Effectiveness and feasibility of Narrative Exposure Therapy (NET) in patients with borderline personality disorder and posttraumatic stress disorder – a pilot study

Abstract

BackgroundThis pilot study focused on the feasibility and potential effectiveness of a protocol based on Narrative Exposure Therapy (NET) that was integrated into a standard inpatient program to treat patients with comorbid Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD).MethodsEleven patients (1 male, 10 female) without previous stabilization periods or the absence of intentional self-injury received NET during a ten-week inpatient program. Patients were assessed again at post-treatment and a 12-month follow-up.ResultsDrop-out rates during treatment were low, with 90.9 % completing NET. Furthermore, acceptance of NET was high, with only one patient rejecting treatment. The program was safe because it did not lead to aggravations in symptom severity at either the post-treatment or 12-month follow-up. Additionally, the rate of self-harming behaviors throughout the treatment phase was low (18.2 %). In fact, treatment was associated with positive effects on PTSD and BPD symptom severity as well as secondary outcome measures, including depression, dissociation and quality of life.ConclusionsThe present study found that NET is feasible and safe in an inpatient setting for treating highly burdened patients with BPD and PTSD. There is also evidence for the potential effectiveness of NET in this highly burdened population.Trial registrationClinicalTrials.gov Identifier: NCT02517723. Registered 6 January 2014.

Feasibility of EMDR for posttraumatic stress disorder in patients with personality disorders: a pilot study

“…Alternatively, it might be due to receiving only (median) four sessions which, for many participants with a severe history of trauma, was probably an insufficient dose to attain remission. Our findings concerning the reduction of dissociative symptoms are consistent with some reports on trauma-focused psychotherapy in BPD (Harned et al, 2012(Harned et al, , 2014Pabst et al, 2012;Steuwe et al, 2016), although others have not observed this change (Bohus et al, 2013).…”

“…Similar findings were also reported in an open-label study with 21 female outpatients who fulfilled at least four criteria for BPD, and had a history of childhood sexual abuse (Steil et al, 2018). Narrative exposure therapy resulted in a reduction of symptoms of PTSD, depression and dissociation in two pilot trials with patients diagnosed with BPD and PTSD (Pabst et al, 2012;Steuwe et al, 2016). Summing up, all studies reported positive effects of psychotherapy for PTSD, save for one non-randomised, controlled study involving interpersonal process group therapy among 11 females diagnosed with BPD who had a history of childhood sexual abuse (Cloitre & Koenen, 2001).…”

“…The number of trauma-focused psychological interventions that may potentially be helpful for treating PTSD in patients with BPD is increasing. Although conclusive data are lacking, findings from several studies suggest that cognitive behavioural therapy, narrative exposure therapy, prolonged exposure (in combination with dialectical behaviour therapy), trauma-focused dialectical behaviour therapy, and cognitive processing therapy are promising interventions for PTSD in these patients (Bohus et al, 2013;Clarke et al, 2008;Harned et al, 2012Harned et al, , 2014Hembree et al, 2004;Holder et al, 2017;Kredlow et al, 2017;Meyers et al, 2017;Pabst et al, 2012;Steuwe et al, 2016;Walter et al, 2012). There is also some evidence to suggest that trauma-focused psychotherapy can be beneficial for other personality disorders as well (Bovin et al, 2017;Walter et al, 2012).…”

“…Meta-analyses have found that these interventions were superior to waiting list conditions (Bisson et al, 2007), and were effective interventions for PTSD in adult survivors of childhood abuse (Ehring et al, 2014). Therefore, the Dutch clinical guidelines for anxiety disorders state that CBT and EMDR are the treatments of choice for patients suffering from PTSD (van Balkom et al, 2013). Patients with personality disorders who seek treatment have emotional dysregulation, impairments in interpersonal functioning, high suicide risk and impulse control problems.…”

Five Applications of Narrative Exposure Therapy for Children and Adolescents Presenting With Post-Traumatic Stress Disorders

“…She chose NET as she felt that she had never had the chance to talk through all her experiences together. There have been two trials of NET in adults with PTSD with comorbid personality disorder, which have demonstrated a considerable reduction in symptoms of both PTSD and borderline personality disorder (35,36). Given this patient's self-harm behavior and difficulty with her emotional regulation and relationships, it was decided that NET might be able to address the breadth of her symptoms and needs, informed by components of these studies.…”