DBT PE
What is Trauma?
Trauma results from exposure to an event or a series of events that are emotionally distressing or life-threatening and lead to long-term adverse effects on a person’s mental, emotional, physical, social, and/or spiritual well-being.
Examples of Traumatic Events:
- Physical, sexual, and emotional abuse
- Childhood neglect
- Living with a family member with mental health or substance use disorders
- Sudden, unexplained separation from a loved one
- Poverty
- Racism, discrimination, oppression
- Violence in the community, war, and terrorism
Common Reactions to Trauma:
- Frequent and intense emotions (e.g., fear, anger, shame, guilt, and sadness)
- Emotional numbness (e.g., shutting off emotions, feeling “dead inside”, feeling disconnected, and being unable to feel positive emotions)
- Engaging in reckless behaviors (e.g., suicide attempts, self-injury, acting impulsively without thinking, and restlessness)
- Difficulty with spontaneity (e.g., perfectionism, excessive planning, and extreme cleanliness or orderliness)
- Relationship difficulties (e.g., being overly trusting, not trusting people at all, not standing up for yourself when others treat you poorly, refusing help when it is offered from others, quickly starting a new relationship when another relationship ends, and doing things to try and get people to leave you alone)
Symptoms of PTSD
- Intrusive thoughts, memories, dreams and/or flashbacks
- Avoidance of trauma reminders and thoughts and feelings related to the trauma
- Significant changes in thought and/or mood
- Hyperarousal (e.g., irritability, angry outbursts, acting aggressively, being “super alert” or on guard, feeling easily startled, difficulty concentrating, and difficulty sleeping)
- Although trauma can happen at any age, trauma in childhood is particularly harmful and can lead to problems in adulthood
- Many adult survivors of childhood trauma struggle with depression, anxiety, and other issues related to emotion regulation
What is DBT Prolonged Exposure?
Many people with trauma-related symptoms understandably engage in avoidance behaviors because dealing with the trauma(s) is too hard. People often avoid in two ways. One is by avoiding the thoughts, feelings, and memories related to the trauma. The other is avoiding people and situations that remind them of the trauma. Although avoiding feels better in the short term, doing so keeps the trauma symptoms around. DBT PE works by approaching and processing trauma-related memories, feelings, and situations so your symptoms improve and you gain more control over your life.
What Does DBT PE Consist Of?
A significant and unique benefit of DBT PE is that you work with the same therapist throughout the course of your treatment. Treatment is delivered in 3 stages:
STAGE 1
- Stage 1 consists of standard DBT which includes weekly individual therapy, group skills training, therapist consultation, and between-session phone coaching. The goal of Stage 1 is to achieve control over life-threatening and other severe behaviors and increase emotion regulation, distress tolerance, mindfulness and interpersonal effectiveness skills.
STAGE 2
- Once clients are effectively using their skills and achieve stability, the goal of Stage 2 is to treat trauma-related symptoms. The DBT PE protocol takes place during weekly 90 to 120-minute individual therapy sessions while clients continue to receive all modes of standard DBT. On average, the DBT PE protocol begins after 20 weeks of DBT and lasts 13 sessions. For clients with more complex trauma histories, additional sessions may be required.
STAGE 3
- Once DBT PE is complete, the goal of Stage 3 is to use DBT to address any remaining problems in living. Often the focus of Stage 3 treatment is to improve relationships and increase productive activities such as work or school.
- Relapse Prevention:
- Many clients who complete DBT PE experience a significant reduction in trauma symptoms. After trauma therapy, it is normal and expected that triggers will sometimes occur and could potentially lead to a recurrence of symptoms. To manage triggers and risk factors effectively, clients are taught how to live an approach lifestyle and develop a relapse prevention plan. After completing trauma therapy and the relapse prevention work, clients feel empowered by knowing they have the skills and experience to confidently manage any residual symptoms and/or triggers.