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Cited by 30Personality Disorders and PsychopathologySuicide and Self-Harm StudiesPosttraumatic Stress Disorder Research

What changes when? The course of improvement during a stage-based treatment for suicidal and self-injuring women with borderline personality disorder and PTSD

Open access
Harned, Melanie S., Gallop, Robert J., Valenstein-Mah, Helen R.·2018·Psychotherapy Research
DOI 10.1080/10503307.2016.1252865PMC PMC6013413
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Abstract

OBJECTIVE: Dialectical Behavior Therapy (DBT) with the DBT Prolonged Exposure (DBT PE) protocol is an integrated treatment for suicidal and self-injuring individuals with PTSD and borderline personality disorder (BPD) that occurs in three stages: Stage 1 targets behavioral dyscontrol, Stage 2 targets posttraumatic stress disorder (PTSD) via the DBT PE protocol, and Stage 3 addresses remaining problems. We evaluated the course of change in multiple outcomes across these three stages and compared them to changes found in DBT alone. METHOD: Participants were 38 women with BPD, PTSD and recent suicidal and/or non-suicidal self-injury. Data were collected weekly or bi-weekly to assess PTSD, BPD, global well-being, state dissociation, and urges to engage in problem behaviors. RESULTS: In DBT + DBT PE, there was a significant improvement in PTSD in Stage 2 and in PTSD, BPD, and state dissociation in Stage 3. Compared to DBT, DBT + DBT PE led to significantly higher global well-being and moderately, but non-significantly, lower PTSD and BPD in Stages 2 and/or 3. CONCLUSIONS: PTSD does not improve until it is directly targeted and changes in other comorbid problems occur after PTSD is treated. Adding the DBT PE protocol to DBT was associated with improvement rather than worsening of outcomes.

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Crossref · 10.1080/10503307.2016.1252865

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  • DBT + DBT PE was associated with improvement in social adjustment, health-related quality of life, and overall functioning-but only after PTSD symptoms and related cognitions were reduced.

    “DBT + DBT PE also was associated with improvement in social adjustment, health-related quality of life, and overall functioning—but only after PTSD symptoms and related cognitions were reduced [62, 64].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [62]

    The Results (Hypothesis 1 and 2; page unavailable) report PTSD symptom reductions during Stage 2 and higher global well-being with DBT + DBT PE in Stages 2 and 3. The paper does not report improvements in social adjustment, health-related quality of life, or overall functioning, and it does not establish that those outcomes improved only after PTSD-related cognitions were reduced. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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 [62]

    The Results report significant PTSD improvement in Stage 2 and significant PTSD and BPD improvement in Stage 3, supporting the claim that adding trauma processing had benefits. But Methods > Subject Flow and Retention reports that only 1 of 18 women who started DBT PE dropped out and 13 completed it; the paper does not establish that most recipients had limited PTSD or BPD improvement. Page numbers were not available in our copy. (LLM, conf=0.88)

    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 [62]

    The Methods (Treatment Groups; page not supplied) describe a systematic integration of prolonged exposure (EX) with DBT. The passages do not establish that cognitive therapy (CT) or EMDR were integrated with DBT, or that these three approaches are the most extensively tested PTSD psychotherapies. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [62]

  • 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 [62]

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Research works printed but not linked: 1

  1. First MB Spitzer RL Gibbon M Williams JBW 1995 Structured clinical interview for axis I DSM-IV disorders - patient edition (SCID-I/P) New York Biometrics Research Department, NY State Psychiatric Institute

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Authors
Harned, M. S., Gallop, R. J., & Valenstein-Mah, H. R.
Affiliations
  • University of Washington (US)
  • West Chester University (US)
Corresponding author
Harned, Melanie S.
ORCID
Venue
Psychotherapy Research
Publisher
Informa UK Limited
Published
2016-11-03
Volume
28
Issue
5
Pages
761-775
ISSN
  • 1050-3307 (ISSN-L)
  • 1468-4381
DOI
10.1080/10503307.2016.1252865
PMC
PMC6013413
OpenAlex
W2546519430
Cited by
30
References
46
Citations by year
2026: 2 · 2025: 5 · 2024: 6 · 2023: 4 · 2021: 6 · 2020: 2 · 2019: 1 · 2018: 4
FWCI
2.23
Type
journal article
Language
en
Open access
Locations
  • Psychotherapy Research (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 › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
dialectical behavior therapy, borderline personality disorder, post-traumatic stress disorder, suicidal behavior, non-suicidal self-injury, women, treatment phases, state dissociation, global well-being, comorbidities
MeSH terms
Dialectical Behavior Therapy, Adult, Borderline Personality Disorder, Female, Humans, Implosive Therapy, Middle Aged, Outcome and Process Assessment, Health Care, Stress Disorders, Post-Traumatic, Suicide, Attempted, Self-Injurious Behavior, Young Adult

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