Dialectical behavior therapy effective for PTSD linked to childhood abuse

Dialectical behavior therapy and cognitive processing therapy appeared to improve PTSD symptoms among women who survived childhood abuse, according to results of a randomized clinical trial published in JAMA Psychiatry.

“Currently, treatment of [childhood abuse]-associated PTSD mostly relies on established treatments that were developed for survivors of adult-onset trauma,” Martin Bohus, MD, PhD, of the Institute of Psychiatric and Psychosomatic Psychotherapy at Heidelberg University in Germany, and colleagues wrote. “Most treatment guidelines recommend prolonged exposure, cognitive processing therapy (CPT) or trauma-focused cognitive behavioral therapy, but there is debate on whether these treatments are sufficient for patients with [childhood abuse]-associated PTSD. Some authors favor phase-based treatments, focusing on emotion regulation before addressing traumatic memories, while others maintain that standard trauma-focused programs without additional components are sufficient.”

Individuals in this patient population may also benefit from the prototypic phase-based treatment, dialectical behavior therapy for PTSD (DBT-PTSD), which was designed to meet the needs of survivors of childhood abuse who had highly complex presentations of PTSD, such as features of borderline personality disorder (BPD). Prior studies served as the first evaluations of this treatment and showed its efficacy under residential treatment conditions.

In the current study, Bohus and colleagues sought to compare the efficacy of DBT-PTSD with that of CPT. They included 193 women who sought treatment at three German university outpatient clinics and prospectively observed participants for 15 months. Inclusion criteria were childhood abuse-associated PTSD diagnosis, as well as meeting three or more DSM-5 criteria for BPD, including affective instability. The investigators randomly assigned 98 and 95 participants to equal dosages and frequencies of DBT-PTSD or CPT, respectively. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score from time of random assignment to 15 months served as the predefined primary outcome. Alongside intent-to-treat analyses based on dimensional CAPS-5 scores, the researchers also used categorical outcome measures to assess symptomatic remission, reliable improvement and reliable recovery.

Results showed CAPS-5 scores significantly improved among both groups, and DBT-PTSD demonstrated a small but statistically significant superiority, with a group difference of 4.82 (95% CI, 0.67-8.96). Participants in the DBT-PTSD group were less likely to drop out early and exhibited higher rates of symptomatic remission, reliable improvement and reliable recovery compared with the CPT group.

“The study shows that even severe forms of [childhood abuse]-associated PTSD that include multiple co-occurring mental disorders and emotion dysregulation can be treated efficaciously,” Bohus and colleagues wrote. “Future studies should strive for a better definition of patient groups that might profit from current therapies. In particular, additional research is required to test whether treatment efficacy might extend beyond adult women, and whether the DBT-PTSD protocol could be condensed to reduce cost burdens and patient burdens and facilitate dissemination.”