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Cited by 44Posttraumatic Stress Disorder ResearchPersonality Disorders and PsychopathologyPsychotherapy Techniques and Applications

A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-Dialectical Behavioural Therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (Sub)clinical borderline personality disorder: study design

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Snoek, Aishah, Beekman, Aartjan T. F., Dekker, Jack, Aarts, Inga, van Grootheest, Gerard, Blankers, Matthijs, Vriend, Chris, van den Heuvel, Odile +1 more·2020·BMC Psychiatry
DOI 10.1186/s12888-020-02713-xPMC PMC7409691
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Abstract

Background: Comorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments – such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment. Method: A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR-DBT ( n = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples. Discussion: This is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry. Trial registration: Clinical Trials, NCT03833453 . Retrospectively registered, 15 March 2019.

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  • 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 [157]

    The Background (page not provided) reports DBT integrations with prolonged exposure and trauma-focused cognitive-behavioural approaches. The Methods describe a planned integrated EMDR-DBT intervention. The paper does not identify EX, CT, and EMDR as the three most extensively tested PTSD psychotherapies, and it describes the EMDR integration as a study design rather than an established treatment result. (LLM, conf=0.84)

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Authors
Snoek, A., Beekman, A. T. F., Dekker, J., Aarts, I., van Grootheest, G., Blankers, M., Vriend, C., van den Heuvel, O., & Thomaes, K.
Affiliations
  • Arkin (NL)
  • Amsterdam Neuroscience (NL)
  • Trimbos Institute (NL)
Corresponding author
Snoek, Aishah
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2020-08-06
Volume
20
Issue
1
Pages
396-396
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-020-02713-x
PMC
PMC7409691
OpenAlex
W3047526489
Cited by
44
References
30
Citations by year
2026: 5 · 2025: 11 · 2024: 15 · 2023: 5 · 2022: 1 · 2021: 7
FWCI
1.30
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (acceptedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Stichting Steunfonds Joodse Geestelijke Gezondheidszorg
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
post-traumatic stress disorder, borderline personality disorder, EMDR, dialectical behavior therapy, comorbidities, predictors of treatment response, hair cortisol, FKBP5, brain-derived neurotrophic factor, DNA methylation, precision psychiatry, cost-effectiveness
MeSH terms
Dialectical Behavior Therapy, Adult, Borderline Personality Disorder, Cost-Benefit Analysis, Eye Movements, Humans, Stress Disorders, Post-Traumatic, Randomized Controlled Trials as Topic, Treatment Outcome, Eye Movement Desensitization Reprocessing

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