DIALECTICAL BEHAVIOR THERAPY PROLONGED EXPOSURE (DBT-PE)
Dialectical Behavior Therapy Prolonged Exposure (DBT PE) is a treatment protocol developed by Melanie Harned, Ph.D., that integrates DBT and PE to treat PTSD among suicidal, self-injuring, multi-diagnostic adolescents and adults. Drawing upon the well-established principles of Prolonged Exposure (PE) therapy (recognized for its efficacy in treating PTSD), the DBT PE protocol employs in vivo and imaginal exposure, complemented by subsequent processing, as central components of its therapeutic approach. This integrated protocol, merging DBT and PE, adopts a stage-based strategy to comprehensively address the complex difficulties faced by clients struggling with PTSD. DBT PE has three stages: Stage 1 focuses on achieving behavioral control and stability with DBT, Stage 2 targets PTSD with the DBT PE protocol, and Stage 3 addresses any remaining life problems with DBT. DBT PE has been shown to be effective in reducing PTSD symptoms, suicidal and self-injurious behaviors, and comorbid disorders among adolescents and adults.
STAGE 01
Stage 1 incorporates the fundamental elements of standard DBT which includes weekly individual therapy, group skills training, therapist consultation team, and between-session phone coaching. The primary emphasis during Stage 1 is to assist clients in gaining control over life-threatening and other severe behaviors while developing the skills necessary to engage in subsequent PTSD treatment safely and effectively. Behavioral skill enhancement emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness.
STAGE 02
​After clients have attained a satisfactory level of stability, Stage 2 takes a direct approach to address PTSD concerns through . The DBT PE protocol is implemented through weekly 90 -120-minute therapy sessions, while clients continue to receive the standard DBT modes.
STAGE 03
Upon the completion of the DBT PE protocol, Stage 3 employs standard DBT to address any residual challenges in daily living. Often, the focal point of Stage 3 treatment revolves around enhancing relationships and fostering increased engagement in productive activities, such as work or school. Clients continue to practice and reinforce their DBT skills while addressing any remaining trauma-related symptoms or challenges. The emphasis is on relapse prevention, building resilience, and maintaining progress beyond the completion of therapy.
How Prolonged Exposure works
Avoidance plays a significant role in sustaining PTSD and delaying the recovery process and individuals with PTSD commonly engage in two forms of avoidance. The first involves attempting to push away memories, thoughts, and feelings associated with the trauma. The second entails avoiding situations, people, and objects that serve as reminders of the traumatic event. While avoiding such thoughts and scenarios may provide short-term relief, it ultimately extends and intensifies post-traumatic reactions over time. The goal of the DBT PE protocol is to assist clients in breaking free from avoidance patterns by helping them confront trauma-related thoughts and situations for effective processing. To achieve this, the DBT PE protocol employs two different types of exposure.
Imaginal Exposure
Imaginal exposure involves revisiting the traumatic experience within one's imagination while describing the details out loud during therapy sessions. Subsequently, the trauma-related thoughts and emotions elicited through this imaginative recounting are processed between patient and therapist. This procedure is highly effective in alleviating symptoms associated with trauma and plays a pivotal role in fostering a fresh perspective on the events that transpired before, during, and after the traumatic experience.
In Vivo Exposure
In vivo exposure involves directly facing avoided situations in the real world. Patients are encouraged to gradually approach safe situations they’ve been avoiding because they are reminders of the trauma, perceived as dangerous, discontinued enjoyable activities linked to depression, or elicit unjustified shame. This method has been shown to be highly effective in decreasing extreme fears and behavioral avoidance that often occur after traumatic experiences.
DBT PE has been shown to be very effective in reducing suicidal and self-injurious behaviors and PTSD symptoms among multi-diagnostic adolescents and adults. By combining the strengths of DBT and PE, DBT PE offers a comprehensive and integrated approach to addressing the complex needs of individuals struggling with trauma and emotion dysregulation. DBT PE helps individuals overcome their fear and avoidance of trauma-related stimuli and memories, improve their psychological well-being and overall functioning, and reclaim their lives from trauma so they can build one worth living.