for example, people with autism spectrum disorder, have this problem. They're focused on tasks and nothing that's happening around them, nothing distracts them, nothing changes their trajectory. Even if they're put at risk, they would still pursue the task. And so cognitive flexibility is a major hallmark of health. Now remember that the narcissist and the psychopath suffer from cognitive distortions. The narcissist has an impaired reality testing. The psychopath doesn't have an impaired reality testing but he has a cognitive distortion that relates to the world at large. In other words, the psychopath's cognitive distortion has to do with his or her internal working model and theory of mind while the narcissist's cognitive distortion has to do with reality, reality testing. So the narcissist misperceives reality and the psychopath misperceives reality but for very different reasons. The psychopath's misperception of reality doesn't amount to a problem with reality testing because it has to do with the internal features, with the way he perceives other people, with the way he understands society and how it works, with his expectations regarding choices and decisions of other people and so on and so forth. In short, the psychopath is very pessimistic when it comes to other people, assumes the worst, always adheres to the worst-case scenario and allows the worst-case scenario to dictate his decisions and choices. So participants with antisocial personalities demonstrated deficits of small effect size on tasks as well as small effect size deficits for extra dimensional errors. I will explain. These results indicate that deficits in cognitive flexibility are pretty common in antisocial personality disorder but not deficits in cognitive stability and this is exactly what we know about psychopaths. They pursue a goal, they're almost autistic in their pursuit of a goal, they're cognitively stable, they're able to pursue a goal, they're able to design a strategy in order to obtain the goal and then they're able to pursue this strategy efficaciously and this is cognitive stability but their ability to shift away from the goal to say well you know I'm giving up on the goal, I'm moving on, I'm trying something else, I'm attempting something new, their ability to give up on a goal is close to zero. They are like these dogs you know that lock their jaws and never let go, pit bulls or whatever they're called, I mean they just can't let go, they don't have cognitive flexibility, even as the environment around them changes they're still going to pursue the goal so a psychopath would be committing a crime and then there's police all over the place and he would still continue to commit the crime even though there are policemen around they're pointing guns at the psychopath he would still continue to commit the crime even though he had been warned numerous times even though he knows what he's doing might lead to adverse consequences, horrible consequences it nothing matters his goal orientation, his cognitive stability is such that it overpowers his ability to change course to redefine goals to let go, he has no cognitive or little cognitive flexibility and in this study researchers also found that participants with post-traumatic stress disorder PTSD and with depression have elevated total errors on the task with moderate effect sizes so in addition to participants with antisocial personality disorder those with binge eating disorder obsessive-compulsive disorder or CD and generalized anxiety disorder GAD they also showed small effect sizes participants with their aforementioned disorders binge or binge eating GAD PTSD they exhibited deficits with medium effect sizes for extra dimensional errors along with participants with antisocial personality disorder people with depression gambling disorder or CD social anxiety disorder and substance dependence has small effect size deficits and this suggests to translate this to english for you it suggests that cognitive flexibility deficits the inability to change course to react to the environment to adopt these deficits occur across various mental disorders and they may result or lead to substance abuse but it's important to understand that people with antisocial personality disorder are impaired when it comes to cognitive flexibility exactly like people with who are depressed people who are addicted people who are who have OCD people who have social anxiety disorder indeed today we link psychopathy with anxiety and I have videos dedicated to this how actually the psychopath suffers from anxiety disorder and substance dependence antisocial personality disorder therefore when it comes to goal orientation and the pursuit of goals is one of a family of disorders okay how to tackle psychopaths what to do with them when they come to therapy when a narcissist comes to therapy a very common mistake is to treat the narcissist as an adult the therapist attempts um ridiculously the therapist attempts to strike a bargain with the narcissist a therapeutic alliance a contract with another with a narcissist who is four years old you know the attempt to apply adult treatment modalities and the elements of adult treatment modalities such as therapeutic alliance to narcissists is idiotic I have no other words to work for it instead we should use child psychology 100 child psychology with narcissists coupled with trauma therapies because narcissism is a post traumatic condition now child psychology does not have therapeutic agreements or alliances or contracts because children are incapable of contracting and this is the root cause of the failure of all treatment modalities bar none when it comes to narcissists the attempt to treat them with the respect and boundaries which are common among adults they're not adults they're children what about psychopaths how to treat what to do with psychopaths what approach is most recommended or appropriate for patients with antisocial personality disorder and the history of trauma this kind of trauma that causes mistrust hostile attribution biases externalized aggression what do we do with these patients so this is a theory called reciprocal altruism reciprocal altruism it was best described by trivers this is a kind of altruism that occurs between unrelated individuals individuals who are not members of the same family so they don't share the same gene pool the assumption in in reciprocal altruism is that if you're good to me now I'll be I'll be good to you in the future there's a kind of credit system if you do me good if you help me in a time of need I remember this and you will have credit with me and I'll reciprocate when you are in a time of need there will be a kind of repayment or at least a promise of repayment of the altruistic act in the future trivers again described in 1971 now there's there are huge debates about this there's Hamilton Hamilton says we don't need to call it reciprocal altruism we should call call it reciprocity because everything every human relationship has to do with reciprocity every human relationship is transactional I'll not go into all this right now although it's a fascinating topic for a future video but it's one way to approach the treatment of people with anti-social personality disorder but before we go there the problem with anti-social personality disorder is the heterogeneity of the population we slap we slap the diagnosis of anti-social personality disorder on millions of people people in prison chief executive officers surgeons surgeons in hospital I mean they're all anti they're all psychopaths and this is a huge problem because the population is heterogeneous and you can't capture all of it with a single diagnosis add to this the polythetic problem in diagnostic in the diagnostic and statistical manual where only five of nine criteria are enough to diagnose and so consequently you can have two people with the same diagnosis and they share only one one clinical criteria one diagnostic criteria they've nothing else in common they're actually diametrically opposed they have one thing in so so it's a huge mess the diagnostic landscape for anti-social personality is an enormous mess and no wonder there are huge debates about for example in the inclusion of psychopathy in the diagnostic and statistical manual Robert Hare, Babyak and others are advocates of this but the committees of the diagnostic and statistical manual over the last 40 years have rejected this they're not accepting because of the heterogeneity okay there's a recent framework in the study of anti-social personality disorder that uses reciprocal altruism theory and it proposes three pathways along which psychopaths can benefit from different modes of clinical therapy focused on specific behaviors and treatment goals and so on the framework of reciprocal altruism theory therefore allows for heterogeneity incorporates a vast arena of clinical features traits and so on and so forth because it's a generalized theory it's not linked intimately with a single diagnosis but it affords canvas upon which we can paint the various anti-social landscapes so for patients with anti-social personality disorder and a history of trauma that causes mistrust hostile hostile attribution biases externalized aggression there is what is called pathway number one pathway number one includes eye movement desensitization and reprocessing therapy EMDR and EMDR enhances empathy for victims and reduces problem behavior in samples of both youths and adults schema therapy and some forms of cognitive behavior therapy may also be appropriate for this subset of patients with anti-social personality disorder and it's not surprising these are patients who developed anti-social personality disorder because they have been traumatized and they have learned the law wrong lessons about humanity people are evil people are out to get you people will hurt you so they developed defensively compensatory anti-social personality disorder in short their anti-social personality disorder anti-social personality psychopathy which is coupled with trauma is a facade is nothing but a shell an act a theater play it's like it's like trying to frighten people away by saying hey i'm a psychopath don't mess with me so this is this is a veneer it's skin deep and it's much easier to penetrate with techniques such as EMDR and schema therapy and the results there are very promising but there are other groups of anti-social personality disorder as i said it's heterogeneous so other individuals with anti-social personality disorder tend to hyper mentalize they have a problem mentalizing as i said there is a disturbance or an impairment in the theory of mind in a theory about how other people function what makes them tick and in the internal working more in a theory about the world and how you fit into the world these are disrupted in this sub segment or subspecies of psychopaths so these individuals have difficulties with decision making and response inhibition and this is known as pathway 2 these patients benefit from mentalization based treatment it improves their ability to mentalize and recognize their own cognitive states and those of others while reducing hostility and enhancing impulse control dialectical behavior therapy by the way is another intervention that targets emotional instability and impulsivity it may be helpful in reducing aggression both verbal and physical as well as criminal offending especially in secondary psychopathy facto 2 psychopathy and finally there's a third group of psychopaths patients with anti-social personality disorder they have high callous unemotional traits this is pathway 3 they lack they lack empathy or emotional empathy they have called empathy cognitive and and reflexive so there's here there's a problem this is what is colloquially known as primary psychopaths here's a problem because they are no effective interventions that can target underlying in these underlying impairments it's not merely a question of cognitive deficit or cognitive distortion it's also an entire ideology or philosophy of life that is implemented by these people and it is founded on a profound inability to empathize with people not because you cannot mentalize them these psychopaths can mentalize actually and they can actually actually mentalize much better than healthy people this is called empathy but once they have mentalized they have no emotional reaction they mentalize they grasp they understand the state of mind of another person but they have no emotional reaction to it if this is someone's who is said they don't react with sadness or with compassion and so instead they are ruthless they're callous they're unemotional they have no access to emotions and here the recommendation in pathway 3 focuses on risk reduction training and cognitive remediation training to assist patients in more effective coping strategies in short with this group we are we are being transactional in therapy we're being transactional we say to these people listen whatever the case may be we're not going to try to change you because we cannot change you but do you really think it's the best way forward do you really think it's helpful to you do you really think you can guarantee or extricate the best outcomes do you really think you can be self-efficacious this way or are you much more likely to end up in prison is this what you want and so we're able to open their eyes cognitively to the need to reduce risky behaviors by not risky behaviors such as novelty seeking or thrill seeking or recklessness so so we teach them to control impulses and to reduce risky choices and decisions that's the maximum that can be done okay now numerous studies have shown over the decades maybe even the centuries because psychopathy is the oldest diagnosis by the way numerous studies have shown that psychopathy tends to ameliorate and mitigate over the years when the psychopath reaches 40 50 years of age at least psychopathic behaviors if not psychopathic traits psychopathic behaviors diminish they're reduced psychopaths mellow with age they become much more normative they become much more conforming to social mores and conventions norms they become much more accepting of the law and so the law abiding so this happens to psychopaths in their 40s and 50s similar to borderline the same thing happens with borderline it's kind of spontaneous remission uh this has been the the common wisdom but there's been a recent meta-analysis that kind of upended the apple cart or rocked the boat or whatever metaphor suits your mood right now this meta-analysis stated that dimensional rank order stability for anti-social personality disorder criteria was high compared to other personality disorders now what is dimensional rank order stability it is the extent that certain traits are maintained over time simple so this meta-analysis looked at the question are the traits of psychopaths stable over the lifespan are they maintained over time but pay attention not behaviors traits there's a big difference you can maintain the same traits and yet your behavior changes so dramatically that you lose the diagnosis now this is the case with the majority of people with borderline personality disorder beyond the age of 45 they maintain critical traits psychodynamics and other psychological elements of borderline personality disorder but they lose so many behaviors so many behaviors change that they are no it's no longer possible to diagnose them with borderline personality disorder and these are known as subclinical borderlines so the same the same applies to psychopathy known as ever claimed that psychopaths lose the traits of psychopathy they are no longer psychopaths they are suddenly people loving and empathic and amazing and compassionate and affectionate no one made this ridiculous claim of course a psychopath is a psychopath is a psychopath for life the same applies to the narcissists by the way no one makes these claims the claim made in multiple studies regarding the psychopath was a psychopath changes his behaviors when he when he crosses the critical threshold of 40 or 50 years old changes his behaviors become a member a member a member of society let's say sublimates if you wish but his traits remain the same his convictions worldview remains the same his personality style remains the same none of these changes and so these meta-analysis supports this contention it seems that the extent the certain traits were maintained over time was high in antisocial personality disorder even when compared to other personality disorders i'm going to read to you an excerpt from the study from an initial pool of 1473 studies 40 were included in our analysis covering 38432 participants wow so many psychopaths it's worrying 56.7% of them maintain the diagnosis of any personality disorder 45.2% maintain the diagnosis of borderline personality disorder over at least one month not very impressive findings on the dimensional mean level stability indicate that most personality disorder criteria significantly decreased from baseline to follow except for antisocial personality disorder obsessive compulsive personality disorder and schizoid personality disorder criteria so in all other personality disorder there's been a decrease in the expression of traits or in the existence of traits in all other personality disorder this includes narcissistic and borderline from baseline but the exception was the exceptions were antisocial obsessive compulsive and schizoid in these three personality disorders the traits remained relatively stable findings on the dimensional rank order stability suggested moderate estimates except for antisocial personality disorder criteria which were found to be high in other words stable stable over the period of the study of the studies findings indicate that both personality disorders and personality disorder criteria were only moderately stable although between study between study heterogeneity was high and stability self-dependent on several methodological factors okay what about the dimensional mean level stability findings let me translate to english yet again dimensional mean level stability means the extent that absolute personality score levels change over time or don't change over time yes they're stable over time so the dimensional mean level stability the extent again the extent that absolute personality score levels change these studies showed that except for antisocial obsessive compulsive and schizoid personality disorder criteria most other personality disorder criteria and that includes narcissistic and borderline significantly decreased from baseline to follower patients with other personality disorder diagnosis were not much more likely than patients with antisocial personality disorder to maintain their diagnosis in short antisocial schizoid schizoid and obsessive compulsive are the worst they seem to be lifelong the traits don't change ameliorate or mitigate so what to do about all this mess there is a new ray of light schema therapy one of my favorites i'm very much in favor of cbt schema therapy transactional analysis so it's one of my favorites mdr is is efficacious i know this is sufficient but i can't wrap my mind around eye movements i mean it looks to me like witchcraft okay so there was a trial the question was how effective was schema therapy compared with treatment as usual for violent inpatient offenders with antisocial personality disorder violent criminals violent uh psychopath so there was a trial and it aimed to test the comparative long-term effectiveness of schema therapy schema therapy is an evidence-based psychotherapy for personality disorders in general and so they compare schema therapy with treatment as usual for inpatient violent offenders as i said now the patients showed moderate to large improvements in outcomes which is pretty amazing i think it's the first study that i'm aware of that shows any change whatsoever when it comes to violent psychopaths but there's a caveat there violent psychopaths are cunning and sharp they may tailor their reaction they may cheat or deceive the researchers and the therapies as simple as that they may simply put on an act of getting better of changing of reforming they do it all the time in probation boards and parole boards i mean it's everyone knows so i can't really trust these outcomes because they involve psychopaths but it's still not easy to pull to pull off schema therapy was superior to treatment as usual for personality disorder symptoms and rehabilitation and it had a small to moderate advantage in multiple secondary outcomes and in improving traits such as self-regulation and self-control which protect against recidivism schema therapy patients also move through rehabilitation more rapidly and this wraps up this extremely painful episode for me because this video makes the claim that there is hope and i hate i hate to break it to you that there is hope for the treatment of antisocial personality disorder and psychopathy it upends my world it challenges my beliefs and you know now i'm really really depressed there is hope oh god this is really bad okay shoshani i hope you survived this video i haven't and see you next time