Systematic review and meta-analysis on efficacy of dialectical behavior therapy variants for treatment of PTSD

 Prillinger, K., Goreis, A., Macura, S., Hajek Gross, C., Lozar, A., Fanninger, S., Mayer, A., Oppenauer, C., Plener, P. L., & Kothgassner, O. D. (2024). A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. European Journal of Psychotraumatology, 15(1), 2406662. https://doi.org/10.1080/20008066.2024.2406662

Summary by: Madlene Radosavljevic

Prillinger and colleagues (2024) conducted a systematic review and meta-analysis to evaluate the efficacy of Dialectical Behavior Therapy (DBT) variants in treating post-traumatic stress disorder (PTSD), especially in individuals with comorbid borderline personality disorder (BPD).

PTSD is a debilitating condition and without effective interventions, it may become chronic. Further, PTSD is often co-occurring with disorders such as borderline personality disorder (BPD), major depression, and non-suicidal self-injury (NSSI). Evidence-based PTSD treatments focus on trauma exposure, which makes the use of these treatments among people with BPD symptoms challenging due to their higher risks of self-harm and suicidality. Thus, DBT, which has shown effectiveness for BPD, was adapted to address comorbid PTSD-BPD cases through two key interventions: DBT for PTSD (DBT-PTSD) and DBT Prolonged Exposure (DBT PE). Because of the lack of comprehensive analysis on the effectiveness of these two interventions, the aforementioned authors carried out this research.

Therefore, they first did a literature search across databases including SCOPUS, PubMed, and the Cochrane Library for studies published before September 2023. After a profound screening of potential studies, they identified 13 relevant articles, which encompassed randomized controlled trials (RCTs), controlled clinical trials (CCTs), and pre-post treatment evaluations. In total, 663 participants were included in this research - 403 received PTSD-specific DBT interventions and 260 were in the control condition. Primary, the outcome was evaluated on severity of PTSD symptoms, while secondary outcomes were measures of BPD symptoms, depression, dissociation, and non-suicidal self-injury (NSSI). Analyses were conducted using the R package metafor.

The meta-analysis revealed that both PTSD-specific DBT treatments had a moderate effect in reducing PTSD symptom severity (g = -0.69) and depression (g = -0.62) compared to control groups. Apart from that, pre-post treatment analyses also showed significant improvements in dissociative symptoms (g = -0.72), BPD-associated symptoms (g = -0.82), and NSSI frequency (g = -0.70). Moreover, assessment of risk of bias showed that 91% of the studies were rated as having moderate overall bias, and 9% had high bias (e.g. randomisation, selection, confounding and measurement biases). Additionally, some studies were statistically underpowered.

These findings suggest that DBT-PTSD and DBT PE interventions are similarly effective in reducing PTSD and depressive symptoms among patients with comorbid BPD. Further support of the utility of these treatments is given by the observed improvements in dissociation, BPD symptoms, and NSSI frequency. Nevertheless, the authors mention the need for future research to systematically assess NSSI, BPD symptoms, and suicidality within stage-based treatment frameworks.

To conclude, this study supports evidence for the effectiveness of DBT-PTSD and DBT PE in treating PTSD among individuals with comorbid BPD symptoms. This article also highlights the importance of individual interventions for this subgroup and demonstrates the need for further research to optimize treatment outcomes.