Patients and Clinicians Describe What It Is Like to Receive DBT-PTSD

A qualitative study published in Borderline Personality Disorder and Emotion Dysregulation has, for the first time, examined how patients and clinicians actually experience Dialectical Behavior Therapy for PTSD (DBT-PTSD), a phase-based, multicomponent psychotherapy developed for people living with both borderline personality disorder (BPD) and complex post-traumatic stress disorder (C-PTSD). While the therapy’s efficacy has been demonstrated in clinical trials, the researchers note that little has been known about how the treatment feels and functions from the inside — for those delivering it and those receiving it.

The study, led by Laurie Nadeau and colleagues, was conducted at a university-affiliated mental health institute. The team interviewed six patients and five clinicians who were involved in DBT-PTSD at the institute. Data were collected through individual interviews and focus groups at multiple time points, allowing the researchers to capture perspectives as the treatment unfolded rather than relying on a single retrospective snapshot.

Analysis followed Reflexive Thematic Analysis, an inductive qualitative method in which themes are generated from the data itself rather than tested against predetermined categories. From this process, the researchers derived five themes that together map the terrain of DBT-PTSD as it is experienced in routine clinical settings.

The first theme identifies trauma-focused exposure as the main mechanism of change perceived by participants.

Yet exposure came at a cost. A second theme captured the demanding nature of trauma-focused exposure, underscoring that the very component participants viewed as central to change was also experienced as arduous. A third theme highlighted the role of the therapeutic alliance in supporting engagement and treatment outcomes, suggesting that the relationship between patient and clinician may be a practical lever for helping patients persist through the hardest phases of the protocol.

The remaining themes concerned the conditions surrounding the therapy rather than its core techniques. One theme described a tension between fidelity and flexibility within the protocol — the recurring question, familiar across manualized psychotherapies, of how strictly the treatment model should be adhered to and where individual adaptation is appropriate. Another theme concerned the influence of individual resources on patients’ experiences with at-home assignments, indicating that patients’ personal circumstances and capacities shaped how the between-session work of the therapy could be carried out.

The authors frame the study as the first qualitative examination of DBT-PTSD, offering insights into its perceived relevance, challenges, and potential impact. They suggest the findings may contribute to clinical training, guide adaptations of the protocol, and help refine trauma interventions for individuals with BPD and C-PTSD — populations for whom treatment is often complicated by the interplay of emotion dysregulation and trauma-related symptoms.

Important caveats apply to how far these results can be generalized. The study drew on a small sample — eleven participants in total, six patients and five clinicians — at a single institution, and qualitative thematic analysis captures perceived experiences rather than measuring treatment effects. The trial was also retrospectively registered on 14 August 2025 on ClinicalTrials.gov (NCT07123974), meaning registration occurred after the research was underway. The published version is an early-release, peer-reviewed accepted article that remains subject to further edits before the final Version of Record.

Even with those limits, the study addresses a real gap. By documenting that exposure is seen as both the engine of change and its heaviest burden, and that the therapeutic alliance and patients’ personal resources shape whether people stay engaged, the findings give clinicians and protocol developers concrete, experience-based targets for training and adaptation.

Subject of Research: Qualitative analysis of patient and clinician experiences with DBT-PTSD for borderline personality disorder and complex PTSD

Article Title: Understanding stakeholder views on dialectical behavior therapy for post-traumatic stress disorder: a qualitative analysis of clinician and patient experiences

Article References: Nadeau, L., Larrivée, É., Paré, A.-S., Therriault, C., Taillefer, A., Charest, F., Hudon, A., Bérubé, F.-A., & Cailhol, L. (2026). Understanding stakeholder views on dialectical behavior therapy for post-traumatic stress disorder: a qualitative analysis of clinician and patient experiences. Borderline Personality Disorder and Emotion Dysregulation. https://doi.org/10.1186/s40479-026-00361-3

Image Credits: AI Generated

DOI: 10.1186/s40479-026-00361-3

Keywords: DBT-PTSD, borderline personality disorder, complex PTSD, qualitative research, trauma-focused exposure, therapeutic alliance, Reflexive Thematic Analysis, psychotherapy, mental health, treatment fidelity, Understanding, stakeholder