Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder?

"Disclosure statement No potential conflict of interest was reported by the author(s)."

"The data for this study originate from the RELEASE study (RELEASE study, German Clinical Trials Registration ID: DRKS00006095). The RELEASE study was a large multicentre randomised controlled clinical trial that compared the efficacy of the newly developed therapy programme DBT-PTSD (Bohus et al., ; Steil et al., ) to the well-established trauma-focused treatment CPT (Müller-Engelmann et al., ; Resick et al., ) in women with PTSD and emotion regulation difficulties after childhood abuse. The study was conducted at three sites in Germany. Approval was obtained from the ethics committees of the three participating universities. Patients who met DSM-5 criteria of PTSD following sexual or physical abuse before the age of 18, who additionally reported three or more criteria of borderline personality disorder, including criterion six (affective instability), and who were available for 1 year of treatment were randomised in a 1:1 ratio to DBT-PTSD or CPT. Exclusion criteria were a lifetime diagnosis of schizophrenia, bipolar I disorder, intellectual disability, or severe psychopathology requiring immediate treatment in a different setting (e.g. a body mass index <.16.5); life-threatening suicide attempts within the last two months, current substance dependence, medical conditions contradicting exposure protocol (e.g. pregnancy), highly unstable life situation (e.g. homelessness), scheduled residential treatment and participation in either CPT or DBT-PTSD treatment during the last year. Both treatments consisted of up to 45 weekly sessions over the course of one year, and up to three monthly booster sessions in the following three months. Diagnostic assessments were administered at six assessment points: intake, three months, six months, nine months, 12 months and the end of treatment (after 15 months). Further details of the trial, such as the CONSORT flow diagram, can be found in the publication of the main results (Bohus et al., ), and the study protocol (Bohus et al., )."