Project Grant R34MH124968

A PILOT EFFECTIVENESS TRIAL OF COGNITIVE PROCESSING THERAPY AUGMENTED WITH SUICIDE RISK MANAGEMENT FOR INDIVIDUALS WITH COMORBID PTSD AND BPD - 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.