Inclusion/Exclusion Criteria and Literature Search for PICO Question

PICO Question: In adults diagnosed with Histrionic Personality Disorder receiving outpatient psychiatric care, how does Cognitive Behavioral Therapy, compared to Psychodynamic Psychotherapy affect emotional regulation?

This PICO question required a systematic search and selection of evidence-based research. Identification of inclusion and exclusion criteria, database selection, search keywords, and Boolean operators, and filters to reduce results to relevant and high-quality sources were required. This study sought Level 1 and 2 evidence from U.S.-based research on Cognitive Behavioral Therapy (CBT) and Psychodynamic Psychotherapy for adults with Histrionic Personality Disorder (HPD).

Inclusion and Exclusion Criteria and Search Strategy

The inclusion and exclusion criteria helped narrow the search to ensure the literature evaluated met the PICO question. The following table lists database searches:

Database Searched

Search Terms / Keywords

Boolean Operators Used

Limits / Filters Applied

Number of Results Found

PubMed

“Histrionic Personality Disorder” AND “Cognitive Behavioral Therapy” AND “emotional regulation”

AND

English; last 5 years; human subjects; adults (18+); United States only

34

PsycINFO

“Histrionic Personality Disorder” OR “Cluster B disorders” AND “CBT” AND “psychodynamic psychotherapy”

OR, AND

Peer-reviewed; last 5 years; U.S.-based studies; English; adults; outpatient setting

27

CINAHL

“Cognitive Behavioral Therapy” AND “Psychodynamic” AND “emotional regulation” AND “Histrionic”

AND

Adults; academic journals; English; United States; published in past 5 years

19

Cochrane Library

“Histrionic Personality Disorder” AND “CBT” OR “psychodynamic therapy”

AND, OR

U.S. studies; systematic reviews; randomized controlled trials; last 5 years

6

The inclusion criteria were as follows:

· Studies published within the last 5 years (to ensure current relevance)

· Peer-reviewed articles from U.S.-based journals or with authors affiliated with U.S. institutions

· English-language studies

· Human subjects aged 18 and older (adults)

· Research conducted in outpatient psychiatric settings

· Studies that directly compare Cognitive Behavioral Therapy and Psychodynamic Psychotherapy or evaluate either intervention’s impact on emotional regulation in patients with Histrionic Personality Disorder

· Level 1 (randomized controlled trials, systematic reviews/meta-analyses) or Level 2 (quasi-experimental, cohort studies) research according to the hierarchy of evidence

The exclusion criteria included:

· Non-U.S.-based research

· Studies conducted in inpatient, forensic, or residential settings

· Articles not available in full text

· Studies involving minors or mixed-age samples without subgroup analysis for adults

· Non-peer-reviewed sources such as editorials, opinion pieces, dissertations, or commentaries

· Research addressing personality disorders other than HPD unless HPD was distinctly analyzed as a subgroup

Database Search Process and Rationale

The first database reviewed was PubMed, a trusted medical resource. Search terms included “Histrionic Personality Disorder,” “Cognitive Behavioral Therapy,” and “emotional regulation.” All PICO question attributes were captured by “AND” operators. Filters limited results to English-language, adult, human, and five-year research. The initial search yielded 34 items. U.S. samples and research relevance were filtered from this pool.

PsycINFO was utilized next since it focuses on psychological and behavioral sciences relevant to HPD and psychotherapy. “Cluster B disorders” and “histrionic personality disorder” were included to maintain specificity. Included were “CBT,” “psychodynamic psychotherapy,” and “emotional regulation.” The Boolean operators “OR” and “AND” were used to extend the search (“HPD OR Cluster B” and “CBT AND psychodynamic psychotherapy”). U.S. research, peer-reviewed publications, and adult outpatient populations were screened. Many of the 27 papers retrieved in this search offered crucial HPD or population treatment information.

Our third database search was CINAHL. Nursing and allied health publications provided a unique perspective. Search terms included “Cognitive Behavioral Therapy,” “Psychodynamic,” “emotional regulation,” and “Histrionic.” “AND” operators covered all key themes. English, U.S. research, academic publications, and adult outpatient care were few. The search yielded 19 results. After reviewing the abstracts, we excluded publications that contained HPD-free or Cluster B data without subgroup findings. The Cochrane Library was searched for RCTs and systematic reviews. Cochrane includes global research, but filters and human selection confine it to U.S.-based or written studies. Search terms included “Histrionic Personality Disorder,” “CBT,” and “psychodynamic therapy.” The analysis included Level 1 evidence and formal reviews that utilized Boolean operators “AND” and “OR,” along with specific filters. Two high-quality systematic reviews met the inclusion criteria and synthesized the literature, but only six findings were discovered.

Reflections on the Process

The exhaustive search required regular refinement to avoid irrelevant or non-U.S. research. Histrionic Personality Disorder is understudied compared to Cluster B illnesses like Borderline or Narcissistic Personality Disorder, making it hard to locate studies (French & Shrestha, 2020; Lilliengren, 2023). To address this, the term “Cluster B” was used as an inclusive search term; however, studies without HPD disaggregation were excluded unless they provided relevant patient data (Chapman et al., 2024). Another issue was that CBT and psychodynamic treatment overlapped in personality disorder research (Leichsenring et al., 2024). If the methodology enabled comparison or emotional regulation effects were characterized and attributed to one modality, CBT and psychodynamic therapy were included (Kaluzeviciute‐Moreton & Lloyd, 2024). Studies were examined utilizing the hierarchy of evidence throughout the search (Voytenko & Huprich, 2025). Following randomized controlled trials, quasi-experimental and prospective cohort research were conducted. Level 1 evidence included comprehensive reviews of several high-quality U.S. studies.

References

Chapman, J., Jamil, R. T., & Fleisher, C. (2024). Borderline personality disorder. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/

French, J. H., & Shrestha, S. (2020). Histrionic personality disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542325/

Kaluzeviciute‐Moreton, G., & Lloyd, C. (2024). “Meeting the client where they are rather than where i’m at”: A qualitative survey exploring CBT and psychodynamic therapist perceptions of psychotherapy integration. British Journal of Psychotherapy, 40(2). https://doi.org/10.1111/bjp.12894

Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry, 23(1), 4–25. https://doi.org/10.1002/wps.21156

Lilliengren, P. (2023). A comprehensive overview of randomized controlled trials of psychodynamic psychotherapies. Psychoanalytic Psychotherapy, 37(2), 117–140. https://doi.org/10.1080/02668734.2023.2197617

Voytenko, V. L., & Huprich, S. K. (2025). Treatment-resistant depression and personality disorders: An update on conceptualization, assessment, and evidence-based psychodynamic approaches. Psychoanalytic Psychology, 42(1), 1–8. https://doi.org/10.1037/pap0000521

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.