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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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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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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“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
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“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.”
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“with 100% of treatment completers achieving sufficient stability to start the DBT PE protocol and 70% completing the full protocol.”
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“In addition, patients showed large improvements in dissociation, trauma-related guilt cognitions, shame, depression, anxiety, and social adjustment.”
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“The treatment was found to be highly acceptable and feasible to implement for a majority of patients”
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“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.”
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Metadata
- 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.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 50
- Issue
- 6
- Pages
- 381-386
- ISSN
- 0005-7967 (ISSN-L)
- 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
- 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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