DBT-PE and Prolonged Exposure Treatment for Trauma

DBT-PE is an extremely effective, evidenced-based treatment for Post-Traumatic Stress Disorder, developed by Melanie Harned, PhD. Prolonged Exposure (PE) is one of the most well-researched types of treatment for PTSD, with exceptional outcomes. Dr. Harned’s research has shown that PE is both highly effective and safe for high-risk and vulnerable populations, and can be successfully combined with DBT treatment.

DBT-PE is adapted to treat a wide range of types of trauma, from an acute traumatic event to C-PTSD, and also highlights that PTSD can be developed through environments or relationships that create traumatic invalidation. DBT-PE maintains the same DBT assumptions that make DBT so special and unique. Our therapists are deeply committed to maintaining the balance of both acceptance and change, while providing a supportive, safe, and encouraging space. Treating individuals who have experienced trauma is one of our greatest passions, and we will be your biggest cheerleaders.

With that said, trauma therapy can be really challenging, and sometimes it can even feel counterintuitive. One of our biggest targets in DBT-PE is targeting avoidance, and that can feel really scary and overwhelming. Avoidance is a major factor that maintains PTSD, and it prevents recovery and healing. While avoidance completely and totally makes sense, and acting on urges to avoid is beyond understandable, avoidance maintains the impacts of acute or chronic trauma in a way that often decreases overall functioning and acts as a barrier to creating and engaging in the life that an individual truly desires. There are two main ways that individuals with PTSD engage in avoidance: pushing away memories, thoughts, and feelings about the trauma, and avoiding situations, people, and objects that are reminders of the trauma. The effects of this can be wide-ranging. And while avoiding trauma-related thoughts and situations does work effectively to reduce distress, anxiety, and pain in the short-term, it undoubtedly prolongs and intensifies post-traumatic reactions in the long-run. It also tends to make an individual’s life much smaller than they want it to be, and it gets in the ways of an individual building their life worth living. DBT-PE is a comprehensive protocol that works to ensure that the patient feels equipped with the coping skills necessary to manage their extremely valid distress that presents in working with these traumatic memories and symptoms.

DBT PE protocol uses two types of exposure:

IMAGINAL EXPOSURE AND PROCESSING

Imaginal exposure involves recounting the traumatic experience and narrating it during individual therapy. This is followed by engaging in collaborative processing of emotions, thoughts, and behaviors that are elicited by the imaginal exposure, and also highlighting notable patterns, related schemas, and how current symptoms and functioning are related and have been shaped by the identified trauma memory we are targeting. Imaginal exposure and processing are extremely effective in reducing trauma-related symptoms and helping to gain new insight about what happened before, during, and after the traumatic events, while identifying areas that we can utilize and shape up skill generalization to more effectively manage the trauma-related symptoms. While this is can be an extremely challenging and painful part of therapy, our therapists are right there with you, encouraging you, supporting you, and validating you every step of the way.

IN VIVO EXPOSURE

In vivo exposure means confronting avoided situations “in real life.” Clients are asked to gradually approach safe situations that they have been avoiding because they potentially remind them of the trauma, are believed to be dangerous, are previously enjoyed activities that may have been stopped due to depression, elicit unjustified shame, etc. In vivo exposure has been found to be unbelievably helpful in building mastery, creating a sense of empowerment and ability to control what is within ones’ control, being able to integrate the traumatic event into ones’ overall experience and sense of self, and to begin to move past the traumatic event. Because we are able to provide both pieces as DBT and PE therapists, we are available to engage in skills coaching when the need presents to support you outside of session when engaging in in vivo exposure as necessary.

The DBT-PE protocol is based on Prolonged Exposure Therapy, developed by Edna Foa, PhD, and is completed in three stages:

1. DBT skill acquisition to achieve behavioral control,

2. Targeting PTSD symptoms through imaginal and in vivo exposure,

3. Return to DBT treatment to address any outstanding issues not targeted through PE.

The commitment to abstain from all suicidal and non-suicidal self-injury for a period of two months before starting treatment is required. On average, DBT-PE is started after 20 weeks of DBT and the PE portion lasts for approximately 13 weeks thereafter.

For more information about DBT-PE, please visit: https://dbtpe.org/treatment-overview/