Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial

Carolin Steuwe, Michaela Berg, Thomas Beblo, Martin Driessen, Carolin Steuwe, Michaela Berg, Thomas Beblo, Martin Driessen

Abstract

Background: Comorbid Posttraumatic Stress Disorder (PTSD) increases the already high symptom burden of patients with Borderline Personality Disorder (BPD). As the gold standard for BPD treatment, Dialectical Behavior Therapy (DBT), does not focus on PTSD, other treatment approaches are needed. Narrative Exposure Therapy (NET) was designed to address multiple traumatic events and may be especially useful in this patient group. The aim of the present study was to determine the efficacy of NET compared to DBT based treatment (DBT-bt) in a randomized controlled trial. Methods: Female patients (n = 60) with BPD and comorbid PTSD were randomized to either a 10-week residential NET or DBT-bt. The primary outcome was change in PTSD severity as assessed by the Clinician Administered PTSD Scale (CAPS). Mixed linear models as well as reliable change, remission, and response rates were used to compare improvement across treatment groups. Results: Mixed linear model showed that patients in both treatments improved significantly over time across all outcome measures. This improvement was not more pronounced in NET (no significant time × type of treatment effect). However, NET resulted in a higher remission rate as compared to DBT-bt. PTSD remission was accompanied by BPD remission in all cases. Conclusions: This study shows the value of trauma-focused therapy in patients with BPD and PTSD for recovery in both disorders. To shorten the duration of both illnesses as much as possible, future studies should focus on the factors predicting treatment success and enabling patients to benefit from trauma-focused treatment as soon as possible. Trial registration: ClinicalTrials.gov, identifier: NCT02517723.

Keywords: borderline personality disorder (BPD); cognitive behavior therapy (CBT); narrative exposure therapy (NET); posttraumatic stress disorder (PTSD); randomized controlled trial (RCT).

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Steuwe, Berg, Beblo and Driessen.

Figures

Figure 1
Figure 1
Patient flow. DBT-bt, Dialectical Behavior Therapy (DBT) based treatment; NET, Narrative Exposure Therapy; LMM, Linear Mixed Models.
Figure 2
Figure 2
(A) Total Clinician-Administered PTSD Scale for DSM-IV [CAPS; (19)] scores of participants randomized to Narrative Exposure Therapy (NET; gray color) or Dialectical Behavior Therapy (DBT) based treatment (DBT-bt; black color) before therapy and at 12-months follow-up. Values below the main diagonal indicate improvements; the dotted diagonals show reliable change. (B) Rates of remission from the diagnosis of PTSD as well as response, reliable improvement and worsening. Data are presented for the treatment completer sample, for the intention-to-treat sample see Supplementary Figure S2 in the Supplementary Material. *p ≤ 0.05.

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