Treating PTSD in Patients with Borderline Personality Disorder

描述（由申请人提供）：边缘型人格障碍（BPD）患者是典型的多问题患者，通常以许多功能障碍行为和合并症诊断来治疗。辩证行为疗法（DBT）是一种全面的认知行为治疗BPD的方法，已被证明可以有效地减少其设计治疗的主要问题；即，自残和自杀行为的频率和严重程度，治疗的维持，以及生活中的严重问题。然而，DBT治疗手册目前并没有规定何时或如何治疗创伤后应激障碍（PTSD），这是一种普遍存在于BPD患者中的合并症诊断，可能维持或加剧BPD标准行为。同样，许多现有的创伤后应激障碍治疗结果研究排除了自杀、药物滥用和多重诊断患者，因此很难确定这些方法对BPD患者的普遍性。本研究拟针对BPD患者制定一种基于延长暴露疗法治疗PTSD的方案，并将其纳入标准DBT，并对该方案的可行性、可接受性和疗效进行初步评估。治疗开发和试点测试过程将分两个阶段进行，包括通过临床预测试制定措施和使治疗方案标准化（第一阶段）；通过随机对照试验（RCT）比较标准DBT + PTSD治疗方案和标准DBT治疗方案（第二阶段），对干预措施进行试点和可行性测试。在试点RCT期间收集的信息将用于后续全面RCT的设计和实施。这项研究有可能显著扩展和改进目前可用于BPD的最具经验支持的治疗方法，同时也证明了暴露治疗创伤后应激障碍可以在BPD人群中安全有效地实施。边缘型人格障碍（BPD）是一种严重的、通常是致命的、代价高昂的公共卫生问题。至关重要的是，研究人员继续扩展和改进现有的有效治疗BPD的方法，本应用程序通过开发治疗PTSD的协议来解决这个问题，该协议可以添加到辩证行为治疗手册中。

DESCRIPTION (provided by applicant): Individuals with borderline personality disorder (BPD) are the quintessential multi-problem patients, often presenting to treatment with numerous dysfunctional behaviors and comorbid diagnoses. Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral treatment for BPD that has been shown effective in reducing the primary problems it is designed to treat; namely, the frequency and severity of self-injurious and suicidal behavior, maintenance in treatment, and severe problems in living. However, the DBT treatment manual does not currently include a protocol specifying when or how to treat posttraumatic stress disorder (PTSD), a comorbid diagnosis that is prevalent in BPD patients and may maintain or exacerbate BPD criterion behaviors. Similarly, many of the existing treatment outcome studies for PTSD have excluded suicidal, substance abusing, and multiply diagnosed patients, thereby making it difficult to determine the generalizability of these approaches to individuals with BPD. The research proposed here is focused on the development of a protocol based on Prolonged Exposure therapy to treat PTSD in BPD patients that can be integrated into standard DBT, as well as the initial evaluation of this protocol's feasibility, acceptability, and efficacy. The treatment development and pilot testing process will occur in two phases, including measure development and standardization of the treatment protocol via clinical pre-testing (Phase 1); and pilot and feasibility testing of the intervention via a randomized controlled trial (RCT) comparing standard DBT + PTSD Protocol to standard DBT Only (Phase 2). Information gathered during the pilot RCT will be used to inform the design and conduct of a subsequent full-scale RCT. This research has the potential to significantly expand and improve upon the most empirically supported treatment currently available for BPD, while also demonstrating that exposure treatments for PTSD can be implemented safely and effectively in a BPD population. Borderline Personality Disorder (BPD) is a serious, often lethal, and expensive public health problem. It is critical that researchers continue to expand and improve upon existing efficacious treatments for BPD, and this application addresses this by developing a protocol for treating PTSD that can be added to the Dialectical Behavior Therapy manual.