Supplementary Material for: Dialectical Behaviour Therapy for Post-traumatic Stress Disorder after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial

Background: Post-traumatic stress disorder (PTSD) with co-occurring severe psychopathology such as borderline personality disorder (BPD) is a frequent sequel of childhood sexual abuse (CSA). CSA-related PTSD has been effectively treated through cognitive-behavioural treatments, but it remains unclear whether success can be achieved in patients with co-occurring BPD. The aim of the present study was to determine the efficacy of a newly developed modular treatment programme (DBT-PTSD) that combines principles of dialectical behaviour therapy (DBT) and trauma-focused interventions. Methods: Female patients (n = 74) with CSA-related PTSD were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. About half of the participants met the criteria for co-occurring BPD. Individuals with ongoing self-harm were not excluded. The primary outcomes were reduction of PTSD symptoms as assessed by the Clinician-Administered PTSD Scale (CAPS) and by the Posttraumatic Stress Diagnostic Scale (PDS). Hierarchical linear models were used to compare improvements across treatment groups. Assessments were carried out by blinded raters at admission, at end of treatment, and at 6 and 12 weeks post-treatment. Results: Under DBT-PTSD the mean change was significantly greater than in the control group on both the CAPS (33.16 vs. 2.08) and the PDS (0.70 vs. 0.14). Between-group effect sizes were large and highly significant. Neither a diagnosis of BPD nor the severity or the number of BPD symptoms was significantly related to treatment outcome. Safety analyses indicated no increase in dysfunctional behaviours during the trial. Conclusion: DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.

研究背景：伴随共病严重精神病理（如边缘型人格障碍（borderline personality disorder, BPD））的创伤后应激障碍（Post-traumatic stress disorder, PTSD）是儿童性虐待（childhood sexual abuse, CSA）的常见后遗症。针对与儿童性虐待相关的创伤后应激障碍，认知行为治疗（cognitive-behavioural treatments）已被证实可取得良好疗效，但对于共病边缘型人格障碍的患者，此类治疗是否同样有效仍不明确。
研究方法：本研究共纳入74名与儿童性虐待相关的创伤后应激障碍女性患者，将其随机分配至12周住院式DBT-PTSD治疗组，或常规治疗等待对照组。约半数受试者符合共病边缘型人格障碍的诊断标准，存在持续性自伤行为的受试者未被排除入组。本研究的主要结局指标为通过临床医师评定的创伤后应激障碍量表（Clinician-Administered PTSD Scale, CAPS）与创伤后应激障碍诊断量表（Posttraumatic Stress Diagnostic Scale, PDS）评估得到的创伤后应激障碍症状减分情况。采用分层线性模型比较两组患者的症状改善程度，由盲法评定者在入组时、治疗结束时以及治疗后6周、12周分别进行评估。
研究结果：DBT-PTSD组的症状平均改善幅度显著优于对照组：临床医师评定的创伤后应激障碍量表得分平均变化量为33.16 vs. 2.08，创伤后应激障碍诊断量表得分平均变化量为0.70 vs. 0.14。组间效应量较大且具有高度统计学显著性。是否诊断为边缘型人格障碍，以及边缘型人格障碍症状的严重程度与症状数量，均与治疗结局无显著相关性。安全性分析显示，试验期间功能失调性行为并未出现增加。
研究结论：DBT-PTSD是治疗与儿童性虐待相关的创伤后应激障碍的有效方案，即便患者共病边缘型人格障碍等严重精神病理情况亦然。