Integrating Dialectical Behavior Therapy and Prolonged Exposure to Treat Co-Occurring Borderline Personality Disorder and PTSD: Two Case Studies☆
Section snippets
Standard DBT
The structure, treatment strategies, and protocols of standard DBT are described in two DBT treatment manuals (Linehan, 1993a, Linehan, 1993b) and were implemented without modification over 1 year of treatment with each of the cases presented here. For each client, standard DBT included four modes of service delivery: (a) weekly individual psychotherapy (1 hour/week), (b) group skills training (2.5 hours/week), (c) phone consultation (as needed), and (d) a weekly therapist consultation team
Identifying Information and Relevant History
“Emma” (the client's name has been changed to preserve anonymity) was a 30-year-old Caucasian female. She had never been married, had two preschool-age daughters, and was cohabiting with her boyfriend (who was also the father of her youngest daughter). Her oldest daughter was the result of a gang rape she experienced at age 25. She completed high school, obtained a Bachelor's degree, and worked in social services for approximately 4 years after graduating from college. One year after giving
Identifying Information and Relevant History
“Natalie” (the client's name has been changed to preserve anonymity) was a 48-year-old, married, Caucasian female who was living with her husband and the youngest of her two daughters. She completed high school and then went on to attend a community college before transferring to a university. Natalie never completed her Bachelor's degree due to being raped while she was a college student at age 23 and dropping out of the university. She married her husband shortly thereafter and then stayed at
Discussion
Despite the fact that 36% to 58% of treatment-seeking individuals with BPD also meet criteria for PTSD (Linehan et al., 2006, Zanarini et al., 1998, Zanarini et al., 2004, Zimmerman and Mattia, 1999), no treatments have specifically been developed or evaluated to treat co-occurring PTSD in a BPD population. The results of the two case studies presented here suggest that a modified version of PE that is implemented concurrently with standard DBT has the potential to significantly decrease PTSD
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Cited by (59)
The role of positive affect processes in the association between posttraumatic stress disorder symptoms and sleep: A multi-study design
2023, Journal of Affective DisordersHeterogeneity in patterns of posttraumatic stress disorder symptoms and sleep disturbances among firefighters: Latent profile analyses
2022, Journal of Psychiatric ResearchCitation Excerpt :This knowledge can enhance PTSD treatments addressing sleep (e.g., cognitive behavioral therapy for insomnia, Walters et al., 2019). Clinicians may target daytime dysfunction through diary cards in Dialectical Behavioral Therapy-Prolonged Exposure (Harned and Linehan, 2008). Further, a clinical focus on anger management, emotion regulation skills, and alleviating depression symptoms may help firefighters with severe levels of co-occurring PTSD symptoms and sleep disturbances.
Deaths of Despair: Conceptual and Clinical Implications
2021, Cognitive and Behavioral PracticeCitation Excerpt :Phase-based interventions have been used to treat complex PTSD and co-occurring conditions, such as borderline personality disorder (BPD; Harned, Korslund, Foa, & Linehan, 2012), substance use disorders (Najavits, Schmitz, Gotthardt, & Weiss, 2005), and schizoaffective disorders (Landes, Garovoy, & Burkman, 2013). For example, Harned and Linehan (2008) developed a protocol that includes Dialectical Behavior Therapy (DBT; Linehan, 1993) in the first phase of treatment to stabilize patients before beginning trauma work. In the second phase of treatment, traumatic experiences are addressed with concurrent use of DBT and a modified version of prolonged exposure (PE; Foa & Rothbaum, 1998).
Acceptance-based behavioral therapy for PTSD
2020, Emotion in Posttraumatic Stress Disorder: Etiology, Assessment, Neurobiology, and TreatmentPosttraumatic stress disorder and positive memories: Clinical considerations
2018, Journal of Anxiety Disorders
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We are grateful to Dr. Elizabeth Dexter-Mazza for her contributions to this project. We also thank the two clients who not only courageously participated in this treatment, but who also gave their consent to the writing of this article in the hope that it will help others who are suffering.