Hybrid Dialectical Behavior Therapy for Veterans to Further Reduce Emotion Regulation Problems and Trauma Symptoms

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Overview

Around 10% of post-active veterans experience post-traumatic stress disorder (PTSD) many years post-mission. PTSD in veterans is frequently associated with challenges in emotion regulation, aggression, suicidality, and financial and psychosocial stress. In 2018, a 12-week clinical treatment programme, the Veterans Intensive Treatment Unit (VIBU), was developed for veterans experiencing these psychiatric symptoms, for whom conventional treatments had proven ineffective. The VIBU provides patients with trauma-focused and dialectical behaviour therapy (DBT). A recent study revealed that the VIBU was effective in reducing psychiatric symptoms. However, a recurrence of symptoms was observed in patients a few months after discharge. Consequently, an aftercare programme consisting of hybrid DBT is offered to consolidate and repeat the DBT skills and apply them in daily life.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

PTSD Emotion Regulation Disorders Substance Abuse

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult veteran (18 years or older), treated at Sinai Center, with knowledge of DBT * Primairy diagnosis of PTSD, determined with CAPS-5, resulting from war-related traumas * Stable for four weeks on their medication (type and doses) * Able to to do online homework assignments and communicate with their therapist via an eHealth platform * Dutch speaking Exclusion Criteria: * Chronic psychosis (psychotic features as comorbidity from PTSD is allowed) or bipolar disorder type 1 * IQ below 80 or cognitive disorders * Severe self-harming behaviour, such as auto-mutilation or suicidal ideations as main problem * Following day treatments or other intensive treatment for residual symptoms

Outcomes

Primary Outcomes

PTSD Checklist for the DSM-5 (PCL-5)

One of the two main outcomes of this study is PTSD symptom score. The self-report questionnaire contains 20 questions with answer options ranging from '0 = Not at all' to '4 = Extremely', resulting in a score between 0-80. A higher score indicates more likelyhood of having PTSD.

Time frame: From the baseline to the end of the follow-up period (between 12-17 months)

Difficulties in Emotion Regulation Scale Short Form (DERS-SF)

One of the two main outcomes of this study is emotion dysregulation severity. The self-report questionnaire contains 18 questions with answer options from '1 = Almost never' to '5 = Almost always', resulting in a score between 18-90. A higher score indicates more difficulties with regulation emotions.

Time frame: From the baseline to the end of the follow-up period (between 12-17 months)

Secondary Outcomes

REFRESH - monitoring

Weekly short questionnaire (i.e., 10 questions) specifically tailored to this population to monitore PTSD, emotion regulation, substance use and DBT skills. Answer options range from '1 = Totally disagree' to '10 = Totally agree', resulting in a score between 10-100. A higher score means a worse outcome.

Time frame: From enrollment to (favourably) the end of the follow-up period (between 12-17 months)