Effectiveness of PTSD Treatment For Suicidal and Multi-Diagnostic Clients

Although several evidence-based treatments (EBTs) for post-traumatic stress disorder (PTSD)
have been found to be effective in research and community settings, individuals with PTSD who
are acutely suicidal, self-injuring, and/or have severe comorbid disorders are typically
excluded from these treatments. The Dialectical Behavior Therapy Prolonged Exposure (DBT PE)
protocol has been shown to be effective in treating PTSD among suicidal, self-injuring, and
multi-diagnostic individuals receiving Dialectical Behavior Therapy (DBT) in research
settings. The present project has two primary aims: (1) to examine the effectiveness of a
multi-component implementation strategy in improving adoption and adherence to the DBT PE
protocol, and (2) to evaluate the feasibility, acceptability, and effectiveness of the DBT PE
protocol in a sample of individuals receiving DBT in public mental health agencies. The
project will be conducted in collaboration with Philadelphia's Department of Behavioral
Health and Intellectual disAbility Services (DBHIDS). This study uses a hybrid type 2
effectiveness-implementation design to simultaneously test the clinical effectiveness of DBT
+ DBT PE and to evaluate an adaptive, multi-component implementation strategy. The
effectiveness trial will use a quasi-experimental, controlled design to evaluate outcomes
among DBT clients with PTSD who do versus do not receive the DBT PE protocol and outcomes
will be benchmarked to those obtained in research settings. Clinical effectiveness outcomes
include measures of PTSD, suicidality, global symptom severity, and quality of life and will
be assessed at four timepoints (baseline, 4, 8, and 12 months) using blinded independent
evaluators. The initial implementation strategy will include an implementation team, online
training, distribution of a treatment manual, in-person workshop, team-based clinical
consultation, and audit and feedback on session content. The implementation strategy will be
adapted as needed during the project using Plan-Do-Study-Act quality improvement methods.
Implementation outcomes include feasibility, acceptability, adoption, fidelity, penetration,
and sustainability of the DBT PE protocol and will be assessed via clinician surveys at 8
timepoints over 2 years (baseline, pre-training, post-training, 4, 8, and 12-months after
initial training during active implementation, and 6 and 12 months follow-up after
implementation is complete). Both effectiveness and implementation outcomes are being
assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat
analyses across multiple time points) and qualitative evaluation (e.g., surveys and
interviews with clients, clinicians, and agency administrators). Four public mental health
agencies with existing DBT programs will be recruited for participation. It is estimated that
this will yield a sample of 25 clinicians who will enroll a maximum of 3 clients each in the
effectiveness trial (n=75 clients total). The project will also engage an advisory board of
stakeholders in the DBHIDS system.

Inclusion Criteria:

- Meets criteria for PTSD

- Currently receiving DBT individual therapy with a clinician enrolled in the study

Exclusion Criteria:

- Not able to understand treatment and research assessments conducted in English