Meyers Laura, Voller Emily K, McCallum Ethan B, Thuras Paul, Shallcross Sandra, Velasquez Tina, Meis Laura
Department of Mental Health, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
J Trauma Stress. 2017 Apr;30(2):178-181. doi: 10.1002/jts.22174. Epub 2017 Mar 22.
Rates of comorbidity between borderline personality disorder and posttraumatic stress disorder (PTSD) are high in veteran populations, and clinicians are hesitant to treat PTSD given high rates of suicidality. Given promising early work integrating dialectical behavior therapy (DBT) and prolonged exposure (PE) therapy, we created a 12-week intensive outpatient program combining these two treatments. PE and DBT were provided concurrently to 33 veterans with PTSD symptoms and BPD symptoms at a large, midwestern Veteran Affairs medical center. Approximately half of the participants were male, with the majority identifying as Caucasian. Participants' ages ranged from 23 to 58 years, with a mean age of 43.21 years. The full-model of DBT was provided; PE was provided twice weekly for approximately 6 weeks of the program. Of participants, 22 veterans successfully completed the program with no dropout during PE. Large pre- to posttreatment effect sizes were found for decreases in PTSD symptoms (d = 1.61) and dysfunctional coping styles (d = 1.55), and an increase in the use of DBT skills (d = 1.02). A moderate effect size was found in the decrease of suicidal ideation (d = 0.64). The results of this pilot program suggest that PTSD can be safely and effectively treated among veterans with comorbid symptoms of borderline personality disorder through the combination of concurrent intensive DBT and PE.
在退伍军人群体中，边缘性人格障碍与创伤后应激障碍（PTSD）的共病率很高，鉴于自杀率很高，临床医生在治疗PTSD时犹豫不决。鉴于将辩证行为疗法（DBT）和延长暴露（PE）疗法相结合的早期工作很有前景，我们创建了一个为期12周的强化门诊项目，将这两种疗法结合起来。在中西部一家大型退伍军人事务医疗中心，对33名有PTSD症状和BPD症状的退伍军人同时提供了PE和DBT。大约一半的参与者是男性，大多数人认定为白种人。参与者年龄在23岁至58岁之间，平均年龄为43.21岁。提供了DBT的完整模式；在该项目约6周的时间里，每周提供两次PE。在参与者中，22名退伍军人成功完成了该项目，在接受PE期间无人退出。发现PTSD症状（d = 1.61）和功能失调的应对方式（d = 1.55）减少，以及DBT技能的使用增加（d = 1.02），治疗前后的效应量都很大。自杀意念的减少发现了中等效应量（d = 0.64）。这个试点项目的结果表明，通过同时进行强化DBT和PE的组合，可以安全有效地治疗患有边缘性人格障碍共病症状的退伍军人中的PTSD。
