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Cited by 64Posttraumatic Stress Disorder ResearchPersonality Disorders and PsychopathologyPsychotherapy Techniques and Applications

Does adding the dialectical behavior therapy prolonged exposure (DBT PE) protocol for PTSD to DBT improve outcomes in public mental health settings? A pilot nonrandomized effectiveness trial with benchmarking

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Harned, Melanie S., Schmidt, Sara C., Korslund, Kathryn E., Gallop, Robert J.·2021·Behavior Therapy
DOI 10.1016/j.beth.2020.08.003PMC PMC8124086
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Abstract

The Dialectical Behavior Therapy Prolonged Exposure (DBT PE) protocol improves DBT's effects on PTSD in research settings, but its effectiveness in community settings is largely unknown. This pilot nonrandomized controlled trial examined DBT with and without DBT PE in four public mental health agencies. Patients (N = 35, 12-56 years old, 80.0% female, 64.7% racial/ethnic minorities, 44.1% sexual minorities) had PTSD, were receiving DBT, and completed assessments every four months over one year. Sixteen patients (45.7%) initiated DBT PE, 19 (54.3%) did not, and dropout did not differ between groups (31.3% vs. 26.3%). The primary barrier to initiating DBT PE was clinician turnover (57.9% of non-initiators). After adjusting for confounds, DBT PE initiators (g = 1.1) and completers (g = 1.4) showed a greater reduction in PTSD than patients who received DBT only (g = 0.5; p's < .05). Rates of reliable improvement in PTSD were 71.4% (DBT PE completers), 53.8% (DBT PE initiators), and 31.3% (DBT). Similar patterns were observed for posttraumatic cognitions, emotion dysregulation, general psychological distress, and limited activity days. There was no worsening of self-injurious behavior or crisis service use among patients who received DBT PE. Benchmarking analyses indicated comparable feasibility, acceptability, and safety, but a smaller magnitude of clinical change, than in efficacy studies. Results require replication in a randomized trial but suggest that DBT PE can be transported effectively to community settings.

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Research works printed but not linked: 3

  1. Derogatis LR (1993). Brief Symptom Inventory: Administration, scoring, and procedures manual. Bloomington, MN: Pearson.
  2. Foa EB, Hembree EA, Rothbaum BO, & Rauch SAM (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences (2nd ed). NY: Oxford University Press.
  3. Verbeke G, & Molenberghs G (2000). Linear Mixed models for Longitudinal Data. NY: Springer.

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Authors
Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gallop, R. J.
Affiliations
  • University of Washington (US)
  • Bellevue Hospital Center (US)
  • West Chester University (US)
Corresponding author
Harned, Melanie S.
ORCID
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2021-05
Volume
52
Issue
3
Pages
639-655
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2020.08.003
PMC
PMC8124086
OpenAlex
W3081936355
Cited by
64
References
47
Citations by year
2026: 10 · 2025: 16 · 2024: 15 · 2023: 12 · 2022: 5 · 2021: 5 · 2020: 1
FWCI
2.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
dialectical behavior therapy, prolonged exposure, post-traumatic stress disorder, community mental health services, treatment effectiveness, benchmarking, clinician turnover, emotional dysregulation, posttraumatic cognitions, psychological distress, self-harm, treatment feasibility and acceptability
MeSH terms
Dialectical Behavior Therapy, Adolescent, Adult, Behavior Therapy, Borderline Personality Disorder, Child, Female, Humans, Male, Mental Health, Middle Aged, Stress Disorders, Post-Traumatic, Treatment Outcome, Benchmarking, Young Adult

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