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

Abstract

Individuals with Borderline Personality Disorder (BPD) and Complex Post-Traumatic Stress Disorder (C-PTSD) often face significant challenges in treatment due to the severity and complexity of their symptoms. Dialectical Behavior Therapy for PTSD (DBT-PTSD) is a phase-based, multicomponent psychotherapy developed to address the needs of this population. While its efficacy has been demonstrated in clinical trials, little is known about how patients and clinicians experience this treatment. This qualitative study explored the perspectives of six patients and five clinicians involved in DBT-PTSD at a university-affiliated mental health institute. Data were collected through individual interviews and focus groups at multiple time points and were analyzed inductively using Reflexive Thematic Analysis. Five themes were generated, including trauma-focused exposure as a main mechanism of change, the role of the therapeutic alliance in supporting engagement and treatment outcomes, the demanding nature of trauma-focused exposure, the tension between fidelity and flexibility within the protocol, and the influence of individual resources on patients’ experiences with at-home assignments. This is the first study to qualitatively examine DBT-PTSD, providing insights into its perceived relevance, challenges, and potential impact. These findings may contribute to clinical training, guide adaptations of the protocol, and contribute to refining trauma interventions for individuals with BPD and C-PTSD. This trial was retrospectively registered on 14 August 2025, ClinicalTrials.gov , TRN: NCT07123974