Academic Journal
Does impulsivity predict treatment outcomes in PTSD with borderline personality disorder features? Results from a randomized clinical trial.
| Τίτλος: | Does impulsivity predict treatment outcomes in PTSD with borderline personality disorder features? Results from a randomized clinical trial. |
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| Συγγραφείς: | Enning F; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim, Heidelberg, Ulm, Germany. Electronic address: frank.enning@zi-mannheim.de., Bohus M; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim, Heidelberg, Ulm, Germany; McLean Hospital, Harvard Medical School, Boston, USA; Department of Clinical Psychology and Psychotherapy, Ruhr-University Bochum, Germany., Priebe K; Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin, Berlin, Germany., Steil R; Institute of Psychology, Goethe University Frankfurt Am Main, Frankfurt, Germany., Görg N; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany., Müller-Engelmann M; Faculty Human Sciences, Department Psychology, Medical School Hamburg, Hamburg, Germany., Roth M; Department of Psychology, Chair of Psychotherapy and Somatopsychology, Humboldt-Universität zu Berlin, Berlin, Germany., Schmahl C; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim, Heidelberg, Ulm, Germany., Kleindienst N; Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim, Heidelberg, Ulm, Germany. |
| Πηγή: | Journal of psychiatric research [J Psychiatr Res] 2026 Nov; Vol. 202, pp. 152-159. Date of Electronic Publication: 2026 Aug 13. |
| Τύπος έκδοσης: | Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Pergamon Press Country of Publication: England NLM ID: 0376331 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1379 (Electronic) Linking ISSN: 00223956 NLM ISO Abbreviation: J Psychiatr Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Pergamon Press |
| Ιατρικοί όροι (MeSH): | Borderline Personality Disorder*/therapy , Borderline Personality Disorder*/complications , Borderline Personality Disorder*/psychology , Impulsive Behavior*/physiology , Stress Disorders, Post-Traumatic*/therapy , Stress Disorders, Post-Traumatic*/complications , Stress Disorders, Post-Traumatic*/psychology , Cognitive Behavioral Therapy*/methods , Dialectical Behavior Therapy*/methods, Humans ; Female ; Adult ; Treatment Outcome ; Psychiatric Status Rating Scales |
| Περίληψη: | Background: Trauma-focused psychotherapies are first-line treatments for posttraumatic stress disorder (PTSD). However, a substantial proportion of clients do not respond adequately or drop out of therapy prematurely. This has sparked interest in identifying individual-level predictors of treatment outcomes, including improvement in PTSD severity and dropout. Impulsivity may be a predictor because it may interfere with key therapeutic processes, such as cognitive restructuring and emotional processing. Consequently, we present a hypothesis-driven secondary analysis of a 15-month randomized clinical trial comparing Dialectical Behavior Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) in women with childhood abuse-related PTSD and borderline personality disorder features to test whether impulsivity, assessed at baseline, predicts PTSD improvement and dropout. We further explore whether the dimensions of impulsivity (non-planning, attentional impulsivity, and motor impulsivity) differentially affect the outcomes in DBT-PTSD vs. CPT. Methods: A total of 193 cis women with PTSD related to childhood abuse and borderline personality disorder features were assessed using the Clinician-Administered PTSD Scale (CAPS) and the Barratt Impulsiveness Scale (BIS-10). Separate probit models and general linear models were applied to predict dropout and pre-to-post changes in PTSD severity (ΔCAPS) from total impulsivity and subscale scores, i.e. non-planning, attentional and motor impulsivity. Results: Overall, dropout rates were higher for participants with higher baseline impulsivity scores (p = 0.049), particularly for those with higher non-planning impulsivity (p = 0.012). In participants randomized to CPT improvement in PTSD symptom severity (ΔCAPS) was negatively related to baseline total impulsivity (p = 0.021). In participants randomized to DBT-PTSD this relation was not significant. Conclusions: The results suggest that impulsivity may predict treatment outcomes. Specifically, patients with elevated impulsivity may be less likely to respond adequately to CPT. If replicated, these findings have implications for personalization of treatment. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Declaration of competing interests No potential conflict of interest was reported by the authors. |
| Contributed Indexing: | Keywords: Childhood abuse; Dialectical behavior therapy; Impulsivity; Posttraumatic stress disorder; Psychotherapy |
| Entry Date(s): | Date Created: 20260819 Date Completed: 20260907 Latest Revision: 20260917 |
| Update Code: | 20260917 |
| DOI: | 10.1016/j.jpsychires.2026.08.017 |
| PMID: | 42617371 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1879-1379 |
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| DOI: | 10.1016/j.jpsychires.2026.08.017 |