Veterans regaining control; preliminary effects of inpatient Dialectical Behavior Therapy based PTSD treatment

Introduction: Trauma-focused therapy (TFT) is highly effective in posttraumatic stress disorder (PTSD). However, there is some evidence that TFT is less effective in specific groups, such as veterans and people with comorbid personality disorders, emotion regulation problems or substance use disorders.Aim: In this pre-post pilot study, we investigated feasibility and effectiveness of a 12-week veteran intensive treatment consisting of integrated Dialectical Behavior Therapy (DBT) and TFT, in Dutch veterans with PTSD, comorbid emotion regulation and/or substance use problems.Results: Self-reported PTSD symptoms (PCL-5) showed a statistically significant decrease from pre- to posttreatment, with a large effect size (Cohen's d = 2.92), as well as general psychiatric symptoms (OQ-45, Cohen's d = 1.85). Self-efficacy (Dutch SES) significantly increased with a medium effect size (Cohen's d = 0.80). Reduction of total score of borderline personality symptoms (PAI-BOR) did not reach statistical significance, although its subscale affective instability showed a statistically significant medium decrease (Cohen's d = 0.59). Feasibility of implementation of the treatment programme was sufficiently good, with a response rate on posttreatment measurements of 66% and 50% at 6 and 10 weeks respectively. Patients who did not completed the posttreatment measurements did not significantly differ on primary and secondary outcome measures from completers.Conclusion: Feasibility and preliminary results from the 12-week DBT-based veteran intensive treatment programme are positive. This provides hope and opportunity for this patient group with a generally less positive response to regular evidence-based PTSD treatments.