7. Project Summary
This project is a pilot effectiveness trial designed to evaluate Cognitive Processing Therapy
augmented with a suicide risk management protocol (CPT+SRM), as a viable treatment for
individuals with comorbid posttraumatic stress disorder (PTSD) and borderline personality
disorder (BPD). PTSD is a significant public health problem associated with debilitating
outcomes such as suicide, employment difficulties, and family disruption. These outcomes are
further compounded when PTSD is comorbid with BPD. The comorbidity of PTSD and BPD
(PTSD-BPD) is as high as 58% and is associated with even greater functional impairment (e.g.,
suicide risk) and, subsequently, healthcare utilization than either disorder alone. Despite the
clinical and economic burden associated with PTSD-BPD, few treatments exist for this
population and emerging treatments are lengthy, intensive, resource-heavy, and difficult to
sustain in real-world community settings. Using an experimental therapeutics approach, this
proposal evaluates CPT+SRM as a parsimonious, integrative intervention that targets key
mechanisms shared across PTSD and BPD- i.e., emotional reactivity and cognitive dysfunction.
The Stanford Outpatient General Adult Psychosocial Treatment Clinic will serve as the
treatment site and study therapists will be community clinicians with part-time appointments at
the clinic. Phase 1 of this investigation will consist of an initial case series (N=5) in which we will
develop and iterate the manual, develop fidelity measures, and streamline our research
procedures. The finalized treatment manual will then be tested in Phase 2, a randomized-
controlled trial (N=28) comparing 12 individual sessions/6 weeks of CPT+SRM (n=14) versus 6
weeks of SRM only (n=14). Participants will be assessed at pre-treatment, mid-treatment/3-
weeks, post-treatment/6-weeks, and 3-month post-treatment follow-up. Aim 1 will be to evaluate
the feasibility, acceptability, and safety of CPT+SRM. Aim 2 will be to preliminarily evaluate the
effectiveness of CPT+SRM. Aim 3 will be to examine the relationship between change in our
putative target mechanisms (measured using self-report, behavioral, and physiological
indicators), and primary clinical outcomes (i.e., PTSD and BPD severity). The long-term
objective of this research is to conduct a subsequent large-scale intervention trial through an
R01 mechanism and ultimately enhance service delivery and accessibility of care for this
clinically complex and economically burdensome population.
