Comparing Dialectical Behavior Therapy with Prolonged Exposure to Standard Prolonged Exposure Therapy for Veterans with PTSD and Suicide Risk

What this Trial Is About

Posttraumatic Stress Disorder PTSD significantly increases suicide risk among Veterans, especially those who have engaged in self-directed violence SDV. This study evaluates two treatments for Veterans with PTSD and high suicide risk a combination of Dialectical Behavior Therapy DBT plus DBT Prolonged Exposure DBT PE, and Prolonged Exposure therapy with suicide risk management PE SRM, the current standard care. The trial aims to fill a critical knowledge gap by comparing these approaches and examining factors affecting their implementation in VA settings. Participants receive either one year of standard DBT combined with the DBT PE protocol or up to 18 sessions of Prolonged Exposure therapy augmented with suicide risk management. DBT includes individual therapy, group skills training, coaching, and team consultation, while DBT PE and PE involve in vivo and imaginal exposure with processing delivered in weekly individual therapy sessions. The study is a multi-site randomized controlled trial conducted in outpatient VA clinics, with assessments over 16 months. During the study, Veterans are assessed at five time points for self-injurious thoughts and behaviors, PTSD severity, suicide ideation, emotion regulation, mental health, and disability. Researchers use interviews, questionnaires, and clinical scales to measure outcomes and gather information on treatment engagement and implementation barriers. The total participation spans 16 months with ongoing monitoring to evaluate the effectiveness and feasibility of these therapies for high-risk Veterans.

Evaluating Treatments for Suicidal Veterans With PTSD