Steuwe Carolin, Berg Michaela, Beblo Thomas, Driessen Martin
Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.
Front Psychiatry. 2021 Nov 26;12:765348. doi: 10.3389/fpsyt.2021.765348. eCollection 2021.
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. Female patients ( = 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. 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. 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. ClinicalTrials.gov, identifier: NCT02517723.
创伤后应激障碍（PTSD）共病会增加边缘性人格障碍（BPD）患者本就很高的症状负担。作为BPD治疗的金标准，辩证行为疗法（DBT）并不关注PTSD，因此需要其他治疗方法。叙事暴露疗法（NET）旨在应对多种创伤事件，可能对该患者群体特别有用。本研究的目的是在一项随机对照试验中确定NET与基于DBT的治疗（DBT-bt）相比的疗效。60名患有BPD和PTSD共病的女性患者被随机分为接受为期10周的住院NET治疗或DBT-bt治疗。主要结局是通过临床医生管理的PTSD量表（CAPS）评估的PTSD严重程度的变化。使用混合线性模型以及可靠变化、缓解和反应率来比较各治疗组的改善情况。混合线性模型显示，两种治疗的患者在所有结局指标上均随时间显著改善。这种改善在NET中并不更明显（无显著的时间×治疗类型效应）。然而，与DBT-bt相比，NET的缓解率更高。所有病例中，PTSD缓解均伴随着BPD缓解。本研究表明了针对创伤的疗法对患有BPD和PTSD的患者在两种疾病康复方面的价值。为了尽可能缩短两种疾病的病程，未来的研究应关注预测治疗成功的因素，并使患者能够尽快从针对创伤的治疗中获益。ClinicalTrials.gov标识符：NCT02517723。
