Assignment Prompt & Instructions
– ## Module3Discussion.docx
– ## Nur670Module4Discussioninstructions.docx
**## Module3Discussion.docx**
6
**Module 3 Discussion**
Student’s Name
Institutional Affiliation
Professor’s Name
Course Name
Due Date
**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
**## Nur670Module4Discussioninstructions.docx**
All Discussions are based on this 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?_
Module 4 Discussion
[https://www.prisma-statement.org/prisma-2020-flow-diagram](https://www.prisma-statement.org/prisma-2020-flow-diagram)
How to create a PRISMA flow diagram
Dear Students,
To assist you in creating your literature diagram, please utilize the following resource:
[PRISMA Flow Diagram GuideLinks to an external site.](https://guides.lib.unc.edu/prisma). This guide provides step-by-step instructions and templates to help you accurately structure and document your literature review process.
A PRISMA diagram visually maps the flow of information through the different phases of a systematic or literature review. To ensure credibility and academic integrity, your diagram must reflect
**real numbers** based on your database searches, screening, and selection, not estimates or placeholders.
**Quick Guide: Creating a PRISMA Diagram with Actual Numbers**
A PRISMA diagram maps how studies are identified, screened, and selected for your literature review. Use
**real, not estimated** numbers. Follow these key steps:
**1. Search and Record**
· Use multiple databases (e.g., PubMed, CINAHL, PsycINFO).
· Document: search date, keywords, Boolean operators, filters.
· Total records retrieved (e.g., PubMed: 320, CINAHL: 290).
**2. Remove Duplicates**
· Use citation managers (e.g., Zotero, EndNote) to de-duplicate.
· Record how many were removed.
**3. Screening (Title/Abstract)**
· Note how many records were screened and excluded at this level.
**4. Full-Text Review**
· Report how many full-text articles were assessed.
· Exclude with reasons (e.g., wrong population, not peer-reviewed).
**5. Final Inclusion**
· Report number of studies included in:
· Qualitative synthesis
· Quantitative synthesis (if applicable)
**Tips**
· Avoid placeholders—use exact numbers.
· Keep detailed records in case you’re asked to verify.
· All the PRISMA components and the
[official PRISMA templateLinks to an external site.](https://www.prisma-statement.org/prisma-2020-flow-diagram) must be used to receive the full points in the main issues category for this assignment.
Let me know if you'd like a template filled out or help listing exclusion reasons.
**_Creating a Search Strategy_**
After studying
[Module 4: Lecture Materials & Resources](https://stu.instructure.com/courses/47535/pages/module-4-lecture-materials-and-resources), discuss the following:
·
1. Create and upload a
**literature flow diagram using the** [**PRISMA templateLinks to an external site.**](https://www.prisma-statement.org/prisma-2020-flow-diagram)
2. Describe the process used to narrow down the search results to the final number of articles selected for your PICO question.
3. Full points for the main issues section of the rubric will be given for including the reasons for the exclusions in your initial post
4. Inclusion of all the final articles
**is required** in the reference section
**Submission Instructions:**
. Your initial post, question 2, should be at least 250 words, formatted and cited in the current APA style.
. Provide support for your work from at least five academic sources, less than 5 years old. Visit
[Purdue OwlLinks to an external site.](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html) for specific examples on how to create in-text citations and cite references using the current APA format.
. Students will use this PICO question when creating the abstract and academic poster.
. Students may not duplicate the PICO question of another student at St. Thomas University.
. Your initial post is worth 8 points.
. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points. (1 point per response)
. All replies must be constructive and use literature where possible
· our assignment will be graded according to the grading rubric.
| | | | | | |
| — | — | — | — | — | — |
| **Discussion Rubric** |
| **Criteria** | **Ratings** | **Points** |
| Identification of Main Issues, Problems, and Concepts | **Distinguished – 4 points** Post is substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic. | **Excellent – 3 points** Post is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be. | **Fair – 1-2 points** Demonstrates limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given. | **Poor – 0 points** Post is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear. | 4 points |
| APA Formatting Guidelines | **Distinguished – 2 points** The reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Excellent – 1 point** The reference page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Fair – 0.5 points** The reference page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Poor – 0 points** The reference page contains no current scholarly academic resources, only internet web pages, or no reference page. Lack of APA guidelines for references provided or in-text citations. | 2 points |
| Writing Mechanics | **Distinguished – 2 points** Rules of grammar, usage, and punctuation are followed; spelling is correct. | **Excellent – 1 point** Few grammatical errors, but sentences could be clearer and more precise. | **Fair – 0.5 points** The paper contains a few grammatical, punctuation, and spelling errors. | **Poor – 0 points** The paper contains numerous grammatical, punctuation, and spelling errors. | 2 points |
| Response to Posts of Peers | **Distinguished – 2 points** Constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each. | **Fair – 1 point** Constructively responded to one other post and either extended, expanded, or provided a rebuttal. | **Poor – 0 points** Provided no response to a peer's post. | 2 points |
| **Total Points** | **10** |
## image1.png
**## Nur670Module4Discussioninstructions.docx**
All Discussions are based on this 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?_
Module 4 Discussion
[https://www.prisma-statement.org/prisma-2020-flow-diagram](https://www.prisma-statement.org/prisma-2020-flow-diagram)
How to create a PRISMA flow diagram
Dear Students,
To assist you in creating your literature diagram, please utilize the following resource:
[PRISMA Flow Diagram GuideLinks to an external site.](https://guides.lib.unc.edu/prisma). This guide provides step-by-step instructions and templates to help you accurately structure and document your literature review process.
A PRISMA diagram visually maps the flow of information through the different phases of a systematic or literature review. To ensure credibility and academic integrity, your diagram must reflect
**real numbers** based on your database searches, screening, and selection, not estimates or placeholders.
**Quick Guide: Creating a PRISMA Diagram with Actual Numbers**
A PRISMA diagram maps how studies are identified, screened, and selected for your literature review. Use
**real, not estimated** numbers. Follow these key steps:
**1. Search and Record**
· Use multiple databases (e.g., PubMed, CINAHL, PsycINFO).
· Document: search date, keywords, Boolean operators, filters.
· Total records retrieved (e.g., PubMed: 320, CINAHL: 290).
**2. Remove Duplicates**
· Use citation managers (e.g., Zotero, EndNote) to de-duplicate.
· Record how many were removed.
**3. Screening (Title/Abstract)**
· Note how many records were screened and excluded at this level.
**4. Full-Text Review**
· Report how many full-text articles were assessed.
· Exclude with reasons (e.g., wrong population, not peer-reviewed).
**5. Final Inclusion**
· Report number of studies included in:
· Qualitative synthesis
· Quantitative synthesis (if applicable)
**Tips**
· Avoid placeholders—use exact numbers.
· Keep detailed records in case you’re asked to verify.
· All the PRISMA components and the
[official PRISMA templateLinks to an external site.](https://www.prisma-statement.org/prisma-2020-flow-diagram) must be used to receive the full points in the main issues category for this assignment.
Let me know if you'd like a template filled out or help listing exclusion reasons.
**_Creating a Search Strategy_**
After studying
[Module 4: Lecture Materials & Resources](https://stu.instructure.com/courses/47535/pages/module-4-lecture-materials-and-resources), discuss the following:
·
1. Create and upload a
**literature flow diagram using the** [**PRISMA templateLinks to an external site.**](https://www.prisma-statement.org/prisma-2020-flow-diagram)
2. Describe the process used to narrow down the search results to the final number of articles selected for your PICO question.
3. Full points for the main issues section of the rubric will be given for including the reasons for the exclusions in your initial post
4. Inclusion of all the final articles
**is required** in the reference section
**Submission Instructions:**
. Your initial post, question 2, should be at least 250 words, formatted and cited in the current APA style.
. Provide support for your work from at least five academic sources, less than 5 years old. Visit
[Purdue OwlLinks to an external site.](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html) for specific examples on how to create in-text citations and cite references using the current APA format.
. Students will use this PICO question when creating the abstract and academic poster.
. Students may not duplicate the PICO question of another student at St. Thomas University.
. Your initial post is worth 8 points.
. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points. (1 point per response)
. All replies must be constructive and use literature where possible
· our assignment will be graded according to the grading rubric.
| | | | | | |
| — | — | — | — | — | — |
| **Discussion Rubric** |
| **Criteria** | **Ratings** | **Points** |
| Identification of Main Issues, Problems, and Concepts | **Distinguished – 4 points** Post is substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic. | **Excellent – 3 points** Post is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be. | **Fair – 1-2 points** Demonstrates limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given. | **Poor – 0 points** Post is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear. | 4 points |
| APA Formatting Guidelines | **Distinguished – 2 points** The reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Excellent – 1 point** The reference page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Fair – 0.5 points** The reference page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Poor – 0 points** The reference page contains no current scholarly academic resources, only internet web pages, or no reference page. Lack of APA guidelines for references provided or in-text citations. | 2 points |
| Writing Mechanics | **Distinguished – 2 points** Rules of grammar, usage, and punctuation are followed; spelling is correct. | **Excellent – 1 point** Few grammatical errors, but sentences could be clearer and more precise. | **Fair – 0.5 points** The paper contains a few grammatical, punctuation, and spelling errors. | **Poor – 0 points** The paper contains numerous grammatical, punctuation, and spelling errors. | 2 points |
| Response to Posts of Peers | **Distinguished – 2 points** Constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each. | **Fair – 1 point** Constructively responded to one other post and either extended, expanded, or provided a rebuttal. | **Poor – 0 points** Provided no response to a peer's post. | 2 points |
| **Total Points** | **10** |
## image1.png
**## Module3Discussion.docx**
6
**Module 3 Discussion**
Student’s Name
Institutional Affiliation
Professor’s Name
Course Name
Due Date
**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
**## Nur670Module4Discussioninstructions.docx**
All Discussions are based on this 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?_
Module 4 Discussion
[https://www.prisma-statement.org/prisma-2020-flow-diagram](https://www.prisma-statement.org/prisma-2020-flow-diagram)
How to create a PRISMA flow diagram
Dear Students,
To assist you in creating your literature diagram, please utilize the following resource:
[PRISMA Flow Diagram GuideLinks to an external site.](https://guides.lib.unc.edu/prisma). This guide provides step-by-step instructions and templates to help you accurately structure and document your literature review process.
A PRISMA diagram visually maps the flow of information through the different phases of a systematic or literature review. To ensure credibility and academic integrity, your diagram must reflect
**real numbers** based on your database searches, screening, and selection, not estimates or placeholders.
**Quick Guide: Creating a PRISMA Diagram with Actual Numbers**
A PRISMA diagram maps how studies are identified, screened, and selected for your literature review. Use
**real, not estimated** numbers. Follow these key steps:
**1. Search and Record**
· Use multiple databases (e.g., PubMed, CINAHL, PsycINFO).
· Document: search date, keywords, Boolean operators, filters.
· Total records retrieved (e.g., PubMed: 320, CINAHL: 290).
**2. Remove Duplicates**
· Use citation managers (e.g., Zotero, EndNote) to de-duplicate.
· Record how many were removed.
**3. Screening (Title/Abstract)**
· Note how many records were screened and excluded at this level.
**4. Full-Text Review**
· Report how many full-text articles were assessed.
· Exclude with reasons (e.g., wrong population, not peer-reviewed).
**5. Final Inclusion**
· Report number of studies included in:
· Qualitative synthesis
· Quantitative synthesis (if applicable)
**Tips**
· Avoid placeholders—use exact numbers.
· Keep detailed records in case you’re asked to verify.
· All the PRISMA components and the
[official PRISMA templateLinks to an external site.](https://www.prisma-statement.org/prisma-2020-flow-diagram) must be used to receive the full points in the main issues category for this assignment.
Let me know if you'd like a template filled out or help listing exclusion reasons.
**_Creating a Search Strategy_**
After studying
[Module 4: Lecture Materials & Resources](https://stu.instructure.com/courses/47535/pages/module-4-lecture-materials-and-resources), discuss the following:
·
1. Create and upload a
**literature flow diagram using the** [**PRISMA templateLinks to an external site.**](https://www.prisma-statement.org/prisma-2020-flow-diagram)
2. Describe the process used to narrow down the search results to the final number of articles selected for your PICO question.
3. Full points for the main issues section of the rubric will be given for including the reasons for the exclusions in your initial post
4. Inclusion of all the final articles
**is required** in the reference section
**Submission Instructions:**
. Your initial post, question 2, should be at least 250 words, formatted and cited in the current APA style.
. Provide support for your work from at least five academic sources, less than 5 years old. Visit
[Purdue OwlLinks to an external site.](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html) for specific examples on how to create in-text citations and cite references using the current APA format.
. Students will use this PICO question when creating the abstract and academic poster.
. Students may not duplicate the PICO question of another student at St. Thomas University.
. Your initial post is worth 8 points.
. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points. (1 point per response)
. All replies must be constructive and use literature where possible
· our assignment will be graded according to the grading rubric.
| | | | | | |
| — | — | — | — | — | — |
| **Discussion Rubric** |
| **Criteria** | **Ratings** | **Points** |
| Identification of Main Issues, Problems, and Concepts | **Distinguished – 4 points** Post is substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic. | **Excellent – 3 points** Post is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be. | **Fair – 1-2 points** Demonstrates limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given. | **Poor – 0 points** Post is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear. | 4 points |
| APA Formatting Guidelines | **Distinguished – 2 points** The reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Excellent – 1 point** The reference page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Fair – 0.5 points** The reference page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Poor – 0 points** The reference page contains no current scholarly academic resources, only internet web pages, or no reference page. Lack of APA guidelines for references provided or in-text citations. | 2 points |
| Writing Mechanics | **Distinguished – 2 points** Rules of grammar, usage, and punctuation are followed; spelling is correct. | **Excellent – 1 point** Few grammatical errors, but sentences could be clearer and more precise. | **Fair – 0.5 points** The paper contains a few grammatical, punctuation, and spelling errors. | **Poor – 0 points** The paper contains numerous grammatical, punctuation, and spelling errors. | 2 points |
| Response to Posts of Peers | **Distinguished – 2 points** Constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each. | **Fair – 1 point** Constructively responded to one other post and either extended, expanded, or provided a rebuttal. | **Poor – 0 points** Provided no response to a peer's post. | 2 points |
| **Total Points** | **10** |
## image1.png
**## Module3Discussion.docx**
6
**Module 3 Discussion**
Student’s Name
Institutional Affiliation
Professor’s Name
Course Name
Due Date
**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
**## Nur670Module4Discussioninstructions.docx**
All Discussions are based on this 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?_
Module 4 Discussion
[https://www.prisma-statement.org/prisma-2020-flow-diagram](https://www.prisma-statement.org/prisma-2020-flow-diagram)
How to create a PRISMA flow diagram
Dear Students,
To assist you in creating your literature diagram, please utilize the following resource:
[PRISMA Flow Diagram GuideLinks to an external site.](https://guides.lib.unc.edu/prisma). This guide provides step-by-step instructions and templates to help you accurately structure and document your literature review process.
A PRISMA diagram visually maps the flow of information through the different phases of a systematic or literature review. To ensure credibility and academic integrity, your diagram must reflect
**real numbers** based on your database searches, screening, and selection, not estimates or placeholders.
**Quick Guide: Creating a PRISMA Diagram with Actual Numbers**
A PRISMA diagram maps how studies are identified, screened, and selected for your literature review. Use
**real, not estimated** numbers. Follow these key steps:
**1. Search and Record**
· Use multiple databases (e.g., PubMed, CINAHL, PsycINFO).
· Document: search date, keywords, Boolean operators, filters.
· Total records retrieved (e.g., PubMed: 320, CINAHL: 290).
**2. Remove Duplicates**
· Use citation managers (e.g., Zotero, EndNote) to de-duplicate.
· Record how many were removed.
**3. Screening (Title/Abstract)**
· Note how many records were screened and excluded at this level.
**4. Full-Text Review**
· Report how many full-text articles were assessed.
· Exclude with reasons (e.g., wrong population, not peer-reviewed).
**5. Final Inclusion**
· Report number of studies included in:
· Qualitative synthesis
· Quantitative synthesis (if applicable)
**Tips**
· Avoid placeholders—use exact numbers.
· Keep detailed records in case you’re asked to verify.
· All the PRISMA components and the
[official PRISMA templateLinks to an external site.](https://www.prisma-statement.org/prisma-2020-flow-diagram) must be used to receive the full points in the main issues category for this assignment.
Let me know if you'd like a template filled out or help listing exclusion reasons.
**_Creating a Search Strategy_**
After studying
[Module 4: Lecture Materials & Resources](https://stu.instructure.com/courses/47535/pages/module-4-lecture-materials-and-resources), discuss the following:
·
1. Create and upload a
**literature flow diagram using the** [**PRISMA templateLinks to an external site.**](https://www.prisma-statement.org/prisma-2020-flow-diagram)
2. Describe the process used to narrow down the search results to the final number of articles selected for your PICO question.
3. Full points for the main issues section of the rubric will be given for including the reasons for the exclusions in your initial post
4. Inclusion of all the final articles
**is required** in the reference section
**Submission Instructions:**
. Your initial post, question 2, should be at least 250 words, formatted and cited in the current APA style.
. Provide support for your work from at least five academic sources, less than 5 years old. Visit
[Purdue OwlLinks to an external site.](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html) for specific examples on how to create in-text citations and cite references using the current APA format.
. Students will use this PICO question when creating the abstract and academic poster.
. Students may not duplicate the PICO question of another student at St. Thomas University.
. Your initial post is worth 8 points.
. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points. (1 point per response)
. All replies must be constructive and use literature where possible
· our assignment will be graded according to the grading rubric.
| | | | | | |
| — | — | — | — | — | — |
| **Discussion Rubric** |
| **Criteria** | **Ratings** | **Points** |
| Identification of Main Issues, Problems, and Concepts | **Distinguished – 4 points** Post is substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic. | **Excellent – 3 points** Post is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be. | **Fair – 1-2 points** Demonstrates limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given. | **Poor – 0 points** Post is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear. | 4 points |
| APA Formatting Guidelines | **Distinguished – 2 points** The reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Excellent – 1 point** The reference page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Fair – 0.5 points** The reference page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations. | **Poor – 0 points** The reference page contains no current scholarly academic resources, only internet web pages, or no reference page. Lack of APA guidelines for references provided or in-text citations. | 2 points |
| Writing Mechanics | **Distinguished – 2 points** Rules of grammar, usage, and punctuation are followed; spelling is correct. | **Excellent – 1 point** Few grammatical errors, but sentences could be clearer and more precise. | **Fair – 0.5 points** The paper contains a few grammatical, punctuation, and spelling errors. | **Poor – 0 points** The paper contains numerous grammatical, punctuation, and spelling errors. | 2 points |
| Response to Posts of Peers | **Distinguished – 2 points** Constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each. | **Fair – 1 point** Constructively responded to one other post and either extended, expanded, or provided a rebuttal. | **Poor – 0 points** Provided no response to a peer's post. | 2 points |
| **Total Points** | **10** |
## image1.png
– 1
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