Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

Harned, Melanie S.; Korslund, Kathryn E.; Foa, Edna B.; Linehan, Marsha M.

doi:10.1016/j.brat.2012.02.011

Cited by 288Personality Disorders and PsychopathologyPosttraumatic Stress Disorder ResearchSuicide and Self-Harm Studies

Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

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Harned, Melanie S., Korslund, Kathryn E., Foa, Edna B., Linehan, Marsha M.·2012·Behaviour Research and Therapy

DOI 10.1016/j.brat.2012.02.011PMC PMC3348973

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Abstract

This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n = 13) received one year of DBT with the DBT PE Protocol, plus three months of follow-up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population.

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DBT may not be as effective for anxiety, unless specifically treated with exposure strategies.
“it may not be as effective for anxiety, unless specifically treated with exposure strategies. 37”
From Dialectical behaviour therapy skills training: A feasibility study with active duty military. (2022) · cites this paper as [37]
The Abstract says standard DBT studies had not specifically targeted PTSD and reports a relatively low PTSD remission rate (35%). The Results and Discussion report improvements in PTSD and anxiety with DBT plus prolonged exposure. The paper therefore supports the point for PTSD, but does not establish that DBT alone is less effective for anxiety generally or compare anxiety outcomes with and without exposure. (LLM, conf=0.85)
Experimental — accuracy not yet measured
In that open trial, the treatment was safe, with no evidence of increased intentional self-injury urges or behaviors and low rates of suicide attempts (9.1%) and NSSI (27.3%).
“The treatment was also safe to administer, with no evidence of increased intentional self-injury urges or behaviors and an overall low rate of suicide attempts (9.1%) and NSSI (27.3%) during the study.”
From A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD (2014) · cites this paper as Harned et al., 2012
In that open trial, all treatment completers achieved sufficient stability to start DBT PE and 70% completed the full protocol.
“with 100% of treatment completers achieving sufficient stability to start the DBT PE protocol and 70% completing the full protocol.”
From A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD (2014) · cites this paper as Harned et al., 2012
In that open trial, patients also showed large improvements in dissociation, trauma-related guilt cognitions, shame, depression, anxiety, and social adjustment.
“In addition, patients showed large improvements in dissociation, trauma-related guilt cognitions, shame, depression, anxiety, and social adjustment.”
From A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD (2014) · cites this paper as Harned et al., 2012
In an open trial of 13 women with borderline personality disorder, PTSD, and recent or imminent intentional self-injury, the treatment was highly acceptable and feasible for most patients.
“The treatment was found to be highly acceptable and feasible to implement for a majority of patients”
From A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD (2014) · cites this paper as Harned et al., 2012

These results are consistent with findings of a prior open trial and provide additional evidence that DBT is an effective and reasonably quick stabilizing treatment for the majority of suicidal and self-injuring BPD patients who require PTSD treatment.
“These results are consistent with the findings of the prior open trial (Harned et al., 2012) and provide additional evidence that DBT is an effective and reasonably quick stabilizing treatment for the majority of suicidal and self-injuring BPD patients who require PTSD treatment.”
From A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD (2014) · cites this paper as Harned et al., 2012
An integrated treatment combining standard DBT with the DBT Prolonged Exposure Protocol has been developed and evaluated to address the constellation of symptoms of suicidal and self-injuring clients with BPD and PTSD.
“DBT researchers have developed and evaluated an integrated treatment to address the challenges in treating the constellation of symptoms of suicidal and self-injuring clients with BPD and PTSD (Harned, Korslund, Foa, & Linehan, 2012;Harned, Korslund, & Linehan, in press;Harned & Linehan, 2008).”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Harned, Korslund, Foa, & Linehan, 2012
The integrated DBT-PE treatment is feasible to implement and leads to large and significant improvements in suicidal ideation, NSSI, symptoms of PTSD, dissociation, shame, anxiety, depression, trauma-related guilt cognitions, and global functioning.
“Case studies (Harned & Linehan, 2008), an open trial (Harned, Korslund, Foa, & Linehan, 2012) and more recently, a pilot randomized controlled trial (Harned, Korslund, & Linehan, in press) have suggested that the integrated DBT-PE treatment is feasible to implement and leads to large and significant improvements in suicidal ideation, NSSI, symptoms of PTSD, dissociation, shame, anxiety, depression”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Harned, Korslund, Foa, & Linehan, 2012
Individuals with comorbid PTSD and BPD are significantly more likely to engage in suicidal and self-harming behaviors.
“Notably, individuals with comorbid PTSD and BPD have been reported to be significantly more likely to engage in suicidal and self-harming behaviors (Harned, Korslund, Foa, & Linehan, 2012).”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Harned, Korslund, Foa, & Linehan, 2012

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Authors: Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M.
Affiliations: University of Washington (US)
University of Pennsylvania (US)
Corresponding author: Harned, Melanie S.
ORCID: Harned, Melanie S.
Korslund, Kathryn E.
Foa, Edna B.
Linehan, Marsha M.
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2012-06
Volume: 50
Issue: 6
Pages: 381-386
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2012.02.011
PMC: PMC3348973
OpenAlex: W1974641794
Cited by: 288
References: 43
Citations by year: 2026: 6 · 2025: 10 · 2024: 15 · 2023: 12 · 2022: 23 · 2021: 41 · 2020: 35 · 2019: 37 · 2018: 16 · 2017: 17 · 2016: 14 · 2015: 20 · 2014: 18 · 2013: 20 · 2012: 4
FWCI: 22.55
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R34MH082143)
Topics: Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords: post-traumatic stress disorder, borderline personality disorder, suicidal ideation, self-harm, dialectical behavior therapy, prolonged exposure, integrated treatment, women, trauma-related guilt, dissociation, treatment acceptability, treatment safety
MeSH terms: Adolescent, Adult, Behavior Therapy, Borderline Personality Disorder, Feasibility Studies, Female, Humans, Middle Aged, Pilot Projects, Stress Disorders, Post-Traumatic, Suicide, Attempted, Self-Injurious Behavior, Treatment Outcome, Young Adult, Patient Preference, Suicidal Ideation

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Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

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