International Society for Traumatic Stress Studies

Treating Veterans with PTSD and Borderline Personality Symptoms

04/12/2017
by Laura Meyers, PhD, ABPP
The DBTPE Journeys program is a novel 12-week intensive outpatient program that combines Dialectical Behavior Therapy (DBT), Prolonged Exposure (PE), and community integration outings to treat co-morbid PTSD and Borderline Personality Disorder.  This program was designed to treat Veterans who are in need of PTSD treatment, yet are unable to engage in trauma-focused treatment due to difficulties with coping with stress, strong emotions, and relationships.  Clinicians are hesitant to treat PTSD in this population due to concerns of exacerbating suicidality, self-harm, or dissociation.  Traditionally, clinicians have believed that it is necessary to have these symptoms under control first through therapies such as DBT before providing trauma therapy.  However, this reasoning delays access to desperately needed treatment for trauma, as DBT alone has not been found to be an effective treatment for PTSD.

In order to target these concerns, as well as to serve patients who live a far distance from DBT and PE providers, we created an intensive outpatient program that provides the full model of DBT (all skills covered 2x over the 12 weeks), and the full PE protocol, which begins in week 2 or once the patients have been free from self-harm for 4 weeks.  If self-harm occurs, PE is stopped until it is under control (though no incidents of self-harm during PE occurred in our sample).   Additionally, community outings were provided twice a week to help patients generalize skills use through practice in real-world settings.

By providing DBT and PE concurrently in an intensive setting, we have found that approximately 2/3 of patients were able to successfully complete both therapies, with large effect sizes in decreases in PTSD symptoms and dysfunctional coping and increases in use of DBT skills, as well as a moderate effect size in decrease in suicidal ideation.  This pilot program indicates that PTSD can be effectively and safely treated in this high-risk population.

Reference Article

Meyers, L., Voller, E. K., McCallum, E. B., Thuras, P., Shallcross, S., Velasquez, T. and Meis, L. (2017), Treating Veterans With PTSD and Borderline Personality Symptoms in a 12-Week Intensive Outpatient Setting: Findings From a Pilot Program. Journal of Traumatic Stress, 30(2), 178-181. doi:10.1002/jts.22174

Discussion Questions

  1. What concerns do clinicians typically have when treating trauma?
  2. What changes would clinicians need to make in their practice to be able to treat high-risk patients?

Author biography

Laura Meyers, PhD, ABPP is the coordinator of the PTSD treatment team at the Minneapolis VA HCS, as well as the coordinator of the DBTPE Journeys Program.  She is certified in PE by the VA Healthcare System and is certified in DBT by the DBT-Linehan Board of Certification.  She provides national trainings in DBT and trains and supervises many gradate residents and interns in DBT and PE.

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