A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-Dialectical Behavioural Therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (Sub)clinical borderline personality disorder: study design

Snoek, Aishah; Beekman, Aartjan; Dekker, Jack; Aarts, Inga; Grootheest, Gerard van; Blankers, Matthijs; Vriend, Chris; Heuvel, Odile A. van den; Thomaes, Kathleen

doi:10.1186/s12888-020-02713-x

Cited by 24 publications

(16 citation statements)

References 86 publications

(94 reference statements)

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“…A third study of an intervention combining an evidence-based PTSD psychotherapy (Eye Movement Desensitization and Reprocessing, EMDR) with DBT is underway at the time of this review, in a randomized clinical trial with patients with PTSD and comorbid full and subthreshold BPD [ 157 ]. Thus, the three most extensively tested approaches to PTSD psychotherapy (EX, CT, and EMDR) have been systematically integrated with DBT.…”

Section: Main Textmentioning

confidence: 99%

Complex PTSD and borderline personality disorder

Ford

Courtois²

2021

bord personal disord emot dysregul

114

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Background This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. Main body The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. Conclusion The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.

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Section: Main Textmentioning

confidence: 99%

Complex PTSD and borderline personality disorder

Ford

Courtois²

2021

bord personal disord emot dysregul

114

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“…The treatment protocol is described more detailed in [ 61 , 62 ], but described here briefly. Patients in the TFT condition will receive EMDR (PTSD+BPD) or ImRs (PTSD+CPD) for a minimum of 12 and a maximum of 18 sessions, delivered within 6 months.…”

Section: Methodsmentioning

confidence: 99%

Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design

Aarts

Vriend

Snoek

et al. 2021

bord personal disord emot dysregul

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Background Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD. Methods We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used. Discussion This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients. Trial registration Clinical Trials, NCT03833453 & NCT03833531. Retrospectively registered, February 2019.

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“…Patients will be randomized equally to ImRs only or integrated ImRs and ST. The study is embedded within a larger study project on treatment efficacy, working mechanisms and prediction of treatment outcome for those with PTSD and comorbid borderline PD or CPD ( 54 , 66 ). The study protocol has been approved by the regional Medical Ethics Committee and will be conducted in accordance with the Dutch Medical Research Involving Human Subjects Act.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The present study addresses these knowledge gaps by comparing treatment efficacy and cost-effectiveness of trauma focused treatment (ImRs) with integrated ImRs and PD focused treatment (ST). In a parallel trial, the treatment efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) will be compared with integrated EMDR and dialectical behavior therapy in PTSD and comorbid borderline PD ( 54 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial

et al. 2021

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Background: Posttraumatic stress disorder (PTSD) is a serious and relatively common mental disorder causing a high burden of suffering. Whereas evidence-based treatments are available, dropout and non-response rates remain high. PTSD and Cluster C personality disorders (avoidant, dependent or obsessive-compulsive personality disorder; CPD) are highly comorbid and there is evidence for suboptimal treatment effects in this subgroup of patients. An integrated PTSD and CPD treatment may be needed to increase treatment efficacy. However, no studies directly comparing the efficacy of regular PTSD treatment and treatment tailored to PTSD and comorbid CPD are available. Whether integrated treatment is more effective than treatment focused on PTSD alone is important, since (1) no evidence-based guideline for PTSD and comorbid CPD treatment exists, and (2) treatment approaches to CPD are costly and time consuming. Present study design describes a randomized controlled trial (RCT) directly comparing trauma focused treatment with integrated trauma focused and personality focused treatment.Methods: An RCT with two parallel groups design will be used to compare the clinical efficacy and cost-effectiveness of “standalone” imagery rescripting (n = 63) with integrated imagery rescripting and schema therapy (n = 63). This trial is part of a larger research project on PTSD and personality disorders. Predictors, mediators and outcome variables are measured at regular intervals over the course of 18 months. The main outcome is PTSD severity at 12 months. Additionally, machine-learning techniques will be used to predict treatment outcome using biopsychosocial variables.Discussion: This study protocol outlines the first RCT aimed at directly comparing the clinical efficacy and cost-effectiveness of imagery rescripting and integrated imagery rescripting and schema therapy for treatment seeking adult patients with PTSD and comorbid cluster C personality pathology. Additionally, biopsychosocial variables will be used to predict treatment outcome. As such, the trial adds to the development of an empirically informed and individualized treatment indication process.Clinical Trial registration:ClinicalTrials.gov, NCT03833531.

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Cited by 24 publications

References 86 publications

Complex PTSD and borderline personality disorder

Complex PTSD and borderline personality disorder

Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design

Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial

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