Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;28(5):761-775.
doi: 10.1080/10503307.2016.1252865. Epub 2016 Nov 3.

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

Melanie S Harned  1 , Robert J Gallop  2 , Helen R Valenstein-Mah  1
Affiliations

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

Melanie S Harned et al. Psychother Res. 2018 Sep.

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.

Keywords: Dialectical Behavior Therapy; PTSD; Prolonged Exposure; borderline personality disorder; intentional self-injury.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Average start and end values for each outcome by stage of treatment and treatment group.
Figure 1
Figure 1
Average start and end values for each outcome by stage of treatment and treatment group.
Figure 1
Figure 1
Average start and end values for each outcome by stage of treatment and treatment group.
Figure 1
Figure 1
Average start and end values for each outcome by stage of treatment and treatment group.
See this image and copyright information in PMC

References

    1. Barnow S, Limberg A, Stopsack M, Spitzer C, Grabe HJ, Freyberger HJ, Hamm A. Dissociation and emotion regulation in borderline personality disorder. Psychological Medicine. 2012;42:783–794. - PubMed
    1. Becker CB, Zayfert C, Anderson E. A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy. 2004;42:277–292. - PubMed
    1. Bohus M, Limberger MF, Frank U, Chapman AL, Kühler T, Stieglitz RD. Psychometric properties of the borderline symptom list (BSL) Psychopathology. 2007;40:126–132. - PubMed
    1. Cloitre M, Koenen KC, Cohen LR, Han H. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology. 2002;70:1067–1074. - PubMed
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

Publication types

MeSH terms

LinkOut - more resources