A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD

Objective: This study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury. Methods: Participants were randomized to DBT (n = 9) or DBT with the DBT Prolonged Exposure (DBT PE) protocol (n = 17) and assessed at 4-month intervals during the treatment year and 3-months post-treatment. Results: Treatment expectancies, satisfaction, and completion did not differ by condition. In DBT + DBT PE, the DBT PE protocol was feasible to implement for a majority of treatment completers. Compared to DBT, DBT + DBT PE led to larger and more stable improvements in PTSD and doubled the remission rate among treatment completers (80% vs. 40%). Patients who completed the DBT PE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT. Among treatment completers, moderate to large effect sizes favored DBT + DBT PE for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global functioning. Conclusions: DBT with the DBT PE protocol is feasible, acceptable, and safe to administer, and may lead to larger improvements in PTSD, intentional self-injury, and other outcomes than DBT alone. The findings require replication in a larger sample. (C) 2014 Elsevier Ltd. All rights reserved.