Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder
Open accessAbstract
Secondary analyses were performed on data from two randomized controlled trials of a cognitive behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) in individuals with severe mental illness (SMI) to examine the feasibility, tolerability, and effectiveness for individuals with borderline personality disorder (BPD). In Study 1, 27 participants received CBT or treatment as usual. In Study 2, 55 participants received CBT or a Brief treatment. Feasibility and tolerability of CBT, PTSD symptoms, and other mental health and functional outcomes were examined, with assessments at baseline, post-treatment, and two follow-up time points. CBT was feasible and tolerable in this population. Study 1 participants in CBT improved significantly more in PTSD symptoms, depression, and self-reported physical health. Study 2 participants in both CBT and Brief improved significantly in PTSD symptoms, posttraumatic cognitions, depression, and overall functioning, with those in CBT acquiring significantly more PTSD knowledge, and having marginally significantly greater improvement in PTSD symptoms. CBT for PTSD was feasible and tolerated in individuals with SMI, BPD, and PTSD, and associated with improvements in PTSD symptoms and related outcomes. Prospective research is needed to evaluate CBT in individuals with BPD, including comparing it with staged interventions for this population.
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CBT is viable and correlated with improvements in symptoms and associated results among people with severe mental illness and borderline personality disorder.
“Additionally, research has demonstrated that cognitive-behavioral therapy (CBT) is viable and correlated with ameliorations in symptoms and associated results among people who also suffer from severe mental illness and borderline personality disorder [70].”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [70]
The Abstract and Discussion report that CBT for PTSD was feasible and associated with improvements in PTSD symptoms and related outcomes among participants with severe mental illness, BPD, and PTSD. The citing sentence omits the PTSD condition and could be read as applying the finding to people with severe mental illness and BPD more generally. (LLM, conf=0.84)
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Cognitive Processing Therapy Veteran/Military Version: Therapist's manual: (514742018-001)
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BackgroundMethodComorbidity between Post-Traumatic Stress Disorder and Borderline Personality Disorder: A Review
Frías, Á., & Palma, C. (2015) · Psychopathology · doi:10.1159/000363145 · Cited by 114 · cited 2× · see citing works
“BPD is thus frequently comorbid with posttraumatic stress disorder (PTSD), with the diagnostic overlap reported to be between 33% and 79% (Frías and Palma, 2015).”
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“Although two studies have examined how persons with borderline characteristics fare in conventional CBT for PTSD, they were limited either the lack of a full diagnostic assessment of BPD (Clarke et al., 2008) or by small sample size (Feeny et al., 2002).”
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Preliminary Reliability and Validity of the Clinician-Administered PTSD Scale for Schizophrenia.
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“PTSD severity and diagnosis was assessed by the Clinician Administered PTSD Scale for DSM-IV (CAPS; Blake et al., 1995) for Study 1, and the CAPS for DSM-IV-Schizophrenia version (Gearon et al., 2004) for Study 2.”
MethodEvaluation of a PTSD psychoeducational program for psychiatric inpatients
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MethodTreatment of Posttraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program
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“A more detailed description of the program is provided in Mueser et al. (2009).”
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“A portion of sessions were randomly reviewed for fidelity and adherence; results are reported elsewhere (Lu et al., 2012; Mueser et al., 2008) and generally indicated high fidelity and adherence.”
ResultConnor, K. M., Davidson, J. R. T., Hughes, D. C., Swartz, M. S., Blazer, D. G., & George, L. K. (2002) · Comprehensive Psychiatry · doi:10.1053/comp.2002.29846 · Cited by 33 · cited 1× · see citing works
“Individuals with PTSD and cooccurring BPD have more severe PTSD symptoms than those with PTSD and other comorbid disorders (Bolton et al., 2006), leading to greater impairment, a worse prognosis, and higher healthcare utilization (Connor et al., 2002; Frías and Palma, 2015).”
BackgroundSymptom correlates of posttraumatic stress disorder in clients with borderline personality disorder
Bolton, E. E., Mueser, K. T., & Rosenberg, S. D. (2006) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2005.12.002 · Cited by 30 · see citing works
A brief intervention for posttraumatic stress disorder in persons with a serious mental illness.
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“The 3-session Brief program content was based on the first three sessions of the CBT program (Nishith et al., 2015).”
Method
Flagged first, then by citations
1 of the 44 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
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Cited by
Sorted by citations
Psychological therapies for people with borderline personality disorder
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“Two other studies offered DBT in combination with other trauma-focused interventions (Bohus et al., 2013; Steil et al., 2018), while the efficacy of CBT was explored in three studies (Clarke, Rizvi, & Resick, 2008; Kredlow et al., 2017).”
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“…trials, comprising 27 and 55 patients diagnosed with major depressive disorder, bipolar disorder, schizophrenia spectrum disorder, including BPD (Kredlow et al., 2017, study I and study II; Mueser et al., 2008, 2015), and 39 with borderlinepersonality characteristics (Clarke, Rizvi, & Resick,…”
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“Additionally, research has demonstrated that cognitive-behavioral therapy (CBT) is viable and correlated with ameliorations in symptoms and associated results among people who also suffer from severe mental illness and borderline personality disorder [70].”
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“…CBT for PTSD including PE and cognitive restructuring (McDonagh et al., 2005; Zayfert et al., 2005), CBT for PTSD including CPT and skills training (Kredlow et al., 2017, study 1 and 2), a combination of PE and cognitive therapy for PTSD (Mills et al., 2012), a combination of exposurebased…”
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“…(only one participant, from the control group, needed to be hospitalized because of alcohol abuse, and the dropout rate was lower than in previous studies using trauma-focused psychotherapy, including those with a severe mental illness (about 30%; Kredlow et al., 2017; Slotema et al., 2019).”
ResultPrevalence of borderline personality disorder and its risk factors in female prison inmates in China
Zhu, X.-M., Zhou, J., Chen, C., Peng, W.-L., Li, W., Ungvari, G. S., Ng, C. H., Wang, X.-P., & Xiang, Y. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.065 · Cited by 21 · see citing works
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Effectiveness of Cognitive Processing Therapy for PTSD in serious mental illness
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“The most widespread psychological treatment approaches are Cognitive Behavior Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), both of which were found to be effective in the treatment of PTSD (Gainer et al., 2020; Kredlow et al., 2017).”
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“%) compared to other trauma-focused [4, 46] and PD studies [47, 48] enhances the internal validity of the findings.”
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“The goal of cognitive reconstruction is to ensure that patients recognize dysfunctional thoughts and cognitive biases, elicit reasonable alternative concepts, and reevaluate their views about themselves, their trauma, and the outside world [21].”
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دياب, أ. ع. (2023) · المجلة المصرية للدراسات النفسية · doi:10.21608/ejcj.2023.319760
The Investigation on the Public Awareness and Treatment of Borderline Personality Disorder
Li, X., & Ma, H. (2024) · Lecture Notes in Education Psychology and Public Media · doi:10.54254/2753-7048/33/20231550
Le grand livre du trauma complexe. De l'enfant à l'adulte
Cagnone, V., Dzierzynski, N., & Abgrall-Barbry, G. (2023) · Dunod eBooks · doi:10.3917/dunod.mengi.2023.01.0079
Traumatherapie im Kindes- und Jugendalter
Pfeiffer, E. (2024) · Trauma und Gewalt · doi:10.21706/tg-18-4-276
Snoek, A. (2024) · doi:10.5463/thesis.960
O’Donnell, M., & Links, P. S. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07679-2
“While full-length CBT produced greater reductions in PTSD symptoms and diagnoses, even the brief 3-session version led to meaningful improvements, suggesting that individuals with BPD-PTSD may benefit from non-staged, trauma-focused CBT [22].”
- Authors
- Kredlow, M. A., Szuhany, K. L., Lo, S., Xie, H., Gottlieb, J. D., Rosenberg, S. D., & Mueser, K. T.
- Affiliations
- Boston University (US)
- Dartmouth College (US)
- Corresponding author
- Mueser, Kim T.
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 249
- Pages
- 86-93
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC5325773
- OpenAlex
- W2570086898
- Cited by
- 33
- References
- 44
- Citations by year
- 2025: 5 · 2024: 6 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 6 · 2019: 3 · 2017: 1
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01MH064662, F31MH103969, F31MH100773)
- 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
- cognitive behavioral therapy, post-traumatic stress disorder, borderline personality disorder, severe mental illness, treatment feasibility, treatment tolerability, depression, posttraumatic cognitions, functional outcome, brief psychotherapy
- MeSH terms
- Adult, Mental Disorders, Borderline Personality Disorder, Depression, Feasibility Studies, Female, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome
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