Reviewer’s report

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

Reviewer's report:

Review: Effectiveness and Feasibility of Narrative Exposure Therapy (NET) in Patients with

Borderline Personality Disorder and Posttraumatic Stress Disorder - a pilot study / Manuscript

Number BPSY-D-15-00315

Dear author,

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:

Background:

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

Methods:

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?

Results:

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%)"

Discussion:

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

burdened patients

Line 14, page 15: Please standardize "drop-out", using before, and "dropout"

Line 4, page 17: The sentence "Because NET…behavioral 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.

Conclusions:

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.

Yes

Does the work include the necessary controls?

If not, please specify which controls are required in your comments to the authors.

No

Are the conclusions drawn adequately supported by the data shown?

If not, please explain in your comments to the authors.

Yes

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:

Acceptable

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

manuscript?

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