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June 14, 2026Open Access

The combination of dialectical behavioral skills training with EMDR in the treatment of borderline personality disorder and psychological trauma: a feasibility randomized trial

Key Points

This study aims to assess the feasibility and preliminary efficacy of combining dialectical behavioral therapy skills training with EMDR for treating BPD and trauma.
Forty-two participants with BPD and trauma were enrolled.
Participants underwent a 6-month DBT-ST group, followed by randomization into DBT-ST continuation or DBT-ST+EMDR.
Feasibility and acceptability were evaluated through qualitative interviews and clinical assessments at multiple time points.
62% retention from baseline to post phase 2, with 81.2% in the DBT-ST group and 72.2% in DBT-ST+EMDR.
DBT-ST+EMDR significantly reduced dissociative symptoms from baseline to post phase 2, while both conditions reduced BPD symptoms.
Qualitative feedback indicated the sequential approach was acceptable and beneficial for preparing participants for trauma work.

Abstract

Comorbid borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) predict poorer treatment outcomes. Available treatments for BPD and psychological trauma are often phase-based, first ensuring stabilization of dysregulated behaviors and emotions and later focusing on treating trauma. This study investigates the feasibility, acceptability, and preliminary efficacy of combining dialectical behavioral therapy group skills training (DBT-ST), consisting of mindfulness, emotion regulation, distress tolerance, and interpersonal-effectiveness skills, with eye movement desensitization and reprocessing (EMDR) individual therapy for patients with BPD and psychological trauma. Forty-two participants with BPD and psychological trauma (40 females, mean age = 28.5, SD = 9.2) participated in the study. All participants underwent an initial 6-month DBT-ST group (phase 1), then those randomized to the experimental group received EMDR, and those in the control condition continued DBT-ST (phase 2). Feasibility and acceptability were assessed through qualitative interviews. Additionally, borderline personality disorder symptoms and trauma-related symptoms were measured as secondary clinical outcomes. Assessments were conducted at baseline, post phase 1, and post phase 2. Overall retention from baseline to post phase 2 was 62%. Descriptively, retention was 81.2% in the DBT-ST continuation group and 72.2% in the DBT-ST+EMDR group, though this difference was not statistically significant. Qualitative interviews suggested that the sequential design was acceptable, and that DBT-ST helped some participants feel more prepared for subsequent trauma-focused work, although these findings are based on a small qualitative subsample. Both conditions reduced BPD symptoms, while only the DBT-ST+EMDR condition significantly reduced dissociative symptoms from baseline to post phase 2. A definitive, fully powered randomized clinical trial is warranted to confirm these findings and optimize the integration of DBT-ST and EMDR. Clinical Trials, NCT04856449. Registered on 08-04-2021.

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