Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial

Abstract

Background: Post-traumatic stress disorder (PTSD) with co-occurring severe psychopathology such as borderline personality disorder (BPD) is a frequent sequel of childhood sexual abuse (CSA). CSA-related PTSD has been effectively treated through cognitive-behavioural treatments, but it remains unclear whether success can be achieved in patients with co-occurring BPD. The aim of the present study was to determine the efficacy of a newly developed modular treatment programme (DBT-PTSD) that combines principles of dialectical behaviour therapy (DBT) and trauma-focused interventions. Methods: Female patients (n = 74) with CSA-related PTSD were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. About half of the participants met the criteria for co-occurring BPD. Individuals with ongoing self-harm were not excluded. The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale (CAPS) and by the Posttraumatic Stress Diagnostic Scale (PDS). Hierarchical linear models were used to compare improvements across treatment groups. Assessments were carried out by blinded raters at admission, at end of treatment, and at 6 and 12 weeks post-treatment. Results: Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS (33.16 vs. 2.08) and the PDS (0.70 vs. 0.14). Between-group effect sizes were large and highly significant. Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome. Safety analyses indicated no increase in dysfunctional behaviours during the trial. Conclusion: DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

“…Although the response rate we obtained (71%) was comparable to the average rate of 60% found in a systematic review (Loerinc et al, 2015), as well as to the response rates of studies with patient populations comparable to ours based on trauma characteristics (Bohus et al, 2013; Cloitre et al, 2010; Schnurr et al, 2007), not all participants improved to the same degree. Our cluster analyses revealed four distinct trajectories based on change patterns: Fast, Slow, Partial, and Non-responders.…”

Dialectical behaviour therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study in an outpatient treatment setting

“…It is based on the principles and methods of Dialectical Behaviour Therapy (DBT; Linehan, 1993) and integrates trauma-focused cognitive and exposure-based interventions (Bohus et al, 2013; Steil et al, 2011). The DBT-PTSD programme follows the DBT hierarchy of treatment targets, which prioritizes life-threatening behaviours, such as suicide attempts, and treatment-interfering behaviours, such as dissociation, over addressing problems reducing quality of life, such as sexual problems.…”

“…However, treatments for CSA-related PTSD are scarce and are less effective than those for PTSD following other traumas (Ehring et al, 2014), especially in patients with more complex symptomatology (Dorrepaal et al, 2014). There is a lack of established, evidenced-based treatments tailored to the needs of these patients (Bohus et al, 2013; Priebe et al, 2012). …”

“…In the two trials completed thus far, inpatient DBT-PTSD has demonstrated efficacy (Bohus et al, 2013; Steil et al, 2011). Compared to the usual treatment, DBT-PTSD was significantly superior in reducing PTSD symptoms, with large between-group effect sizes.…”

“…Compared to the usual treatment, DBT-PTSD was significantly superior in reducing PTSD symptoms, with large between-group effect sizes. Neither a diagnosis of BPD nor BPD symptom severity was significantly related to treatment outcome (Bohus et al, 2013). …”