Title: Effectiveness and Feasibility of Narrative Exposure Therapy (NET) in Patients with
Borderline Personality Disorder and Posttraumatic Stress Disorder - a pilot study
Version: 0 Date: 10 Mar 2016
Reviewer: Svenja Eichhorn
Review: Effectiveness and Feasibility of Narrative Exposure Therapy (NET) in Patients with
Borderline Personality Disorder and Posttraumatic Stress Disorder - a pilot study / Manuscript
The submitted manuscript constitutes the first work examining NET in patients with
posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD), dealing with the
risk of self-injury and suicide. Because exposure in trauma therapy is discussed critically due to a
widely supposed risk of emotional decompensation and increasing self-injury or suicidality, the
work represents a very important contribution, stating that narrative exposure of traumatic
experiences is less destabilizing for even patients with BPD than proposed, yet. The pilot study
aims at providing first data evaluating the feasibility and potential effectiveness of an inpatient
NET- based treatment-program, focusing on the patient's safety by measuring the urge to self-
injure or commit suicide during the NET-treatment. Although the pilot study lacks controls and
the data is based on n=10 participants, the work convinces through its detailed and coherent
theoretical framework, clear methodology, its innovational potential and clinical relevance. The
authors, emphasizing the need for a large-scaled randomized controlled approach, showed high
first effects of NET reducing PTSD and BPD in inpatients. The fact that even high burdened
BPD patients showed no remarkable risk for decompensation underlines the clinical significance
of this pilot study.
In the following there are points that need to be revised in my opinion:
Line 6, page 4: Please specify "patients" and exemplarly name some of the often appearing
psychiatric symptoms, as well as some behavioral abnormalities.
Line 11, page 4: Plaease put no space in front of the percent symbol
Line 33, page 6: "Moreover, these trials" Please specify the meaning of this sentence/ the
consequence of this fact.
Line 48, page 6: please put some references to underline the well evaluated approach
Please state which and how many patients of the ward were asked for participation in NET. How
were they chosen? In which period?
Line 55, page 7 / line 9, page 8: please standardize the notation of DSM-IV and put the reference
where it firstly occurs. Is it DSM-IV oder DSM-IV-TR?
Line 11, page 8: Please specify "our inpatient program".
Line 43, page 8: Please remove "(SIC)". It has been introduced in line 21, already.
Line 18, page 9: I propose to write: "the last session, where the written report was provided to
the patient, was 50-90 minutes".
Line 29, page 10: Please specify the aspect of RCI: Does the change of plus/minus 10.30 points
refer to a special measurement?
Line 43, page 11: categorizing participants by married/non-married today is not that meaningful
than splitting them into relationship/no relationship
Line 16, page 12: Please correct the number in the bracket: "(1,9.09%)"
Line 28, page 14: Please write "as well as ON secondary outcomes" or "such as a
DECREASE IN depression, dissociation and INCREASE in quality of life"
Line 48, page 14: Please explain shortly WHY NET is that feasable in this population of highly
Line 14, page 15: Please standardize "drop-out", using before, and "dropout"
Line 4, page 17: The sentence "Because NETbehavioral strategies" seams to be redundant,
could be deleted, eventually?! Perhaps start the following sentence with "Additionally" instead of
"In contrast"? The link is not clear to me.
Line 26, page 18: Please complete the sentence "in treating highly burdened patients WITH
PTSD AND BPD in an inpatient setting"
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
4. Have you received reimbursements, fees, funding, or salary from an organization that
holds or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests'
below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal http://creativecommons.org/licenses/by/4.0/