{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T02:36:06Z","timestamp":1785206166775,"version":"3.55.0"},"reference-count":29,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Intrusive memories are a core symptom of posttraumatic stress disorder (PTSD), yet their retrospective assessment is prone to biases, making real-time methods such as e-diaries essential. While trauma-focused treatments target intrusive symptoms, their efficacy has not yet been evaluated using real-time assessments.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to use e-diaries to assess and compare the effects of dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on intrusive memories and related inner tension in a large sample of women with childhood abuse\u2013related PTSD and co-occurring borderline personality disorder (BPD) symptoms.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In a multicenter randomized controlled trial, 193 women with PTSD related to childhood sexual or physical abuse and at least 3 BPD criteria were randomized to receive either DBT-PTSD or CPT. e-Diary assessments were conducted at 3 time points: before treatment, after 6 months, and after 12 months of therapy. At each time point, participants reported intrusive memories and related inner tension over 5 consecutive days using an event-based design.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Both intrusive memories and related inner tension decreased significantly over time (intrusions: \u00df=\u20130.53,\n P<\/jats:italic>\n <.001; inner tension: \u00df=\u20130.15,\n P<\/jats:italic>\n <.001). While reductions in intrusion frequency did not differ significantly between treatment groups (\u00df=0.05,\n P<\/jats:italic>\n =.45), DBT-PTSD was associated with significantly greater reductions in intrusion-related inner tension compared with CPT (\u00df=\u20130.16,\n P<\/jats:italic>\n <.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study provides the first real-time evaluation of trauma-focused PTSD treatments using e-diaries in daily life. Both interventions were associated with reduced intrusion frequency, while DBT-PTSD showed greater reductions in associated emotional distress\u2014potentially reflecting its emphasis on emotion-regulation strategies and distress tolerance, which may be particularly relevant for individuals with comorbid BPD symptoms. These findings highlight the value of e-diaries for capturing treatment-related symptom change in ecologically valid contexts.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/81081","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:10:07Z","timestamp":1762956607000},"page":"e81081-e81081","source":"Crossref","is-referenced-by-count":2,"title":["Intrusive Memory Frequency and Related Inner Tension Following Dialectical Behavior Therapy or Cognitive Processing Therapy for Posttraumatic Stress Disorder: An e-Diary Study"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4496-7398","authenticated-orcid":false,"given":"Sara E","family":"Schmitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2769-5944","authenticated-orcid":false,"given":"Ulrich W","family":"Ebner-Priemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1696-2488","authenticated-orcid":false,"given":"Nikolaus","family":"Kleindienst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8155-8692","authenticated-orcid":false,"given":"Franziska","family":"Friedmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-3608","authenticated-orcid":false,"given":"Martin","family":"Bohus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5367-5664","authenticated-orcid":false,"given":"Regina","family":"Steil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0015-6983","authenticated-orcid":false,"given":"Meike","family":"M\u00fcller-Engelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6332-397X","authenticated-orcid":false,"given":"Matthias F","family":"Limberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8449-4017","authenticated-orcid":false,"given":"Lisa-Marie","family":"Hartnagel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2733-701X","authenticated-orcid":false,"given":"Philip","family":"Santangelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2662-7509","authenticated-orcid":false,"given":"Kathlen","family":"Priebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Publishing; 2013. ISBN: 9780890425558","DOI":"10.1176\/appi.books.9780890425596"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/s0005-7967(99)00069-8","article-title":"Dysfunctional meaning of posttraumatic intrusions in chronic PTSD","volume":"38","author":"Steil","journal-title":"Behav Res Ther"},{"issue":"3","key":"R3","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1037\/pas0000486","article-title":"The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): development and initial psychometric evaluation in military veterans","volume":"30","author":"Weathers","journal-title":"Psychol Assess"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2018.08.005","article-title":"Intrusive memories of trauma: a target for research bridging cognitive science and its clinical application","volume":"69","author":"Iyadurai","journal-title":"Clin Psychol Rev"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1023\/B:JOTS.0000029266.88369.fd","article-title":"Characteristics and content of intrusive memories in PTSD and their changes with treatment","volume":"17","author":"Hackmann","journal-title":"J Trauma Stress"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.brat.2004.04.006","article-title":"Unwanted memories of assault: what intrusion characteristics are associated with PTSD?","volume":"43","author":"Michael","journal-title":"Behav Res Ther"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/s10862-016-9540-3","article-title":"The expression of posttraumatic stress symptoms in daily life: a review of experience sampling methodology and daily diary studies","volume":"38","author":"Chun","journal-title":"J Psychopathol Behav Assess"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1037\/a0033816","article-title":"Frequency of intrusions and flashbacks in patients with posttraumatic stress disorder related to childhood sexual abuse: an electronic diary study","volume":"25","author":"Priebe","journal-title":"Psychol Assess"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1409062","article-title":"Trauma-related memories in PTSD after interpersonal violence: an ambulatory assessment study","volume":"8","author":"Kleindienst","journal-title":"Eur J Psychotraumatol"},{"key":"R10","doi-asserted-by":"crossref","unstructured":"Sch\u00e4fer I Gast U Hofmann A Knaevelsrud C Lampe A Liebermann P et al. S3-Leitlinie Posttraumatische Belastungsst\u00f6rung. Springer; 2019. ISBN: 9783662597828","DOI":"10.1007\/978-3-662-59783-5"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1159\/000348451","article-title":"Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: a randomised controlled trial","volume":"82","author":"Bohus","journal-title":"Psychother Psychosom"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40479-019-0099-y","article-title":"A research programme to evaluate DBT-PTSD, a modular treatment approach for complex PTSD after childhood abuse","volume":"6","author":"Bohus","journal-title":"Bord Personal Disord Emot Dysregul"},{"issue":"2","key":"R13","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1037\/0022-006X.76.2.243","article-title":"A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence","volume":"76","author":"Resick","journal-title":"J Consult Clin Psychol"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1001\/jamapsychiatry.2020.2148","article-title":"Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) compared with Cognitive Processing Therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: a randomized clinical trial","volume":"77","author":"Bohus","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1037\/0033-2909.99.1.20","article-title":"Emotional processing of fear: exposure to corrective information","volume":"99","author":"Foa","journal-title":"Psychol Bull"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/s0005-7967(99)00123-0","article-title":"A cognitive model of posttraumatic stress disorder","volume":"38","author":"Ehlers","journal-title":"Behav Res Ther"},{"issue":"3","key":"R17","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.janxdis.2005.02.004","article-title":"Changes in intrusive memories associated with imaginal reliving in posttraumatic stress disorder","volume":"20","author":"Speckens","journal-title":"J Anxiety Disord"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.cbpra.2022.04.005","article-title":"Brief imaginal exposure for PTSD: trajectories of change in distress","volume":"30","author":"Zoellner","journal-title":"Cogn Behav Pract"},{"issue":"16","key":"R19","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.jpsychires.2010.04.016","article-title":"Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population","volume":"44","author":"Pagura","journal-title":"J Psychiatr Res"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1796188","article-title":"Psychotherapy for posttraumatic stress disorder in patients with borderline personality disorder: a systematic review and meta-analysis of its efficacy and safety","volume":"11","author":"Slotema","journal-title":"Eur J Psychotraumatol"},{"issue":"9","key":"R21","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1097\/00005053-200009000-00005","article-title":"A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: etiological and clinical characteristics","volume":"188","author":"Heffernan","journal-title":"J Nerv Ment Dis"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1037\/0022-006X.73.3.515","article-title":"Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse","volume":"73","author":"McDonagh","journal-title":"J Consult Clin Psychol"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1538267","article-title":"Inpatient dialectical behavior therapy combined with trauma-focused therapy for PTSD and borderline personality disorder symptoms: study design of the naturalistic trauma therapy study","volume":"16","author":"Kamstra","journal-title":"Front Psychiatry"},{"key":"R24","unstructured":"First MB Williams JB Karg RS Spitzer RL . User\u2019s Guide for the SCID-5-CV Structured Clinical Interview for DSM-5 Disorders: Clinical Version. American Psychiatric Publishing; 2016. ISBN: 9781585625246"},{"issue":"3","key":"R25","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1001\/archpsyc.1994.03950030051005","article-title":"The international personality disorder examination. The World Health Organization\/alcohol, drug abuse, and mental health administration international pilot study of personality disorders","volume":"51","author":"Loranger","journal-title":"Arch Gen Psychiatry"},{"issue":"6","key":"R26","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1037\/ccp0000016","article-title":"A randomized clinical trial of group cognitive processing therapy compared with group present-centered therapy for PTSD among active duty military personnel","volume":"83","author":"Resick","journal-title":"J Consult Clin Psychol"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1080\/00223891003670232","article-title":"Development and psychometric characteristics of the Dissociation Tension Scale","volume":"92","author":"Stiglmayr","journal-title":"J Pers Assess"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1159\/000173701","article-title":"The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties","volume":"42","author":"Bohus","journal-title":"Psychopathology"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1007\/s10608-011-9423-6","article-title":"Mechanisms of change in cognitive processing therapy and prolonged exposure therapy for PTSD: preliminary evidence for the differential effects of hopelessness and habituation","volume":"36","author":"Gallagher","journal-title":"Cognit Ther Res"}],"container-title":["JMIR Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mental.jmir.org\/2025\/1\/e81081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:14:46Z","timestamp":1782843286000},"score":1,"resource":{"primary":{"URL":"https:\/\/mental.jmir.org\/2025\/1\/e81081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":29,"URL":"https:\/\/doi.org\/10.2196\/81081","relation":{},"ISSN":["2368-7959"],"issn-type":[{"value":"2368-7959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]},"article-number":"v12i6e81081"}}