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

May combine two claims.

Among treatment completers, DBT plus DBT PE patients attended more individual therapy sessions than DBT patients, a non-significant effect (DBT M=41.0, SD=9.3; DBT plus DBT PE M=48.5, SD=11.3; t(9)=1.2, p=.27, g=0.7).

“and among treatment completers (DBT: M=41.0, SD=9.3, DBT + DBT PE: M=48.5, SD=11.3; t(9)=1.2, p=.27, g=0.7).”

May combine two claims.

In the ITT sample, the rate of any NSSI during the study was 68.8% in DBT+DBT PE and 87.5% in DBT.

“In the ITT sample, the rate of any NSSI during the study was 68.8% in DBT + DBT PE and 87.5% in DBT.”

May combine two claims.

Among DBT PE completers, the average number of sessions was 12.7 (SD=2.9, range=9-17) and the average number of trauma memories targeted was 3.0 (SD=1.7, range=1-6).

“Of these, 6 (75%) completed the protocol in an average of 12.7 sessions (SD=2.9, range=9–17) during which an average of 3.0 trauma memories were targeted (SD=1.7, range=1–6).”

May combine two claims.

In the ITT sample, the rate of any suicide attempt during the study was 37.5% in DBT+DBT PE and 50.0% in DBT.

“In the ITT sample, the rate of any suicide attempt during the study was 37.5% in DBT + DBT PE and 50.0% in DBT.”

May combine two claims.

Pre-post changes in suicide attempt frequency were moderate to large in DBT+DBT PE (g's=0.6-0.8) and small in DBT (g's=0.0-0.4).

“Pre-post changes in the frequency of suicide attempts were moderate to large in DBT + DBT PE (g’s=0.6–0.8) and small in DBT (g’s=0.0–0.4).”

May combine two claims.

Among patients who started DBT PE, 2 (25%) were not taking an SSRI and 6 (75%) stayed at a stable SSRI dose during that treatment portion.

“Among patients who started the DBT PE protocol, 2 (25%) were not taking an SSRI and 6 (75%) remained at a stable dose of an SSRI during this portion of the treatment.”

May combine two claims.

There was a significant difference by condition in the pattern of pre-post session change in suicide urges, with suicide urges more likely to decrease after sessions in DBT+DBT PE (29.7% vs 18.2%; χ2(1)=8.0, p<.01) and to remain unchanged after sessions in DBT (76.7% vs 60.3%; χ2(1)=14.1, p<.001).

“Moreover, there was a significant difference in the pattern of pre-post session change in urges to commit suicide by condition, which was accounted for by the fact that suicide urges were more likely to decrease after sessions in DBT + DBT PE (29.7% vs. 18.2%; χ2(1)=8.0, p<.01) and to remain unchanged after sessions in DBT (76.7% vs. 60.3%, χ2(1)=14.1, p<.001).”

May combine two claims.

Treatment expectancies, satisfaction, and completion did not differ by condition.

“Treatment expectancies, satisfaction, and completion did not differ by condition.”

May combine two claims.

DBT plus DBT PE produced larger and more stable PTSD improvements than DBT.

“Compared to DBT, DBT + DBT PE led to larger and more stable improvements in PTSD”

May combine two claims.

Pre- and post-session urges to commit suicide and self-injure were higher and more stable among DBT patients than among DBT+DBT PE patients.

“Pre- and post-session urges to commit suicide and self-injure were higher and more stable among patients in DBT compared to those in DBT + DBT PE (Table 2).”

May combine two claims.

Among the 9 patients who did not start DBT PE, the reasons were dropout (4), PTSD remission without targeted treatment (3), and insufficient stability (2).

“Of the 9 patients that did not start the DBT PE protocol, reasons for not starting included: dropped out of treatment (n=4; 44.4%), PTSD remitted without targeted treatment (n=3; 33.3%), and did not achieve sufficient stability (n=2; 22.2%).”

May combine two claims.

In the DBT+DBT PE condition, 8 of 17 patients (47.1%) began the DBT PE protocol and 9 (52.9%) did not.

“Of the 17 patients in the DBT+DBT PE condition, 8 (47.1%) started the DBT PE protocol and 9 (52.9%) did not.”

May combine two claims.

Excluding that therapist's four patients, completion rates were 71.4% in DBT and 66.7% in DBT plus DBT PE.

“Excluding this therapist’s four patients, the treatment completion rates were: DBT=71.4%, DBT + DBT PE=66.7%.”

May combine two claims.

At intake, 19 patients (73.1%) preferred combined DBT and PE, while 7 (26.9%) preferred DBT only.

“At intake, the majority of patients indicated a preference for a combined DBT and PE treatment (n=19, 73.1%) and the remainder preferred to receive DBT only (n=7, 26.9%).”

May combine two claims.

Reasons for not completing DBT PE were difficulty controlling NSSI (n=1) and unwillingness to continue (n=1).

“Reasons for non-completion included difficulty controlling NSSI (n=1) and unwillingness to continue (n=1).”

May combine two claims.

Therapist treatment expectancies were very positive and did not differ between conditions (DBT: M=5.8, SD=0.9; DBT+DBT PE: M=5.9, SD=0.8; t(82)=0.6, p=.55, g=0.1).

“In addition, therapist treatment expectancies were very positive and did not differ between conditions (DBT: M=5.8, SD=0.9, DBT + DBT PE: M=5.9, SD=0.8, t(82)=0.6, p=.55, g=0.1)”

May combine two claims.

Premature dropout occurred on average at week 19.3 in DBT (SD=9.7) and week 29.3 in DBT plus DBT PE (SD=13.4).

“Premature dropout occurred on average at week 19.3 in DBT (SD=9.7) and 29.3 in DBT + DBT PE (SD=13.4).”

May combine two claims.

Among DBT+DBT PE patients, neither the average intensity nor the pattern of change of pre-post session suicide and self-injury urges differed between DBT and DBT PE protocol sessions.

“Among patients in DBT + DBT PE, neither the average intensity nor the pattern of change of pre-post session urges to commit suicide and self-injure differed between DBT and DBT PE protocol sessions (Table 2).”

May combine two claims.

During follow-up, 91.7% of DBT+DBT PE patients and 100% of DBT patients were abstinent from suicidal behavior.

“During the follow-up period, 91.7% of patients in DBT + DBT PE and 100% of patients in DBT were abstinent from suicidal behavior.”

May combine two claims.

At 3-month follow-up, changes in PTSD severity remained very large in DBT+DBT PE (g's=1.4-1.6) and large in DBT (g's=0.9).

“At 3-month follow-up, changes in PTSD severity remained very large in DBT + DBT PE (g’s=1.4–1.6) and large in DBT (g’s=0.9).”

May combine two claims.

Simple slopes analyses indicated that anxiety decreased significantly in DBT+DBT PE (β=−3.0, t(54)=4.6, p<.0001) but not in DBT (β=−2.0, t(54)=1.9, p=.06).

“In addition, simple slopes analyses indicated that anxiety decreased significantly in DBT + DBT PE (β=−3.0, t(54)=4.6, p<.0001), but not in DBT (β=−2.0, t(54)=1.9, p=.06).”

May combine two claims.

Pre-post changes in NSSI frequency were very large in DBT+DBT PE (g's=1.0-1.1) and large in DBT (g's=0.8).

“Pre-post changes in the frequency of NSSI were very large in DBT + DBT PE (g’s=1.0–1.1) and large in DBT (g’s=0.8).”

May combine two claims.

There was a significant reduction in global severity in DBT+DBT PE (β=−0.3, t(54)=5.1, p<.0001), but only a trend in DBT (β=−0.2, t(54)=2.0, p=.05).

“Similarly, there was a significant reduction in global severity in DBT + DBT PE (β=−0.3, t(54)=5.1, p<.0001), but only a trend in DBT (β=−0.2, t(54)=2.0, p=.05).”

May combine two claims.

Among DBT+DBT PE patients, urges to commit suicide and self-injure rarely increased immediately after exposure tasks (8-11%) and were no more likely to increase after DBT PE sessions (9-10%) than DBT sessions (10-14%).

“Among patients in DBT + DBT PE, urges to commit suicide and self-injure rarely increased immediately after exposure tasks (8–11%) and were no more likely to increase after DBT PE sessions (9–10%) than DBT sessions (10–14%).”

May combine two claims.

A majority of DBT+DBT PE completers (60-100%) showed reliable and clinically significant improvement on each outcome at post-treatment and/or follow-up, compared to 0-20% of DBT completers.

“In addition, a majority of completers in DBT + DBT PE (60–100%) showed reliable and clinically significant improvement on each of these outcomes at post-treatment and/or follow-up, compared to 0–20% of completers in DBT.”

May combine two claims.

At 3-month follow-up, no DBT patients (0%) were in PTSD remission, whereas remission rates remained high in DBT+DBT PE (ITT=50.0%, completers=60.0%).

“At 3-month follow-up, no patients in DBT (0%) were in remission, whereas remission rates remained high in DBT + DBT PE (ITT = 50.0%, completers = 60.0%).”

May combine two claims.

Within-group effect sizes for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global severity were generally very large in DBT+DBT PE (ITT average g=1.2, range=0.4-2.1), particularly among DBT PE protocol completers (average g=2.0, range=0.6-3.9).

“Within-group effect sizes for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global severity were generally very large in DBT + DBT PE (ITT average g=1.2, range=0.4–2.1), particularly among DBT PE protocol completers (average g=2.0, range=0.6–3.9).”

May combine two claims.

At post-treatment, PTSD remission rates were 58.3% (ITT) and 80.0% (completers) in DBT+DBT PE, and 33.3% (ITT) and 40.0% (completers) in DBT.

“At post-treatment, rates of PTSD remission were: DBT + DBT PE (ITT = 58.3%, completers = 80.0%) and DBT (ITT = 33.3%, completers = 40.0%).”

May combine two claims.

At post-treatment, between-group effect sizes for NSSI were small in the ITT sample (g=0.0) and moderate in favor of DBT+DBT PE among treatment completers (g=0.6).

“At post-treatment, between-group effect sizes were small in the ITT sample (g=0.0) and moderate in favor of DBT + DBT PE among treatment completers (g=0.6).”

May combine two claims.

At 3-month follow-up, between-group effect sizes were generally small in the ITT sample (average g=0.3, range=0.0-0.7) and moderate among treatment completers (average g=0.7, range=0.4-1.1).

“At 3-month follow-up, between-group effect sizes were generally small in the ITT sample (average g=0.3, range=0.0–0.7) and moderate among treatment completers (average g=0.7, range=0.4–1.1).”

May combine two claims.

At post-treatment, DBT+DBT PE completers were 1.3 times more likely to show reliable and clinically significant PTSD improvement (80% vs 60%) and 2 times more likely to achieve diagnostic remission (80% vs 40%) than DBT patients.

“At post-treatment, completers in DBT + DBT PE were 1.3 times more likely to report reliable and clinically significant improvement in PTSD (80% vs. 60%) and 2 times more likely to achieve diagnostic remission (80% vs. 40%) than those in DBT.”

May combine two claims.

At post-treatment, a majority of ITT patients had reliably improved and reached normal functioning (DBT+DBT PE=58.3%, DBT=50.0%), and recovery was highest among DBT+DBT PE completers (80%).

“At post-treatment, a majority of patients in the ITT sample had reliably improved and reached a normal level of functioning (i.e., recovered; DBT + DBT PE=58.3%, DBT=50.0%), and recovery was highest among DBT + DBT PE treatment completers (80%).”

May combine two claims.

At 3-month follow-up, the rate of recovery remained unchanged in DBT+DBT PE but decreased to 0% in DBT.

“At 3-month follow-up, the rate of recovery remained unchanged in DBT + DBT PE, but decreased to 0% in DBT.”

May combine two claims.

The rate of PTSD remission among patients who did not receive the DBT PE protocol was 33% in both conditions, comparable to a prior DBT study (35%).

“In general, the rate of PTSD remission among patients who did not receive the DBT PE protocol was 33% in both conditions, a rate comparable to that found in a prior study of DBT (35%; Harned et al., 2008).”

• cites Harned et al., 2008Not checked yet

  Not checked in the free run.

May combine two claims.

In DBT, within-group effect sizes on these secondary outcomes were generally large in the ITT sample (average g=0.9, range=0.3-1.6) and among treatment completers (average g=0.8, range=0.2-1.4).

“In DBT, within-group effect sizes on these secondary outcomes were generally large in both the ITT sample (average g=0.9, range=0.3–1.6) and among treatment completers (average g=0.8, range=0.2–1.4).”

May combine two claims.

At post-treatment, between-group effect sizes in favor of DBT+DBT PE were generally moderate in the ITT sample (average g=0.5, range=0.2-1.0) and very large among treatment completers (average g=1.1, range=0.7-1.4).

“At post-treatment, between-group effect sizes in favor of DBT + DBT PE were generally moderate in the ITT sample (average g=0.5, range=0.2–1.0) and very large among treatment completers (average g=1.1, range=0.7–1.4).”

May combine two claims.

Between-group effect sizes at post-treatment and follow-up were small in the ITT sample (g's=0.0-0.1) and moderate among treatment completers (g's=0.6-0.7).

“Between-group effect sizes at post-treatment and follow-up were small in the ITT sample (g’s=0.0–0.1) and moderate among treatment completers (g’s=0.6–0.7).”

May combine two claims.

Patients in both treatments reported positive treatment expectancies and high satisfaction, and rates of treatment completion did not differ between conditions.

“Specifically, patients in both treatments reported positive treatment expectancies and high satisfaction, and rates of treatment completion did not differ between conditions.”

May combine two claims.

Significant Time x Completer and Condition x Completer interactions were found for trauma-related guilt cognitions, indicating that completers showed significantly greater improvement than non-completers across time, particularly for DBT+DBT PE completers.

“However, significant Time x Completer and Condition x Completer interactions were found for trauma-related guilt cognitions, indicating that completers showed a significantly greater improvement than non-completers across time, and this was particularly true for completers in DBT + DBT PE.”

May combine two claims.

There were very large pre-post changes in PTSD severity in both conditions (g's>1.2), with the largest effect for DBT PE protocol completers (g=2.9).

“There were very large pre-post changes in PTSD severity in both conditions (g’s>1.2), with the largest effect found for DBT PE protocol completers (g=2.9).”

Probably not a substantial claim: may not pass S3 (load-bearing).

People with both borderline personality disorder and PTSD have suicide attempt rates two to five times higher than those with either disorder alone.

“Individuals with both BPD and PTSD are a particularly high risk group, with rates of suicide attempts two and five times higher than individuals with BPD or PTSD alone (Pagura et al., 2010).”

• cites Pagura et al., 2010 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

An RCT found DBT-PTSD superior to a treatment-as-usual waitlist for PTSD, depression, and global functioning, but not for borderline personality disorder severity or dissociation.

“Results indicated that DBT-PTSD was superior to TAU-WL in improving PTSD, depression, and global functioning, but not BPD severity or dissociation”

• cites Bohus et al., 2013 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

About 60% of patients with borderline personality disorder have made multiple suicide attempts.

“More than 70% of BPD patients report a history of multiple episodes and methods of NSSI and 60% report multiple suicide attempts (Zanarini et al., 2008).”

• cites Zanarini et al., 2008Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Early childhood trauma raises the risk of adult trauma in people with borderline personality disorder.

“Early childhood trauma has been implicated in the development of BPD (e.g., Battle et al., 2004; Widom, Czaja, & Paris, 2009) and increases the risk of adult trauma among individuals with BPD (Zanarini et al., 1999).”

• cites Zanarini et al., 1999Not checked yet

  Not checked in the free run.

May combine two claims.

DBT prioritizes intentional self-injury and other behavioral dyscontrol and does not routinely target PTSD.

“DBT prioritizes targeting of intentional self-injury and other forms of behavioral dyscontrol, and does not routinely target PTSD.”

• cites Linehan, 1993aNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A feasibility trial of Narrative Exposure Therapy for PTSD in patients with comorbid borderline personality disorder found a large pre-post reduction in PTSD (g = 0.92).

“Results indicated a large pre-post reduction in PTSD (g = 0.92).”

• cites Pabst et al., 2012Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In clinical samples of people with borderline personality disorder, about half also meet criteria for PTSD.

“Among individuals with BPD, the rate of co-occurring PTSD is approximately 30% in community samples (Grant et al., 2008; Pagura et al., 2010) and 50% in clinical samples (Harned, Rizvi, & Linehan, 2010; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004).”

• cites Harned, Rizvi, & Linehan, 2010Not checked yet

  Not checked in the free run.

• cites Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004Not checked yet

  Not checked in the free run.

May combine two claims.

The efficacy of existing PTSD treatments is unknown for suicidal and self-injuring patients and for people meeting full borderline personality disorder criteria.

“However, the efficacy of existing PTSD treatments for suicidal and self-injuring patients, as well as individuals meeting full diagnostic criteria for BPD, is unknown.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Early childhood trauma has been implicated as contributing to the development of borderline personality disorder.

“Early childhood trauma has been implicated in the development of BPD (e.g., Battle et al., 2004; Widom, Czaja, & Paris, 2009) and increases the risk of adult trauma among individuals with BPD (Zanarini et al., 1999).”

• cites Battle et al., 2004Not checked yet

  Not checked in the free run.

• cites Widom, Czaja, & Paris, 2009Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Over 70% of patients with borderline personality disorder have a history of multiple NSSI episodes and methods.

“More than 70% of BPD patients report a history of multiple episodes and methods of NSSI and 60% report multiple suicide attempts (Zanarini et al., 2008).”

• cites Zanarini et al., 2008Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

In community samples of people with borderline personality disorder, roughly 30% also meet criteria for PTSD.

“Among individuals with BPD, the rate of co-occurring PTSD is approximately 30% in community samples (Grant et al., 2008; Pagura et al., 2010) and 50% in clinical samples (Harned, Rizvi, & Linehan, 2010; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004).”

• cites Grant et al., 2008 sourceNot checked yet

  Not checked in the free run.

• cites Pagura et al., 2010 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Among suicidal and self-injuring patients with borderline personality disorder, PTSD more than doubles the frequency of NSSI.

“In addition, the presence of PTSD more than doubles the frequency of NSSI among suicidal and self-injuring BPD patients (Harned et al., 2010).”

• cites Harned et al., 2010Not checked yet

  Not checked in the free run.

May combine two claims.

PTSD maintains or worsens intentional self-injury in borderline personality disorder, because such behaviors are often triggered by PTSD symptoms and trauma cues.

“PTSD has been found to maintain or exacerbate intentional self-injury in BPD, as these behaviors are often precipitated by PTSD symptoms (e.g., flashbacks, nightmares) and exposure to trauma-related cues (Harned et al., 2010).”

• cites Harned et al., 2010Not checked yet

  Not checked in the free run.

May combine two claims.

The impact of borderline personality disorder treatments on PTSD is limited or unknown, and untreated PTSD may worsen treatment response.

“Taken together, these findings indicate that the impact of BPD treatments on PTSD is either limited or unknown and, when not addressed, PTSD may negatively impact treatment response.”

May combine two claims.

DBT with the DBT PE protocol is feasible, acceptable, and safe to administer.

“DBT with the DBT PE protocol is feasible, acceptable, and safe to administer”

Probably not a substantial claim: may not pass S3 (load-bearing).

Twenty-six participants were consecutively enrolled.

“Participants (n=26) were consecutively enrolled into the study”

May combine two claims.

The pilot RCT randomized participants to DBT plus DBT PE (n=17) or DBT (n=9) with a 2:1 allocation ratio.

“Using a 2:1 allocation ratio, participants were randomized to DBT + DBT PE (n=17) or DBT (n=9).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Patients in DBT were more likely to be married than those in DBT plus DBT PE (44.4% vs. 0%, χ2(1)=8.9, p<.01).

“Patients in DBT were more likely to be married than those in DBT + DBT PE (44.4% vs. 0%, χ2(1)=8.9, p<.01).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two DBT PE sessions per dyad were coded: one pre-exposure session and one imaginal exposure session.

“Two DBT PE protocol sessions were coded per dyad, including one randomly selected session from the pre-exposure sessions (Sessions 1–3) and one randomly selected session from the imaginal exposure sessions (Sessions 4+).”

May combine two claims. The quote only partly states this claim.

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.”

• cites Harned et al., 2012 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One influential subject on the DES-T was excluded from the model; no other influential observations or subjects were found.

“These analyses revealed one influential subject on the DES-T who was excluded from the model; no other influential observations or subjects were found in any model.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Therapists without PE certification attended a one-day DBT PE workshop and received supervision from a certified PE supervisor during their first patient.

“Therapists not certified in PE attended a 1-day workshop on the DBT PE protocol and received supervision from a certified PE supervisor during the administration of the DBT PE protocol with their first patient.”

May combine two claims.

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.”

• cites Harned et al., 2012 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Independent clinical assessors who were blind to treatment condition conducted all assessments.

“All assessments were conducted by independent clinical assessors who were blind to treatment condition.”

Classified as probably not a substantial claim. May combine two claims.

All coders were trained to reliability by approved coders, and reliability checks covered a random 10% of coded sessions.

“All coders were trained to reliability by approved coders of each instrument and reliability checks were conducted on a random selection of 10% of all coded sessions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All therapists had intensive DBT training, and two were certified PE therapists and supervisors.

“All therapists had been intensively trained in DBT and two were certified PE therapists and supervisors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The DBT adherence measure coded a random 10% of all DBT sessions.

“The DBT adherence measure (Linehan & Korslund, 2003) was used to code a random selection of 10% of all DBT sessions for adherence.”

• cites Linehan & Korslund, 2003Not checked yet

  Not checked in the free run.

May combine two claims.

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.”

• cites Harned et al., 2012 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Prior treatments' limitations include excluding patients with acute suicidality or recent serious suicide attempts, using restrictive settings, and targeting only one disorder.

“Although both of these treatments reflect advances toward developing more inclusive interventions to treat PTSD in BPD patients engaging in NSSI, limitations include the exclusion of patients with acute suicidality or recent serious suicide attempts, the use of more restrictive treatment settings (residential and inpatient), and the focus on targeting a single disorder (PTSD).”

Probably not a substantial claim: may not pass S3 (load-bearing).

All study procedures followed IRB-approved procedures.

“All study procedures were conducted in accord with IRB approved procedures.”

May combine two claims.

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”

• cites Harned et al., 2012 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

With 26 participants, 31% assessment attrition, and within-subject correlation of 0.31, power was 64.1% to detect a large effect (d=0.8).

“Given the sample size of 26, an observed attrition from assessments of 31%, and an average within-subject correlation of ρ=0.31, the study had power of 64.1% to detect a large effect (d = 0.8).”

May combine two claims.

On average, therapists in both conditions delivered adherent DBT (M=4.1, SD=0.2, ICC=0.99), and adherence did not differ by condition (t(93)=0.3, p=.80).

“Results indicate that on average therapists in both conditions delivered adherent DBT (M’s=4.1, SD’s=0.2, ICC=0.99) and adherence ratings did not differ by condition (t(93)=0.3, p=.80).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Overall, 17.4% of DBT PE sessions were coded.

“Overall, 17.4% of DBT PE sessions were coded.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Doctoral students and postdoctoral fellows received individual DBT supervision from a licensed professional throughout the study.

“Doctoral students and postdoctoral fellows received individual DBT supervision from a licensed professional throughout their study participation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The PE adherence measure was modified for the DBT PE protocol's changes to standard PE elements.

“The PE adherence measure (Foa, Kushner, Capaldi, & Yadin, 2010) was modified to reflect changes to the standard PE therapy elements and results in a global score ranging from 0 (Very Poor) to 3 (Excellent).”

• cites Foa, Kushner, Capaldi, & Yadin, 2010Not checked yet

  Not checked in the free run.

May combine two claims.

More generally, patients in DBT+DBT PE had superior outcomes across a range of domains compared to DBT, particularly those who completed the DBT PE protocol.

“More generally, patients in DBT + DBT PE had superior outcomes across a range of domains compared to those in DBT, particularly those who completed the DBT PE protocol.”

May combine two claims.

The most common barrier to implementing PTSD treatment in this population appears to be premature dropout from DBT, whereas failure to stabilize was the least common barrier.

“Indeed, the most common barrier to implementing PTSD treatment in this population appears to be premature dropout from DBT, whereas failure to stabilize was the least common barrier.”

May combine two claims.

These findings indicate that providing PTSD treatment to severe BPD patients does not exacerbate, and may even reduce, suicidal and self-injurious urges and behaviors.

“These findings indicate that providing PTSD treatment to severe BPD patients does not exacerbate, and may even reduce, suicidal and self-injurious urges and behaviors.”

May combine two claims.

Dissociation and shame each prospectively predict intentional self-injury in BPD.

“For example, dissociation and shame each prospectively predict intentional self-injury in BPD (Brown, Linehan, Comtois, Murray, & Chapman, 2009; Wedig et al., 2012).”

• cites Brown, Linehan, Comtois, Murray, & Chapman, 2009Not checked yet

  Not checked in the free run.

• cites Wedig et al., 2012Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study had several notable strengths, including selection of a high-risk and highly comorbid sample, evaluation of a novel intervention, and use of a rigorous randomized, controlled design with a strong comparison condition.

“This study had several notable strengths, including the selection of a high-risk and highly comorbid sample, the evaluation of a novel intervention, and the use of a rigorous randomized, controlled design with a strong comparison condition.”

May combine two claims.

Pre- and post-session urges to commit suicide and self-injure were significantly higher among DBT patients than DBT+DBT PE patients, suggesting that integrating PTSD treatment into DBT may actually decrease these urges across treatment as a whole.

“In addition, pre- and post-session urges to commit suicide and self-injure were significantly higher among patients in DBT compared to those in DBT + DBT PE, suggesting that integrating PTSD treatment into DBT may actually decrease urges to engage in these behaviors across treatment as a whole.”

May combine two claims.

Integrating exposure-based PTSD treatment into DBT did not negatively impact treatment acceptability and appears to be the preferred treatment approach.

“Instead, integrating exposure-based PTSD treatment into DBT did not negatively impact treatment acceptability and, in fact, appears to be the preferred treatment approach (Harned, Tkachuck, & Youngberg, 2013).”

• cites Harned, Tkachuck, & Youngberg, 2013Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Given the low power in this study, emphasis was placed on indices of clinical rather than statistical significance.

“Given the low power in this study, emphasis was placed on indices of clinical rather than statistical significance.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Changes in PTSD symptoms account for 80% of changes in depression during PE.

“This is consistent with research showing that changes in PTSD symptoms account for 80% of changes in depression during PE (Aderka, Gillihan, McLean, & Foa, 2013).”

• cites Aderka, Gillihan, McLean, & Foa, 2013Not checked yet

  Not checked in the free run.

May combine two claims.

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.”

• cites Harned et al., 2012 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The primary limitation of this study is the small sample size, which was further complicated by the higher than usual rate of treatment dropout.

“The primary limitation of this study, however, is the small sample size, which was further complicated by the higher than usual rate of treatment dropout.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A limitation is that recruiting specifically for individuals with BPD and PTSD may have resulted in a sample of BPD patients that was more motivated to receive PTSD treatment than may be the case among individuals with BPD and PTSD more generally.

“A limitation of the study is that recruiting specifically for individuals with BPD and PTSD may have resulted in a sample of BPD patients that was more motivated to receive PTSD treatment than may be the case among individuals with BPD and PTSD more generally.”

May combine two claims.

The effects achieved in DBT were less stable, as no patients remained in recovery or remission from PTSD three months after treatment ended, whereas these rates remained high in DBT+DBT PE (50-60%).

“In addition, the effects achieved in DBT were less stable, as no patients remained in recovery or remission from PTSD three months after treatment ended, whereas these rates remained high in DBT + DBT PE (50–60%).”

May combine two claims.

These findings contrast with common clinician concerns that exposure therapy for PTSD is likely to be unacceptable to many patients and may increase their desire to drop out of therapy.

“These findings stand in contrast to common clinician concerns that exposure therapy for PTSD is likely to be unacceptable to many patients and may increase their desire to drop out of therapy (Becker et al., 2004).”

• cites Becker et al., 2004 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

These findings suggest that DBT reduces PTSD severity, but targeted PTSD treatment is likely necessary to reach diagnostic remission.

“These findings suggest that DBT reduces the severity of PTSD, but targeted PTSD treatment is likely to be necessary to reach the level of diagnostic remission.”

May combine two claims.

Both treatments were comparably acceptable and feasible to implement.

“Both treatments were found to be comparably acceptable and feasible to implement.”

May combine two claims.

This reduction is likely accomplished not only by making PTSD treatment contingent on resolution of these behaviors (a motivating factor), but also by reducing PTSD symptoms that may have previously precipitated intentional self-injury.

“This is likely accomplished not only by making PTSD treatment contingent on the resolution of these behaviors (a motivating factor for many patients), but also by reducing the PTSD symptoms that may have previously precipitated intentional self-injury.”