Narrative Exposure Therapy in Women With Borderline Personality Disorder and Posttraumatic Stress Disorder

Sponsor

Evangelisches Krankenhaus Bielefeld gGmbH (Other)

Overall Status

Completed

CT.gov ID

NCT02517723

Collaborator

(none)

Enrollment

Location

Arms

Actual Duration (Months)

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Narrative Exposure Therapy (NET) is an evidence-based trauma-focussed treatment, suitable for survivors of prolonged and repeated exposure to traumatic stress and childhood adversity. Patients with Borderline Personality Disorder (BPD) often suffer from a comorbid Posttraumatic Stress Disorder (PTSD) caused by multiple traumatic events. Therapeutic aims are the reduction of PTSD-Symptoms in these patients via activation of associative neural networks related to traumatic experiences and habituation of fear and the placement of traumatic experiences in a reconstructed, detailed and consistent autobiography. This practice enables the processing of and coping with painful memories and the construction of clear contingencies of dangerous and safe conditions, generally leading to significant emotional recovery. The investigators assume that using NET the reduction of PTSD symptom severity is greater compared to treatment by Dialectical-Behavioral Therapy (DBT).

Condition or Disease	Intervention/Treatment	Phase
Borderline Personality Disorder Stress Disorders, Post-Traumatic	Behavioral: Narrative Exposure Therapy Behavioral: Dialectical Behavior Therapy Behavioral: Standard Inpatient Care Other: Waiting List	N/A

Study Design

Study Type:

Interventional

Actual Enrollment :

67 participants

Allocation:

Randomized

Intervention Model:

Factorial Assignment

Masking:

Single (Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

A Randomized Controlled Clinical Trial (RCCT) to Test the Effectiveness of Narrative Exposure Therapy (NET) Versus Dialectical-Behavioral Therapy in Reducing Trauma Related Symptoms in Women Suffering From Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD)

Actual Study Start Date :

Apr 1, 2014

Actual Primary Completion Date :

Jan 31, 2020

Actual Study Completion Date :

Jan 31, 2020

Arms and Interventions

Arm	Intervention/Treatment
Experimental: SIC + NET Waiting List + Standard Inpatient Care + Narrative Exposure Therapy	Behavioral: Narrative Exposure Therapy Narrative Exposure Therapy (NET) is based on Testimony Therapy in combination with cognitive behavioural exposure techniques and elements of client-centered counselling. The clients can restore their autobiographic memories about their traumatic experiences. In this way fragmentary memories are transformed into a coherent narrative structure. This practice enables the processing of painful emotions and the construction of clear contingencies of dangerous and safe conditions, generally leading to significant emotional recovery. Therapeutic aims are the reduction of PTSD-Symptomload via activation of fear-network and habituation of fear and the placement of traumatic experiences in a reconstructed, detailed and consistent autobiography. NET will be applied in eight sessions (90-120min/session) in a standardized, manualized manner. Other Names: NET Behavioral: Standard Inpatient Care Unspecific group therapy that is identical in both groups (music therapy etc.) Other Names: SIC Other: Waiting List Treatment as usual in the community (no DBT, no exposure of trauma memories)
Active Comparator: SIC + DBT Waiting List + Standard Inpatient Care + Dialectical Behavior Therapy	Behavioral: Dialectical Behavior Therapy Dialectical behavior therapy is a cognitive behavioral treatment program developed by Marsha Linehan to treat suicidal clients meeting criteria for BPD. It directly targets suicidal behavior, behaviors that interfere with treatment delivery, and other dangerous, severe, or destabilizing behaviors. Via standard DBT patients improve behavioral capabilities, motivation for skillful behavior, generalization of gains to the natural environment, structuring the treatment environment so that it reinforces functional rather than dysfunctional behaviors. It also targets the therapist capabilities and motivation to treat patients effectively. Patients get weekly individual psychotherapy (1 h/wk), group skills training (3.75 h/wk), a weekly therapist consultation team meetings. Other Names: DBT Behavioral: Standard Inpatient Care Unspecific group therapy that is identical in both groups (music therapy etc.) Other Names: SIC Other: Waiting List Treatment as usual in the community (no DBT, no exposure of trauma memories)

Arm

Intervention/Treatment

Experimental: SIC + NET

Waiting List + Standard Inpatient Care + Narrative Exposure Therapy

Behavioral: Narrative Exposure Therapy

Narrative Exposure Therapy (NET) is based on Testimony Therapy in combination with cognitive behavioural exposure techniques and elements of client-centered counselling. The clients can restore their autobiographic memories about their traumatic experiences. In this way fragmentary memories are transformed into a coherent narrative structure. This practice enables the processing of painful emotions and the construction of clear contingencies of dangerous and safe conditions, generally leading to significant emotional recovery. Therapeutic aims are the reduction of PTSD-Symptomload via activation of fear-network and habituation of fear and the placement of traumatic experiences in a reconstructed, detailed and consistent autobiography. NET will be applied in eight sessions (90-120min/session) in a standardized, manualized manner.

Other Names:

NET

Behavioral: Standard Inpatient Care

Unspecific group therapy that is identical in both groups (music therapy etc.)

Other Names:

SIC

Other: Waiting List

Treatment as usual in the community (no DBT, no exposure of trauma memories)

Active Comparator: SIC + DBT

Waiting List + Standard Inpatient Care + Dialectical Behavior Therapy

Behavioral: Dialectical Behavior Therapy

Dialectical behavior therapy is a cognitive behavioral treatment program developed by Marsha Linehan to treat suicidal clients meeting criteria for BPD. It directly targets suicidal behavior, behaviors that interfere with treatment delivery, and other dangerous, severe, or destabilizing behaviors. Via standard DBT patients improve behavioral capabilities, motivation for skillful behavior, generalization of gains to the natural environment, structuring the treatment environment so that it reinforces functional rather than dysfunctional behaviors. It also targets the therapist capabilities and motivation to treat patients effectively. Patients get weekly individual psychotherapy (1 h/wk), group skills training (3.75 h/wk), a weekly therapist consultation team meetings.

Other Names:

DBT

Behavioral: Standard Inpatient Care

Unspecific group therapy that is identical in both groups (music therapy etc.)

Other Names:

SIC

Other: Waiting List

Treatment as usual in the community (no DBT, no exposure of trauma memories)

Outcome Measures

Primary Outcome Measures

Change from first investigation in Posttraumatic Symptom Severity at 18 months (Clinician-Administered PTSD Scale; CAPS) [first investigation (t1), after waiting list (3 months, t2), directly after therapy (3 months, t1), 1 year after therapy (15 months, t3)]

Secondary Outcome Measures

Change from first investigation in Borderline Symptome Severity at 18 months(Borderline Symptom Liste; BSL) [first investigation (t1), after waiting list (3 months, t2), directly after therapy (6 months, t3), 1 year after therapy (18 months, t4)]
Change from first investigation in Severity of Dissociative Symptoms at 18 months (Fragebogen zu Dissoziativen Symptome ;FDS) [first investigation (t1), after waiting list (3 months, t2), directly after therapy (6 months, t3), 1 year after therapy (18 months, t4)]
Change from first investigation in Severity of Depressive Symptoms at 18 months (Becks Depressions Inventar II, BDI-II) [first investigation (t1), after waiting list (3 months, t2), directly after therapy (6 months, t3), 1 year after therapy (18 months, t4)]
Change from first investigation in Quality of Life at 12 months (WHO-Qualitiy of Life; WHOQOL) [first investigation (t1), after waiting list (3 months, t2), directly after therapy (6 months, t3), 1 year after therapy (18 months, t4)]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 65 Years

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

age ≥ 18 years
DSM-IV-TR diagnoses of BPD and PTSD
legal competence
none or stable medication
illegal drug abstinence for at least the last 6 months
capacity to consent and contract

Exclusion Criteria:

other severe mental disorders (e.g., bipolar disorder, acute psychosis)
simultaneous consumption of drugs
simultaneous participation in other treatment-studies
pregnancy or breastfeeding
lack of capability to negotiate a no-suicide agreement
suicide attempt or attempts during the 8 weeks prior to start of treatment
perpetrator-contact
Body Mass Index (BMI) < 16

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Clinic of Psychiatry, Evangelisches Krankenhaus Bielefeld	Bielefeld		Germany	33617

Sponsors and Collaborators

Evangelisches Krankenhaus Bielefeld gGmbH

Investigators

Study Director: Carolin Steuwe, M.Sc., Clinic of Psychiatry, Evangelisches Krankenhaus Bielefeld
Principal Investigator: Martin Driessen, Prof. Dr. med., Clinic of Psychiatry, Evangelisches Krankenhaus Bielefeld