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Cited by 39Personality Disorders and PsychopathologyPosttraumatic Stress Disorder ResearchPsychotherapy Techniques and Applications

Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions

Open access
Harned, Melanie S., Wilks, Chelsey R., Schmidt, Sara C., Coyle, Trevor N.·2018·Behaviour Research and Therapy
DOI 10.1016/j.brat.2018.02.002PMC PMC5837954
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Abstract

Although functional impairment typically improves during evidence-based psychotherapies (EBPs) for borderline personality disorder (BPD), functional levels often remain suboptimal after treatment. The present pilot study evaluated whether and how integrating PTSD treatment into an EBP for BPD would improve functional outcomes. Participants were 26 women with BPD, PTSD, and recent suicidal and/or self-injurious behavior who were randomized to receive one year of Dialectical Behavior Therapy (DBT) or DBT with the DBT Prolonged Exposure (DBT PE) protocol for PTSD. Five domains of functioning were assessed at 4-month intervals during treatment and at 3-months post-treatment. DBT + DBT PE was superior to DBT in improving global social adjustment, health-related quality of life, and achieving good global functioning, but not interpersonal problems or quality of life. Results of time-lagged mixed effects models indicated that, across both treatments, reductions in PTSD severity significantly predicted subsequent improvement in global social adjustment, global functioning, and health-related quality of life, whereas reductions in post-traumatic cognitions significantly predicted later improvement in all functional outcomes except global social adjustment. These findings provide preliminary evidence supporting the role of change in PTSD severity and trauma-related cognitions as active mechanisms in improving functional outcomes among individuals with BPD and PTSD.

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Crossref · 10.1016/j.brat.2018.02.002

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59 of 59 references verified0 citation errors · 0 not checkable

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  • PTSD was found to improve only when trauma memory processing was initiated.

    “PTSD was found to improve only when trauma memory processing was initiated.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [64]

    The Method > Treatments section says that three participants’ PTSD remitted without targeted treatment and before they initiated DBT PE, which uses exposure and processing of trauma memories. This contradicts the claim that PTSD improved only after trauma memory processing began. Page numbers are not available in our copy. (LLM, conf=0.91)

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  • Almost half (40%) of the DBT + DBT PE recipients did not move beyond Phase 1, and 30% of those who began PE did not complete it.

    “Almost half (40%) of the DBT + DBT PE recipient did not move beyond Phase 1, and 30% of those who began PE did not complete it.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [64]

    The Method > Treatments passage reports that 9 of 17 DBT + DBT PE recipients (52.9%) did not initiate PE, not 40%. It also reports that 6 of the 8 who began PE completed it, meaning 25% did not complete it, not 30%. The passage does not describe non-initiation as remaining in “Phase 1.” (LLM, conf=0.88)

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  • DBT + DBT PE was not associated with significantly greater reductions than DBT alone in PTSD, BPD, or dissociation symptoms or urges to commit suicide or self-harm.

    “Although DBT + DBT PE was associated with higher levels of general well-being than DBT alone, DBT + DBT PE was not associated with significantly greater reductions than DBT alone in PTSD, BPD, or dissociation symptoms or urges to commit suicide or self-harm.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [64]

    The Results section (Time-lagged Prediction of Functional Outcomes; page not available) says the primary outcome study found significantly greater improvement in PTSD severity among patients who completed DBT + DBT PE than among those who completed DBT. That contradicts the claim’s blanket statement about PTSD reductions. This paper does not establish the claimed absence of significant differences in BPD symptoms, dissociation, or suicide and self-harm urges. (LLM, conf=0.86)

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  • Adding PTSD trauma memory processing to DBT had some benefits, but most women receiving that intervention either dropped out or had limited improvement in PTSD or BPD symptoms.

    “Thus, adding PTSD trauma memory processing to DBT had some benefits, but most women receiving that intervention either dropped out or had limited improvement in PTSD or BPD symptoms.”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [64]

    The Method (Treatments; page unavailable) confirms that DBT incorporated trauma-memory processing and that some participants dropped out, but only 4 of 17 assigned to DBT + DBT PE dropped out before exposure began; 6 of the 8 who began exposure completed it. The paper reports benefits, including 80% PTSD remission among those who completed the integrated treatment (introductory passage; page unavailable). It does not support the claim that most recipients dropped out or had limited improvement in PTSD or BPD symptoms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The three most extensively tested approaches to PTSD psychotherapy (EX, CT, and EMDR) have been systematically integrated with DBT.

    “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 [64]

    The Method > Treatments passage (page not provided) says that prolonged exposure was integrated into DBT individual therapy. The paper does not say that cognitive therapy (CT) or EMDR was integrated with DBT, or establish that these are the three most extensively tested approaches. (LLM, conf=0.88)

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Cites

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2 of the 61 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Foa EB Hembree EA Rothbaum BO 2007 Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences New York, NY Oxford University Press
  2. Frisch MB 1994 QOLI: Quality of life inventory: Manual and treatment guide New York, NY Pearson

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Authors
Harned, M. S., Wilks, C. R., Schmidt, S. C., & Coyle, T. N.
Affiliations
University of Washington (US)
Corresponding author
Harned, Melanie S.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2018-04
Volume
103
Pages
53-61
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2018.02.002
PMC
PMC5837954
OpenAlex
W2792631858
Cited by
39
References
61
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 8 · 2019: 2 · 2018: 2
FWCI
5.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (acceptedVersion)
  • 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 › Psychotherapy Techniques and Applications
Keywords
borderline personality disorder, post-traumatic stress disorder, functional outcome, dialectical behavior therapy, PTSD symptom severity, posttraumatic cognitions, social adaptation, health-related quality of life, suicidal behavior, self-harm, therapeutic mechanisms, women
MeSH terms
Dialectical Behavior Therapy, Adolescent, Adult, Behavior Therapy, Borderline Personality Disorder, Female, Humans, Implosive Therapy, Middle Aged, Pilot Projects, Social Adjustment, Stress Disorders, Post-Traumatic, Treatment Outcome, Young Adult, Suicidal Ideation

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