Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre

Figures & data

Figure 1. Patient flow and missings.

Table 1. Sample baseline characteristics (after imputation).

	Unmatched (n = 156)									Matched (n = 32)
	DBT-PTSD (n = 45)			TAU (n = 111)						DBT-PTSD (n = 16)		TAU (n = 16)
	N	M or %	SD	N	M or %	SD	p	SMD^a	Missing (%)	M or %	SD	M or %	SD	p	SMD^a
Age	45	47.2	9.49	111	43.0	11.1	.020	0.42	0	44.9	9.24	47.9	10.2	.399	0.30
Sex (female)	45	86.7		111	81.1		.403	0.13	0	81.3		87.5		.500	0.17
Education (> secondary education)	45	37.8		111	44.1		.466	0.12	5.8	37.5		31.3		.710	0.13
Employment	45	11.1		111	7.2		.523	0.13	7.1	18.8		12.5		.626	0.17
Treatment duration	45	60.8	21.8	111	55.1	16.4	.080	−0.31	0	58.4	19.2	61.1	15.3	.664	0.16
No. of times in clinic	45	1.40	0.84	111	1.71	1.15	.100	0.29	6.4	1.56	0.96	1.75	1.06	.605	0.19
No. diagnoses	45	3.56	2.04	111	4.86	2.02	<.001	0.64	0	3.94	1.57	3.88	1.59	.912	−0.04
Chronicity (> 2 years)	45	97.8		111	99.1		.495	0.11	6.4	100		100			0
CTQtotal	31	75.4	10.5	76	69.9	11.7	.027	−0.48	4.71	71.4	10.6	69.2	13.3	.613	−0.18

^a Standardized mean difference = difference in mean or proportions divided by the standard error; imbalance between groups is defined as absolute value greater than 0.20 (corresponding to a small effect size).

Note: DBT-PTSD = Dialectical Behaviour Therapy – Posttraumatic Stress Disorder, TAU = Treatment as usual, CTQ = Childhood Trauma Questionnaire.

Table 2. Sample baseline characteristics: Supplementary (matched) data set.

	Matched (n = 32)
	DBT-PTSD (n = 16)		TAU (n = 16)
	M or %	SD	M or %	SD	p	SMD^a
Age	44.9	9.24	47.9	10.2	.399	0.30
Sex (female)	81.3		87.5		.500	0.17
Education (>secondary education)	37.5		31.3		.710	0.13
Employment	18.8		12.5		.626	0.17
Treatment duration	58.4	19.2	61.1	15.3	.664	0.16
No. of times in clinic	1.56	0.96	1.75	1.06	.605	0.19
No. diagnoses	3.94	1.57	3.88	1.59	.912	−0.04
Chronicity (>2 years)	100		100			0
CTQtotal	71.4	10.6	69.2	13.3	.613	−0.18

^a Standardized mean difference = difference in mean or proportions divided by the standard error; imbalance between groups is defined as absolute value greater than 0.20 (corresponding to a small effect size).

Note: DBT-PTSD = Dialectical Behaviour Therapy – Posttraumatic Stress Disorder, TAU = Treatment as usual, CTQ = Childhood Trauma Questionnaire.

Table 3. Treatment outcomes in different treatment groups after imputation: Primary outcomes.

		Available data						Intent to treat data
		Tbaseline		Tpost-treatment				Tpost-treatment
Measure	Group	N	M(SD)	N	M(SD)	d^a	p	N	M(SD)	d^a	p	ANOVA^b	Factor	p
PCL-C Total score	DBT-PTSD	39	65.6 (7.59)	20	48.7 (13.5)	1.38	<.001	39	55.8 (13.3)	0.71	<.001	F(1,134) = 55.01	Time	<.001
	TAU	97	61.8 (10.5)	60	56.1 (11.3)	0.70	<.001	97	58.2 (11.4)	0.50	<.001	F(1,134) = 0.172	Group	.679
	d^c				0.49		.05		0.19		.32	F(1,134) = 11.54	Gr. x ti.	<.001
PCL-C Re-experiencing	DBT-PTSD	39	3.81 (0.74)	20	2.95 (0.99)	0.93	<.001	39	3.32 (0.97)	0.56	.001	F(1,134) = 20.15	Time	<.001
	TAU	97	3.72 (0.93)	60	3.59 (0.84)	0.21	.12	97	3.62 (0.89)	0.16	.12	F(1,134) = 0.490	Group	.485
	d^c				0.61		.02		0.34		.08	F(1,134) = 9.07	Gr. x ti.	.003
PCL-C Numbing/avoidance	DBT-PTSD	39	5.18 (0.73)	20	3.73 (1.19)	1.50	<.001	39	4.31 (1.20)	0.74	<.001	F(1,134) = 20.15	Time	<.001
	TAU	97	4.67 (0.94)	60	4.41 (0.89)	0.41	.002	97	4.49 (1.02)	0.32	.002	F(1,134) = 0.490	Group	.485
	d^c				0.50		.05		0.17		.37	F(1,134) = 9.07	Gr. x ti.	.003
PCL-C Hyperarousal	DBT-PTSD	39	4.27 (0.78)	20	3.13 (1.15)	1.29	<.001	39	3.63 (1.14)	0.66	<.001	F(1,134) = 49.39	Time	<.001
	TAU	97	4.17 (0.81)	60	3.78 (0.89)	0.68	<.001	97	3.92 (0.87)	0.49	<.001	F(1,134) = 0.430	Group	.513
	d^c				0.56		.03		0.32		.10	F(1,134) = 10.30	Gr. x ti.	.002
DES-II	DBT-PTSD	41	42.1 (20.6)	20	31.3 (17.9)	0.98	<.001	41	34.7 (20.1)	0.56	<.001	F(1,135) = 14.01	Time	<.001
	TAU	96	31.5 (17.4)	59	30.3 (18.0)	0.06	.632	96	31.0 (18.4)	0.05	.631	F(1,135) = 4.71	Group	.032
	d^c				0.05		.853		0.20		.291	F(1,135) = 10.59	Gr. x ti.	.001
PTCI total score	DBT-PTSD	39	148.0 (29.8)	20	115.4 (45.3)	1.31	<.001	39	124.6 (40.8)	0.69	<.001	F(1,134) =  39.76	Time	<.001
	TAU	97	139.4 (31.4)	60	133.8 (34.9)	0.32	.02	97	135.1 (32.2)	0.25	<.001	F(1,34) =  0.026	Group	.871
	d^c				0.60		.02		0.30		.11	F(1,134) = 19.19	Gr. x ti.	<.001

^a Cohen’s d was computed using the pooled standard deviation of scores at admission (t1) and discharge (t2).

^b Repeated measures analysis of variance with intent to treat data.

^c Cohen’s d was computed using the pooled standard deviation of scores at discharge (t2) from the DBT-PTSD and TAU groups.

Figure 2. Effect sizes (Cohen’s d) of primary outcomes for available data and ITT data of the DBT-PTSD and TAU group.

Table 4. Treatment outcomes in different treatment groups after imputation: Secondary outcomes.

		Available data						Intent to treat data
		Tbaseline		Tpost-treatment				Tpost-treatment
Measure	Group	N	M(SD)	N	M(SD)	d^a	p	N	M(SD)	d^a	p	ANOVA^b	Factor	p
MSI-BPD	DBT-PTSD	42	6.47 (2.19)	21	5.24 (3.05)	0.65	.007	42	5.63 (2.78)	0.42	.009	F(1,129) = 17.18	Time	<.001
	TAU	89	5.54 (2.30)	53	4.27 (2.57)	0.48	<.001	89	4.83 (2,53)	0.36	.001	F(1,129) = 4.311	Group	.032
	d^c				0.36		.170		0.31		.102	F(1,129) = 0.121	Gr. x ti.	.728
PHQ-9	DBT-PTSD	43	17.7 (4.41)	22	11.5(4.96)	1.18	<.001	43	14.3 (5.51)	0.65	<.001	F(1,149) = 68.60	Time	<.001
	TAU	108	16.9 (4.86)	66	12.5 (4.81)	1.28	<.001	108	13.8 (5.04)	0.78	<.001	F(1,149) = 0.559	Group	.456
	d^c				0.19		.441		0.09		.637	F(1,149) = 0.169	Gr. x ti.	.681
GAD-7	DBT-PTSD	44	13. (3.81)	22	9.27 (5.28)	1.04	<.001	44	11.2 (5.01)	0.59	<.001	F(1,150) = 46.96	Time	<.001
	TAU	108	14.2 (4.24)	66	10.6 (4.73)	0.89	<.001	108	11.8 (4.85)	0.61	<.001	F(1,150) = 0.432	Group	.512
	d^c				0.26		.291		0.11		.524	F(1,150) = 0.053	Gr. x ti.	.818
ERQ Reappraisal	DBT-PTSD	42	22.5 (7.81)	21	28.8 (5.98)	1.01	<.001	42	26.2 (7.74)	0.58	<.001	F(1,133) = 26.19	Time	<.001
	TAU	93	22.5 (7.77)	55	26.1 (6.46)	0.48	<.001	93	24.7 (6.95)	0.36	<.001	F(1,133) = 0.35	Group	.556
	d^c				0.44		.094		0.21		.260	F(1,133) = 1.79	Gr. x ti.	.183
ERQ Suppression	DBT-PTSD	42	19.1 (5.09)	21	16.5 (4.93)	0.70	.004	42	17.3 (4.73)	0.45	.006	F(1,134) = 5.26	Time	.023
	TAU	94	17.0 (5.53)	56	17.2 (4.48)	0.01	.921	94	17.0 (4.81)	0.01	.921	F(1.134) = 1.91	Group	.169
	d^c				0.14		.590		0.06		.748	F(1.134) = 5.78	Gr. x ti.	.018
WHODAS	DBT-PTSD	44	22.8 (8.05)	22	18.4 (8.57)	0.99	<.001	44	19.8 (7.95)	0.58	<.001	F(1,140) = 38.6	Time	<.001
	TAU	98	22.9 (8.07)	62	18.6 (8.26)	0.76	<.001	98	20.0 (7.97)	0.55	<.001	F(1,140) = 0.01	Group	.928
	d^c				0.03		.907		0.02		.901	F(1,140) = 0.01	Gr. x ti.	.909

Note: DBT-PTSD = Dialectical Behavioural Therapy – Posttraumatic Stress Disorder, TAU = Treatment as usual, MSI-BPD = McLean Screening Instrument for Borderline Personality Disorder, PHQ-9 = Patient Health Questionnaire-9, GAD-7 = Brief Measure for assessing General Anxiety Disorder, ERQ = Emotion Regulation Questionnaire, WHODAS = WHO Disability Assessment Schedule.

^a Cohen’s d was computed using the pooled standard deviation of scores at admission (t1) and discharge (t2).

^b Repeated measures analysis of variance with intent to treat data.

^c Cohen’s d was computed using the pooled standard deviation of scores at discharge (t2) from the DBT-PTSD and TAU groups.

Table 5. Supplementary analysis (matched data) of treatment outcomes in different treatment groups: Primary outcomes.

		Available data						Intent to treat data (n = 16)
		Tbaseline		Tpost-treatment				Tpost-treatment
Measure	Group	N	M(SD)	N	M(SD)	d^a	p	M(SD)	d^a	p	ANOVA^b	Factor	p
PCL-C Total score	DBT-PTSD	16	65.4 (7.48)	6	50.7 (12.6)	1.39	.019	59.1 (11.6)	0.58	.036	F(1,30) = 13.46	Time	<.001
	TAU	16	66.8 (7.86)	10	61.5 (7.17)	1.27	.003	61.2 (6.89)	0.79	.006	F(1,30) = 0.456	Group	.848
	d^c				1.14		.044	0.22		.544	F(1,30) = 0.037	Gr. x ti.	.505
PCL-C Re-experiencing	DBT-PTSD	16	3.51 (0.89)	6	2.83 (1.08)	0.95	.067	3.21 (0.98)	0.48	.075	F(1,30) = 8.117	Time	.008
	TAU	16	4.13 (0.78)	10	4.10 (0.40)	0.82	.039	3.90 (0.71)	0.58	.034	F(1,30) = 5.244	Group	.029
	d^c				1.75		.004	0.81		.030	F(1,30) = 0.166	Gr. x ti.	.687
PCL-C Numbing/ avoidance	DBT-PTSD	16	4.99 (0.62)	6	3.67 (0.98)	1.53	.013	4.42 (0.97)	0.60	.030	F(1,30) = 7.173	Time	.012
	TAU	16	4.87 (1,04)	10	4.79 (0.82)	0.39	.252	4.70 (0.95)	0.30	.244	F(1.30) = 0.068	Group	.796
	d^c				1.27		.027	0.29		.422	F(1,30) = 2.108	Gr. x ti.	.157
PCL-C Hyperarousal	DBT-PTSD	16	4.30 (0.76)	6	4.50 (0.96)	1.44	.017	3.83 (0.90)	0.58	.034	F(1,30) = 11.29	Time	.002
	TAU	16	4.35 (0.68)	10	3.96 (0.87)	0.98	.013	4.04 (0.80)	0.67	.017	F(1,30) = 0.270	Group	.607
	d^c				0.79		.149	0.25		.484	F(1,30) = 0.481	Gr. x ti.	.493
DES-II	DBT-PTSD	16	36.9 (19.6)	6	29.4 (14.2)	1.42	.018	32.3 (18.5)	0.58	.035	F(1,30) = 3.551	Time	.069
	TAU	16	37.5 (14.8)	10	39.9 (15.5)	0.20	.548	35.8 (15.1)	0.16	.537	F(1,30) = 0.129	Group	.722
	d^c				0.70		.198	0.21		.557	F(1,30) = 0.750	Gr. x ti.	.393
PTCI total score	DBT-PTSD	16	144.4 (24.2)	6	112.7 (31.6)	1.39	.019	128.5 (28.9)	0.58	.036	F(1,30) = 7.66	Time	.010
	TAU	16	147.3 (35.9)	10	145.4 (32.9)	0.50	.150	139.7 (32.1)	0.38	.147	F(1,30) = 0.500	Group	.485
	d^c				1.01		.071	0.37		.306	F(1,30) = 0.984	Gr. x ti.	.329

Note: DBT-PTSD = Dialectical Behavioural Therapy – Posttraumatic Stress Disorder, TAU = Treatment as usual, PCL-C = Posttraumatic Stress Disorder Checklist-Civilian Version, DES-II = Dissosciative Experience Scale, PTCI = Posttraumatic Cognitions Inventory.

^a Cohen’s d was computed using the pooled standard deviation of scores at admission (t1) and discharge (t2).

^b Repeated measures analysis of variance with intent to treat data.

^c Cohen’s d was computed using the pooled standard deviation of scores at discharge (t2) from the DBT-PTSD and TAU groups.

Table 6. Supplementary analysis (matched data) of treatment outcomes in different treatment groups: Secondary outcomes.

		Available data						Intent to treat data (n = 16)
		Tbaseline		Tpost-treatment				Tpost-treatment
Measure	Group	N	M(SD)	N	M(SD)	d^a	p	M(SD)	d^a	p	ANOVA^b	Factor	p
MSI-BPD	DBT-PTSD	16	6.90 (1.85)	6	4.17 (1.60)	1.79	.007	5.78 (2.22)	0.63	.023	F(1,30) = 9.211	Time	.005
	TAU	16	6.88 (1.15)	10	5.00 (2.62)	0.63	.079	5.81 (2.40)	0.47	.080	F(1,30) = 0.0001	Group	.995
	d^c				0.36		.497	0.015		.966	F(1,30) = 0.008	Gr. x ti.	.931
PHQ-9	DBT-PTSD	16	17.7 (4.92)	6	11.7 (3.56)	1.47	.015	14.9 (4.94)	0.59	.032	F(1,30) = 16.38	Time	<.001
	TAU	16	18.1 (4.36)	11	13.5 (4.72)	1.21	.002	13.8 (4.31)	0.83	.005	F(1,30) = 0.051	Group	.823
	d^c				0.41		.432	0.23		.522	F(1,30) = 0.726	Gr. x ti.	.401
GAD-7	DBT-PTSD	16	14.3 (4.44)	6	9.33 (4.50)	0.79	.112	12.9 (5.23)	0.42	.112	F(1,30) = 7.298	Time	.011
	TAU	16	14.1 (3.94)	11	11.4 (3.67)	0.67	.049	12.0 (3.88)	0.53	.052	F(1,30) = 0.233	Group	.633
	d^c				0.51		.329	0.19		.595	F(1,30) = 0.158	Gr. x ti.	.633
ERQ Reappraisal	DBT-PTSD	16	22.9 (7.04)	6	24.7 (7.00)	0.16	.714	23.2 (6.92)	0.10	.690	F(1,30) = 2.308	Time	.139
	TAU	16	21.7 (8.36)	10	24.5 (8.00)	0.48	.161	24.1 (7.50)	0.37	.157	F(1,30) = 0.004	Group	.950
	d^c				0.02		.967	0.12		.734	F(1,30) = 1.359	Gr. x ti.	.253
ERQ Suppression	DBT-PTSD	16	17.3 (6.19)	6	15.7 (5.57)	0.61	.199	16.4 (5.12)	0.35	.184	F(1,30) = 0.132	Time	.719
	TAU	16	18.1 (6.56)	10	18.1 (4.28)	0.08	.798	18.4 (5.01)	0.07	.791	F(1,30) = 0.557	Group	.461
	d^c				0.12		.742	0.41		.259	F(1,30) = 0.719	Gr. x ti.	.403
WHODAS	DBT-PTSD	16	23.9 (9.18)	6	21.1 (10.7)	1.11	.042	22.4 (9.01)	0.52	.055	F(1,30) = 9.767	Time	.004
	TAU	16	23.6 (6.83)	11	20.3 (8.23)	0.80	.024	20.4 (6.97)	0.61	.028	F(1,30) = 0.181	Group	.674
	d^c				0.08	0.880		0.26		.474	F(1,30) = 1.384	Gr. x ti.	.249

Note: DBT-PTSD = Dialectical Behavioural Therapy – Posttraumatic Stress Disorder, TAU = Treatment as usual, MSI-BPD = McLean Screening Instrument for Borderline Personality Disorder, PHQ-9 = Patient Health Questionnaire-9, GAD-7 = Brief Measure for assessing General Anxiety Disorder, ERQ = Emotion Regulation Questionnaire, WHODAS = WHO Disability Assessment Schedule.

^a Cohen’s d was computed using the pooled standard deviation of scores at admission (t1) and discharge (t2).

^b Repeated measures analysis of variance with intent to treat data.

^c Cohen’s d was computed using the pooled standard deviation of scores at discharge (t2) from the DBT-PTSD and TAU groups.

Data availability statement

The datasets presented in this article are not readily available because of the vulnerability of the study sample. Participants of this study did not agree for their data to be shared publicly, so supporting data is not available.