Melanie S Harned1, Kathryn E Korslund2, Marsha M Linehan2. 1. Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA. Electronic address: mharned@u.washington.edu. 2. Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA.
Abstract
OBJECTIVE: This study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury. METHODS: Participants were randomized to DBT (n=9) or DBT with the DBT Prolonged Exposure (DBT PE) protocol (n=17) and assessed at 4-month intervals during the treatment year and 3-months post-treatment. RESULTS:Treatment expectancies, satisfaction, and completion did not differ by condition. In DBT+DBT PE, the DBT PE protocol was feasible to implement for a majority of treatment completers. Compared to DBT, DBT+DBT PE led to larger and more stable improvements in PTSD and doubled the remission rate among treatment completers (80% vs. 40%). Patients who completed the DBT PE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT. Among treatment completers, moderate to large effect sizes favored DBT+DBT PE for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global functioning. CONCLUSIONS:DBT with the DBT PE protocol is feasible, acceptable, and safe to administer, and may lead to larger improvements in PTSD, intentional self-injury, and other outcomes than DBT alone. The findings require replication in a larger sample.
RCT Entities:
OBJECTIVE: This study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury. METHODS:Participants were randomized to DBT (n=9) or DBT with the DBT Prolonged Exposure (DBTPE) protocol (n=17) and assessed at 4-month intervals during the treatment year and 3-months post-treatment. RESULTS: Treatment expectancies, satisfaction, and completion did not differ by condition. In DBT+DBT PE, the DBTPE protocol was feasible to implement for a majority of treatment completers. Compared to DBT, DBT+DBT PE led to larger and more stable improvements in PTSD and doubled the remission rate among treatment completers (80% vs. 40%). Patients who completed the DBTPE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT. Among treatment completers, moderate to large effect sizes favored DBT+DBT PE for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global functioning. CONCLUSIONS:DBT with the DBTPE protocol is feasible, acceptable, and safe to administer, and may lead to larger improvements in PTSD, intentional self-injury, and other outcomes than DBT alone. The findings require replication in a larger sample.
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