Therapies for Antisocial Personality Disorder: CBT, DBT, and Beyond

When you think of Antisocial Personality Disorder (ASPD), you might imagine someone cold, calculating, or even dangerous. The truth, though, is often far more complex - and, for many living with ASPD, far more painful than most realize. It's a disorder marked by patterns of manipulation, deceit, disregard for others, and often a lack of remorse. These behaviors can severely affect not only the individual but also everyone around them.

What makes ASPD especially difficult is that most individuals don’t actively seek help. Many times, therapy is introduced after legal issues, substance misuse, or broken relationships. Still, while ASPD presents significant treatment challenges, there are effective therapeutic approaches—if the individual is willing to engage and if the therapist is equipped with the right tools.

In this blog, we’ll walk through the main therapies that have shown promise for ASPD, including Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), as well as other lesser-known but powerful approaches. We'll also look at how therapy can be adapted for this unique population and where hope lies, even when the odds feel stacked.

What Is Antisocial Personality Disorder?

ASPD is classified under Cluster B personality disorders in the DSM-5. It often shows up as a chronic pattern of:

• Ignoring or violating social norms and rules
• Deceiving or manipulating others for personal gain
• Acting impulsively without regard for consequences
• Showing little guilt or remorse, even when others are harmed
• Difficulty forming genuine, empathetic relationships

ASPD (antisocial personality disorder) often begins in adolescence, typically following a history of conduct disorder. By adulthood, these patterns may solidify - but that doesn't mean they're set in stone.

1. Cognitive Behavioral Therapy (CBT): How It Helps

CBT is one of the most widely used forms of therapy for a range of psychological conditions, and it has some evidence of effectiveness in ASPD. The core idea of CBT is that our thoughts influence our behaviors, and by changing the way we think, we can shift how we act.

In the case of ASPD, individuals often hold deep-rooted beliefs such as:

• 'Everyone lies, so I need to get ahead first'.
• 'People are weak. If I don’t take advantage, someone else will'.
• 'Rules are for fools'.

These distorted thoughts justify harmful or manipulative behavior. CBT gently challenges these beliefs and introduces healthier, more constructive ways to think and respond.

In Practice

CBT with someone who has ASPD may focus on:

• Identifying antisocial thoughts and reframing them
• Building awareness of consequences (not just legal, but emotional and relational)
• Practicing impulse control
• Exploring alternative behaviors and responses in social situations.

It's not a quick fix, and engagement can be slow, especially if the client doesn’t see a problem with their behavior. But with patience and consistency, CBT can reduce criminal behavior, substance abuse, and aggression.

2. Dialectical Behavior Therapy (DBT)

DBT is often associated with Borderline Personality Disorder, but many therapists now use it to treat ASPD, especially when impulsivity and emotional dysregulation are present.

What Makes DBT Different?

DBT isn't just about changing behavior—it also emphasizes validation. It says, 'I understand why you feel that way—but let's find a better way to handle it'. For people with ASPD, this can be surprisingly effective. They're often used to being judged or written off, so a more accepting therapeutic stance may feel new and build trust.

Key Skills Taught in DBT:

• Mindfulness: Becoming aware of one’s emotions and triggers in the moment
• Distress Tolerance: Learning to sit with difficult feelings without lashing out
• Emotion Regulation: Naming and managing emotions that lead to harmful behavior
• Interpersonal Effectiveness: Developing more respectful, assertive ways of relating to others.

Group DBT sessions can be especially useful - they give individuals a chance to test new behaviors in real time and receive feedback.

3. Mentalization-Based Therapy (MBT)

Many people with ASPD struggle to understand what others are thinking or feeling. This leads to poor social decisions and shallow or harmful relationships.

MBT helps by teaching the skill of mentalizing—the ability to reflect on what’s going on in your own mind and in the minds of others.

In a session, a therapist might pause a story and ask, 'What do you think your friend was feeling at that moment?' or 'Why do you think you reacted that way?'

Over time, this helps the client build empathy, perspective-taking, and better social judgment. MBT is more exploratory and less structured than CBT or DBT, but it can make a big impact in helping someone with ASPD connect more meaningfully with others.

4. Schema Therapy

Schema Therapy is especially useful for long-standing personality issues. It focuses on deep, early-rooted beliefs - called schemas - that often develop from unmet emotional needs in childhood.

People with ASPD may have schemas like:

• 'The world is dangerous—I must dominate to survive'.
• 'I'll never be loved, so I'll use others before they use me'.

Schema Therapy helps identify these patterns and develop healthier modes of coping. It’s a more intensive, longer-term therapy, but it works on changing the foundation, not just surface behaviors.

5. Group Therapy & Therapeutic Communities

Group therapy is a powerful tool for individuals with ASPD, especially in settings like correctional facilities or rehab centers. It provides:

• Honest feedback from peers
• A space to see the effects of one’s behavior on others
• A chance to build and test healthier social skills.

Therapeutic communities—structured environments where individuals live, work, and heal together—can be even more transformative. They're based on accountability, shared responsibility, and behavioral reinforcement.

For some, this setting is the first time they truly experience what a healthy community looks like.

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6. Medications: A Supporting Role

While no medication treats ASPD directly, certain symptoms can be managed:

• Mood stabilizers for aggression or impulsivity
• Antidepressants (like SSRIs) for irritability
• Antipsychotics for severe behavioral dysregulation

Medication often supports therapy by reducing barriers to engagement, but it's not a replacement.

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7. The Real Challenge: Engagement

The biggest hurdle in treating ASPD is often getting someone to stay in therapy. Many are mandated by courts or family members. Others come only after a crisis.

To improve engagement, therapists often use Motivational Interviewing at the start—exploring the person’s own goals (like avoiding jail, keeping custody of a child, or staying employed) and connecting therapy to those goals.

Empathy, structure, and boundaries are key. Therapy for ASPD requires a therapist who is firm but nonjudgmental, honest yet compassionate.

Conclusion: Is Change Possible?

Yes, but it’s not quick or easy. Progress with ASPD often comes in small steps: fewer outbursts, better relationships, more accountability. Some clients begin to recognize the emotional cost of their behaviors and choose a different path.

And even if full personality change is rare, harm reduction is a very real and meaningful goal. If someone with ASPD can learn to pause before hurting others, that's a victory. If they can begin to feel empathy or rebuild a relationship, that’s life-changing.

It all starts with the right approach—and a belief that, underneath the defenses, there’s still a human being who wants to be seen and understood.