In a Spanish feasibility study, 42 patients entered a trial built around an initial six-month DBT skills phase, followed by randomization to add EMDR or continue the skills work alone. The authors conclude a definitive trial is warranted.

At a public outpatient unit in Spain that specializes in borderline personality disorder, 42 patients entered a study built around an initial six-month skills-training phase drawn from dialectical behavior therapy, or DBT. All but two were women; their average age was 28.5. In the trial’s second phase, participants were randomized: some added eye movement desensitization and reprocessing, or EMDR, a trauma-focused therapy; the rest continued skills training alone.

The study, published in Borderline Personality Disorder and Emotion Dysregulation, is a feasibility trial. Its primary question was whether patients living with both borderline personality disorder and psychological trauma would accept, and stay with, a staged design that puts skills first and trauma processing second.

Most did. Retention from baseline to the end of the second phase was 62 percent. Among participants who started phase 2, 13 of 16 completed in the skills-only group and 13 of 18 completed in the combined group, corresponding to 81.2 percent and 72.2 percent; the gap was not statistically significant. A small subset interviewed afterward described the staged design as acceptable, and some said the skills phase left them feeling more prepared for trauma-focused work.

The clinical outcomes were secondary. Borderline symptoms fell in both groups. Only patients receiving both DBT skills and EMDR showed a significant reduction in dissociative symptoms from baseline to the end of the second phase.

Forty-two patients at one public clinic gave the authors the grounds to propose a definitive, randomized trial.

Questions This Brief Can Answer

What did the trial test?

It tested the feasibility and acceptability of a staged study design: an initial six-month DBT skills-training phase, followed by randomization to EMDR plus skills work or continued skills work alone.

Was this a clinical sequencing recommendation?

No. The article is a feasibility trial, and this brief treats it as trial-planning evidence rather than practice guidance or a protocol recommendation.

How many participants stayed through the second phase?

Retention from baseline to the end of phase 2 was 62 percent. Among phase 2 starters, completion was 13 of 16 in the skills-continuation group and 13 of 18 in the DBT skills plus EMDR group.

What did the study report about symptoms?

Clinical outcomes were secondary. Borderline symptoms fell in both groups, and the authors reported a significant reduction in dissociative symptoms only in the DBT skills plus EMDR group from baseline to the end of phase 2.

What conclusion did the authors draw?

The authors concluded that a definitive, fully powered randomized clinical trial is warranted to confirm the findings and refine how DBT skills training and EMDR might be integrated in research.

Selected Sources

• Soler, Elices, Canosa-García, Schmidt, Lupo, Valiente-Gómez, Amann, Perez-Sola, and Pascual. “The combination of dialectical behavioral skills training with EMDR in the treatment of borderline personality disorder and psychological trauma: a feasibility randomized trial.” Borderline Personality Disorder and Emotion Dysregulation (2026). https://doi.org/10.1186/s40479-026-00351-5
• ClinicalTrials.gov. “DBT Skills Plus EMDR for BPD and Trauma” (NCT04856449). https://clinicaltrials.gov/study/NCT04856449