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

• A RCT compared DBT with and without the DBT PE protocol in 26 BPD women with PTSD.
• Treatment expectancies, satisfaction, and retention did not differ by treatment.
• The DBT PE protocol was feasible to deliver for a majority of treatment completers.
• Rates of intentional self-injury were 1.3–2.4 times lower in DBT + DBT PE than DBT.
• DBT + DBT PE led to larger, more stable gains in PTSD and other outcomes than DBT.

ObjectiveThis study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury.MethodsParticipants 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.ResultsTreatment 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.ConclusionsDBT 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.