How to Combine DBT with EMDR for Trauma

Patients with borderline personality disorder tolerate trauma therapy better when they learn emotion regulation skills first

STUDY: Soler J et al, Borderline Personal Disord Emot Dysregul 2026

STUDY TYPE: Randomized feasibility trial

FUNDING: EMDR Europe (Grant Number: 2020-03)

Background

EMDR is an effective psychotherapy for PTSD, and this trial tested it in in borderline personality disorder with a history of trauma, starting the EMDR after stabilizing the impulsivity and emotional dysregulation through a course of DBT.

The Study

• 42 adults with borderline personality disorder and psychological trauma (95% women, mean age 28)
• All received 6 months of group DBT skills training, then were randomized to 16 sessions of individual EMDR or 6 more months of DBT skills

Both groups reduced borderline symptoms from baseline to the end of treatment. Only the DBT+EMDR group significantly reduced dissociative symptoms (β = −11.92, p < .001).

Overall retention to the end of phase 2 was 62%, with no significant difference between groups. In qualitative interviews, four of seven participants in the EMDR group said they could not have tolerated trauma processing without first completing DBT.

Side Effects

Five participants dropped out of EMDR due to emotional dysregulation or sleep disruption from trauma processing. One was hospitalized briefly for acute life stress. No severe adverse events occurred.

Limitations

Small sample, mostly women, single Spanish center. Qualitative interviews came only from completers, introducing positive bias. No PTSD diagnostic assessment was conducted after treatment.

Practice Implications

1. This is a feasibility trial, meant to pave the way for a larger study.
2. For now, it tells us that EMDR can work for trauma-symptoms in borderline personality disorder, but the treatment carries risks of emotional dysregulation and should not be attempted before those symptoms stabilize, such as with DBT.