Effectiveness of combined dialectical behavior therapy and prolonged exposure in an intensive outpatient program for veterans.

Authors

Jacob Schachter, Zachary S Michal, Emily K Voller, Lindsay M Andrews Wiebusch, Matthew E Kaler, Craig A Marquardt

Published in

Psychological services. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Among veterans with borderline personality disorder (BPD), comorbidity with posttraumatic stress disorder (PTSD) is frequent. Clinicians are often hesitant to treat PTSD symptoms among this population, given the chronically elevated suicide risk. We examined the real-world effectiveness of an intensive outpatient program (IOP) with combined dialectical behavior therapy (DBT) and trauma-focused prolonged exposure (PE). Twelve weeks of full-model DBT was provided with PE administered simultaneously for approximately 6 weeks. Most veterans met criteria for both full-threshold PTSD (89%) and BPD (74%). Among the 180 veterans enrolled, 134 finished the protocol (74%). We observed large pre-posttreatment effect sizes for decreases in self-reported PTSD symptoms (d = 1.46), borderline symptomatology (d = 0.92), depression (d = 0.95), and anxiety (d = 0.81) as well as increases in DBT skills (d = -0.91). Medium effect sizes were found for decreases in subjective stress (d = 0.71), suicidal ideation and planning behaviors (d = 0.54), and dysfunctional coping (d = 0.68). On average across all clinical outcome measures, 52% of veterans experienced at least a partial response to treatment (≥30% score reduction), 49% demonstrated reliable changes, and 46% finished the program in at least partial remission (i.e., normative or subthreshold scores). These results are evidence for the effectiveness of DBT PE-style interventions, which can be delivered in IOPs for higher risk veterans with serious presentations of comorbid PTSD and BPD symptoms. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:
42474997
Bibliographic data and abstract were imported from PubMed on 20 Jul 2026.

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