The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder

Abstract

Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre-and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

Psychotherapy for posttraumatic stress disorder in patients with borderline personality disorder: a systematic review and meta-analysis of its efficacy and safety

“…EMDR was studied by our group (Slotema et al, 2019 ) and interpersonal process group therapy also in a single study (Cloitre & Koenen, 2001 ). A combination of EMDR, PE with physical training and psycho-education was offered in one study (De Jongh et al, 2020 ).…”

“…The trauma-focused treatments were offered in an individual setting in the majority of the studies, while seven provided a combination of group and individual therapy (Bohus et al, 2013 ; Clarke et al, 2008 ; Harned et al, 2012 ; Hembree et al, 2004 ; Meyers et al, 2017 ; Steil et al, 2018 ; Walter et al, 2012 ), with one investigating group therapy. In four studies, treatments were delivered in an inpatient setting (Bohus et al, 2013 ; De Jongh et al, 2020 ; Steuwe et al, 2016 ; Walter et al, 2012 ), in one both in an in- and an outpatient setting (Pabst et al, 2014 ), and the other 12 studies all had outpatient settings.…”

“…In seven studies both male and female patients participated (De Jongh et al, 2020 ; Kredlow et al, 2017 ; Meyers et al, 2017 ; Slotema et al, 2019 ; Steuwe et al, 2016 ; Walter et al, 2012 ), with the other studies evaluating treatments in female patients only.…”

“…The following traumas were reported: childhood sexual abuse and other traumas in nine studies (De Jongh et al, 2020 ; Harned et al, 2012 , 2014 ; Hembree et al, 2004 ; Kredlow et al, 2017 ; Slotema et al, 2019 ; Steuwe et al, 2016 ; Walter et al, 2012 ), childhood sexual abuse in three studies (Bohus et al, 2013 ; Cloitre & Koenen, 2001 ; Steil et al, 2018 ), sexual and nonsexual assault in two (Feeny et al, 2002 ; Pabst et al, 2014 ), and military sexual assault, military assault and sexual assault in one, respectively (Clarke et al, 2008 ; Holder et al, 2017 ; Meyers et al, 2017 ).…”

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme

“…The intensive trauma-focused treatment format consisted of two consecutive weeks, with 4 days of treatment each week, in which patients went home for the weekend in between (De Jongh et al, 2020 ; Van Toorenburg et al, 2020 ; Van Woudenberg et al, 2018 ; Voorendonk, Sanches, De Jongh, & Van Minnen, 2019 ; Wagenmans, Van Minnen, Sleijpen, & De Jongh, 2018 ; Zoet, Wagenmans, Van Minnen, & De Jongh, 2018 ). The intensive treatment programme is developed to treat patients suffering from severe PTSD and is specifically designed to reduce the drop-out rates for PTSD patients.…”