Intrusive Memory Frequency and Related Inner Tension Following Dialectical Behavior Therapy or Cognitive Processing...

Intrusive memories are a core symptom of posttraumatic stress disorder (PTSD), yet their retrospective assessment is prone to biases, making real-time methods such as e-diaries essential. While trauma-focused treatments target intrusive symptoms, their efficacy has not yet been evaluated using real-time assessments.

This study aimed to use e-diaries to assess and compare the effects of dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on intrusive memories and related inner tension in a large sample of women with childhood abuse-related PTSD and co-occurring borderline personality disorder (BPD) symptoms.

In a multicenter randomized controlled trial, 193 women with PTSD related to childhood sexual or physical abuse and at least 3 BPD criteria were randomized to receive either DBT-PTSD or CPT. e-Diary assessments were conducted at 3 time points: before treatment, after 6 months, and after 12 months of therapy. At each time point, participants reported intrusive memories and related inner tension over 5 consecutive days using an event-based design.

Both intrusive memories and related inner tension decreased significantly over time (intrusions: ß=-0.53, P<.001; inner tension: ß=-0.15, P<.001). While reductions in intrusion frequency did not differ significantly between treatment groups (ß=0.05, P=.45), DBT-PTSD was associated with significantly greater reductions in intrusion-related inner tension compared with CPT (ß=-0.16, P<.001).

This study provides the first real-time evaluation of trauma-focused PTSD treatments using e-diaries in daily life. Both interventions were associated with reduced intrusion frequency, while DBT-PTSD showed greater reductions in associated emotional distress-potentially reflecting its emphasis on emotion-regulation strategies and distress tolerance, which may be particularly relevant for individuals with comorbid BPD symptoms. These findings highlight the value of e-diaries for capturing treatment-related symptom change in ecologically valid contexts.