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Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial
Open accessAbstract
Importance: Childhood abuse significantly increases the risk of developing posttraumatic stress disorder (PTSD), often accompanied by symptoms of borderline personality disorder (BPD) and other co-occurring mental disorders. Despite the high prevalence, systematic evaluations of evidence-based treatments for PTSD after childhood abuse are sparse. Objective: To compare the efficacy of dialectical behavior therapy for PTSD (DBT-PTSD), a new, specifically designed, phase-based treatment program, against that of cognitive processing therapy (CPT), one of the best empirically supported treatments for PTSD. Design, Setting, and Participants: From January 2014 to October 2016, women who sought treatment were included in a multicenter randomized clinical trial with blinded outcome assessments at 3 German university outpatient clinics. The participants were prospectively observed for 15 months. Women with childhood abuse-associated PTSD who additionally met 3 or more DSM-5 criteria for BPD, including affective instability, were included. Data analysis took place from October 2018 to December 2019. Interventions: Participants received equal dosages and frequencies of DBT-PTSD or CPT, up to 45 individual sessions within 1 year and 3 additional sessions during the following 3 months. Main Outcomes and Measures: The predefined primary outcome was the course of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score from randomization to month 15. Intent-to-treat analyses based on dimensional CAPS-5 scores were complemented by categorical outcome measures assessing symptomatic remission, reliable improvement, and reliable recovery. Results: Of 955 consecutive individuals assessed for eligibility, 193 were randomized (DBT-PTSD, 98; CPT, 95; mean [SD] age, 36.3 [11.1] years) and included in the intent-to-treat analyses. Analysis revealed significantly improved CAPS-5 scores in both groups (effect sizes: DBT-PTSD: d, 1.35; CPT: d, 0.98) and a small but statistically significant superiority of DBT-PTSD (group difference: 4.82 [95% CI, 0.67-8.96]; P = .02; d, 0.33). Compared with the CPT group, participants in the DBT-PTSD group were less likely to drop out early (37 [39.0%] vs 25 [25.5%]; P = .046) and had higher rates of symptomatic remission (35 [40.7%] vs 52 [58.4%]; P = .02), reliable improvement (53 [55.8%] vs 73 [74.5%]; P = .006), and reliable recovery (34 [38.6%] vs 52 [57.1%]; P = .01). Conclusions and Relevance: These findings support the efficacy of DBT-PTSD and CPT in the treatment of women with childhood abuse-associated complex PTSD. Results pertaining to the primary outcomes favored DBT-PTSD. The study shows that even severe childhood abuse-associated PTSD with emotion dysregulation can be treated efficaciously. Trial Registration: German Clinical Trials Register: DRKS00005578.
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“Both treatments resulted in reductions in PTSD symptoms, but those improvements and PTSD remission and reliable change were greater in DBT-PTSD and only DBT-PTSD resulted in reduced dissociation, depression, and BPD symptoms.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [9]
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“Thus, the three most extensively tested approaches to PTSD psychotherapy (EX, CT, and EMDR) have been systematically integrated with DBT.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [9]
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“Mindfulness and acceptance-based approaches have shown promise as alternative interventions to trauma-focused therapies for PTSD.”
From Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial (2024) · cites this paper as Borhus et al., 2020
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“Both treatments resulted in reductions in PTSD symptoms, but those improvements and PTSD remission and reliable change were greater in DBT-PTSD and only DBT-PTSD resulted in reduced dissociation, depression, and BPD symptoms.”
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“Both treatments resulted in reductions in PTSD symptoms, but those improvements and PTSD remission and reliable change were greater in DBT-PTSD and only DBT-PTSD resulted in reduced dissociation, depression, and BPD symptoms.”
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“Significantly fewer women dropped out prematurely from DBT-PTSD (25.5%) and CPT (39%).”
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Metadata
- Authors
- Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K.
- Affiliations
- Harvard University (US)
- Heidelberg University (DE)
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
- Goethe University Frankfurt (DE)
- Humboldt-Universität zu Berlin (DE)
- Duke Medical Center (US)
- AWP Berlin, Berlin, Germany
- Corresponding author
- Bohus, Martin
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2020-12-01
- Volume
- 77
- Issue
- 12
- Pages
- 1235
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC7376475
- OpenAlex
- W3044324912
- Cited by
- 265
- References
- 67
- Citations by year
- 2026: 53 · 2025: 46 · 2024: 47 · 2023: 38 · 2022: 43 · 2021: 33 · 2020: 5
- FWCI
- 11.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Bildung und Forschung (01KR1303A, BMBF 01KR1303A, grant BMBF 01KR1303A)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, cognitive processing therapy, childhood abuse, women, borderline personality disorder, comorbid mental disorders, treatment efficacy, symptom remission, CAPS-5, individual psychotherapy, trauma-focused psychotherapy, neuroticism, women's mental health services, Germany, United States
- MeSH terms
- Adverse Childhood Experiences, Dialectical Behavior Therapy, Adult, Female, Humans, Middle Aged, Remission Induction, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Adult Survivors of Child Abuse, Young Adult, Patient Acuity
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