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

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:

• PTSD
• borderline personality disorder
• intentional self-injury
• Dialectical Behavior Therapy
• Prolonged Exposure

Acknowledgements

Portions of this data were presented at the 2012 Annual Convention of the Association for Behavioral and Cognitive Therapies, National Harbor, MD. We would like to thank the clients, therapists, assessors, and staff at the Behavioral Research and Therapy Clinics for their contributions to this research. Dr Harned is a trainer and consultant for Behavioral Tech, LLC.

Additional information

Funding

This work was supported by grant [R34MH082143] from the National Institute of Mental Health to the first author.