Hybrid Dialectical Behavior Therapy for Veterans to Further Reduce Emotion Regulation Problems and Trauma Symptoms (REFRESH)

June 11, 2026 updated by: Arkin

REfreshment of Dialectical Behaviour Therapy for Veterans to Further Reduce Symptoms and Prevent Relapse of Post-traumatic Stress Disorder and Emotion Regulation Symptoms by Guided Self-Help

Around 10% of post-active veterans experience post-traumatic stress disorder (PTSD) many years post-mission. PTSD in veterans is frequently associated with challenges in emotion regulation, aggression, suicidality, and financial and psychosocial stress. In 2018, a 12-week clinical treatment programme, the Veterans Intensive Treatment Unit (VIBU), was developed for veterans experiencing these psychiatric symptoms, for whom conventional treatments had proven ineffective. The VIBU provides patients with trauma-focused and dialectical behaviour therapy (DBT). A recent study revealed that the VIBU was effective in reducing psychiatric symptoms. However, a recurrence of symptoms was observed in patients a few months after discharge. Consequently, an aftercare programme consisting of hybrid DBT is offered to consolidate and repeat the DBT skills and apply them in daily life.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult veteran (18 years or older), treated at Sinai Center, with knowledge of DBT
  • Primairy diagnosis of PTSD, determined with CAPS-5, resulting from war-related traumas
  • Stable for four weeks on their medication (type and doses)
  • Able to to do online homework assignments and communicate with their therapist via an eHealth platform
  • Dutch speaking

Exclusion Criteria:

  • Chronic psychosis (psychotic features as comorbidity from PTSD is allowed) or bipolar disorder type 1
  • IQ below 80 or cognitive disorders
  • Severe self-harming behaviour, such as auto-mutilation or suicidal ideations as main problem
  • Following day treatments or other intensive treatment for residual symptoms

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Hybrid DBT
All participants will follow the same hybrid DBT program (i.e., group sessions, individual sessions and online homework assignments). Randomization will determine the length of the waiting period between baseline and start of the intervention (i.e., hybrid DBT).
Behavioral: Hybrid dialectical behavior therapy
Hybrid DBT will be provided to veterans who have followed a 3-month inpatient DBT treatment. The hybrid DBT will include face-to-face skill groups, online individual sessions and online homework assignements.
Other Names:
  • DBT
  • Dialectical behavior therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
PTSD Checklist for the DSM-5 (PCL-5)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
One of the two main outcomes of this study is PTSD symptom score. The self-report questionnaire contains 20 questions with answer options ranging from '0 = Not at all' to '4 = Extremely', resulting in a score between 0-80. A higher score indicates more likelyhood of having PTSD.
From the baseline to the end of the follow-up period (between 12-17 months)
Difficulties in Emotion Regulation Scale Short Form (DERS-SF)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
One of the two main outcomes of this study is emotion dysregulation severity. The self-report questionnaire contains 18 questions with answer options from '1 = Almost never' to '5 = Almost always', resulting in a score between 18-90. A higher score indicates more difficulties with regulation emotions.
From the baseline to the end of the follow-up period (between 12-17 months)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
REFRESH - monitoring
Time Frame: From enrollment to (favourably) the end of the follow-up period (between 12-17 months)
Weekly short questionnaire (i.e., 10 questions) specifically tailored to this population to monitore PTSD, emotion regulation, substance use and DBT skills. Answer options range from '1 = Totally disagree' to '10 = Totally agree', resulting in a score between 10-100. A higher score means a worse outcome.
From enrollment to (favourably) the end of the follow-up period (between 12-17 months)

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Outcome Questionnaire (OQ-30.2)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This self-report questionnaire gives an indication of overall psychiatric symptoms and entails 30 items. Answers options go from '0 = almost never' to '4 = almost alywas'. The score ranges between 0-120, with a higher score indicating a worse outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
Alcohol Use Disorders Identification Test (AUDIT)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This self-report questionnaire contains 10 items with answer options from '0 = never' to '4 = high usage', resulting in a score between 0-40. A higher score indicates having alcohol problems.
From the baseline to the end of the follow-up period (between 12-17 months)
Drug Use Disorders Identification Test (DUDIT)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This self-report questionnaire contains 11 items with answer options from '0 = never' to '4 = high usage', resulting in a score between 0-40. A higher score indicates having drug problems.
From the baseline to the end of the follow-up period (between 12-17 months)
Individual Recovery Outcome Counter (i-ROC)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaires measures wellbeing outcomes. This self-report questionnaire of 12 items uses answer options from '1 = Never' to '6 = Always', resulting in a score ranging between 12-72. A higher score indicates a better outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
General Self-Efficacy Scale (GSES)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire measures self-efficacy. This self-report questionnaire of 10 items, with answer options from '1 = Not at all true' to '4 = Exactly true', with scores ranging from 10-40. A higher score indicates more self-efficacy.
From the baseline to the end of the follow-up period (between 12-17 months)
Dialectical behavioral therapy skills (DBT-skills)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire asks participants about their use of DBT skills. This self-report questionnaire of 17 items has answer options from '1 = never' to '5 = often', giving a score rangen between 17-85. A higher score indicates a positive outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
Level of Personality Functioning Scale (LPFS 2.0)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire measures the level of personality functioning. This self-report questionnaire contains 12 items, with answers ranging from '1 = not often true' to '4 = often true', resulting in a score between 12-48. A higher score indicates a worse outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
Inventarisatielijst Sociale Betrokkenheid (ISB)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire is about social wellbeing. This self-report questions contains 11 items, with results from '1 = almost never' to '4 = almost always', resulting in a score between 11-44. A higher score indicates a positive outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
Aggression questionnaire (AGQ)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire measures different forms of aggression. This self-report questionnaire contains 29 items, with answer from '1 = Extremely uncharacteristic' to '5 = Extremely characteristic', resulting in a score between 29-145. A higher score indicates a worse outcome.
From the baseline to the end of the follow-up period (between 12-17 months)
Suicidal Ideation Attributes Scale (SIDAS)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire measures suicidal ideation. This self-report questionnaire contains 5 items, with answer from '0 = Not at all' to '10 = Completely', resulting in a score between 0-50. A higher score indicates a higher level of suicidal ideation.
From the baseline to the end of the follow-up period (between 12-17 months)
Non-Suicidal Self-Injury Assement Tool screener (NSSI-AT screener)
Time Frame: From the baseline to the end of the follow-up period (between 12-17 months)
This questionnaire measures self-injurious behavior. This self-report questionnaire contains 7 items asking about the frequency and severity of self-injurious behaviour. There is no scoring.
From the baseline to the end of the follow-up period (between 12-17 months)
Childhood Trauma Questionnaire (CTQ)
Time Frame: At baseline
This questionnaire assess childhood maltreatment. This self-report questionnaire contains 28 items, with answers from '1 = Never true' to '5 = Very often true', resulting in a score between 28-140. A higher score indicate a worse outcome.
At baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Arkin

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 1, 2026

Primary Completion (Estimated)

September 1, 2028

Study Completion (Estimated)

October 1, 2028

Study Registration Dates

First Submitted

February 23, 2026

First Submitted That Met QC Criteria

June 11, 2026

First Posted (Actual)

June 17, 2026

Study Record Updates

Last Update Posted (Actual)

June 17, 2026

Last Update Submitted That Met QC Criteria

June 11, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REFRESH
  • NL-010470 (Registry Identifier: METC Amsterdam)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Very sensitive personal information.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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