The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder

Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen’s d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms

Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial)

Background New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration This trial is registered in the Netherlands Trial Register (Trial NL9120)

Fully remote intensive trauma-focused treatment for PTSD and complex PTSD

Background: It is unknown whether remotely delivered intensive trauma-focused therapy not only is an effective treatment for PTSD, but also for Complex PTSD. Objective: Testing the hypothesis that a brief, fully remotely administered intensive trauma-focused treatment programme for individuals with PTSD and Complex PTSD would be safe, and associated with a significant decline of the corresponding symptoms and diagnostic status. Method: The treatment sample consisted of 73 consecutive patients diagnosed with PTSD according to the CAPS-5. According to the ITQ (n = 70) 33 (47.1%) patients also fulfilled the diagnostic criteria of Complex PTSD. The 4-day treatment programme contained a combination of prolonged exposure, EMDR therapy, physical activities and psycho-education. Treatment response was measured using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ) for classifying Complex PTSD and indexing disturbances in self-organization (DSO). Results: Overall CAPS-5, PCL-5, and ITQ-DSO scores decreased significantly from pre- to post-treatment (Cohen’s ds 2.12, 1.59, and 1.18, respectively), while the decrease was maintained to six months follow-up. At post-treatment, 60 patients (82.2%) no longer met the diagnostic criteria of PTSD, while the proportion of patients with Complex PTSD decreased from 47.1% to 10.1%. No drop out, and no personal adverse events occurred. Conclusions: The results support the notion that intensive, trauma-focused treatment is feasible, safe and associated with a large decrease in PTSD and Complex PTSD symptoms, even when it is brief, and applied fully remote

Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder

Background: Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce. Objective: The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up. Methods: A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up. Results: Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's ds: 1.58 and 0.98, respectively), and these results were maintained at 6- (ds: 1.20 and 1.01) and 12-month follow-up (ds: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred. Conclusion: The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD

Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial)

Background: New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives: This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods: Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions: This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration: This trial is registered in the Netherlands Trial Register (Trial NL9120)