DBT
Prolonged Exposure
Improve Trauma Symptoms
The Dialectical Behavior Therapy-Prolonged Exposure (DBT-PE) protocol was developed as a form of therapy geared toward improving symptoms for individuals suffering with post- traumatic stress disorder (PTSD) and complex trauma, especially those who are multi-diagnostic, engaging in high risk behaviors, have seen little or no improvement after previous treatments, and who are unable to live a fulfilling life due to their symptoms.
How Does DBT-PE Fit into the DBT Process?
When individuals are struggling with severe PTSD or complex trauma symptoms, especially with self-harming or self-destructive behaviors that have been difficult to treat with traditional or even comprehensive DBT on its own, the DBT-PE protocol may be recommended. In most cases, clients begin with several sessions of traditional DBT skills training before beginning the DBT-PE protocol. After completing the DBT-PE protocol, they return to traditional DBT programs to address any additional or uncovered concerns.
How Does the DBT-PE Protocol Work?
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Stage 1
Comprehensive DBT including individual and group therapy sessions, phone coaching, and therapy team consultations. Some clients also opt for family skills training at this stage, but it is most often included in stage 3 for individuals who are working through the DBT-PE protocol.
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Stage 2
The DBT-PE protocol is used to directly address PTSD and complex trauma symptoms while clients continue their comprehensive DBT work outside of sessions.
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Stage 3
Once the DBT-PE protocol is completed, clients return to just their comprehensive DBT plan. At this point, the DBT skills are applied more directly to parts of the client’s life that need improvement, including relationships, workplace skills, and other areas where the client is struggling.
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The DBT-PE protocol itself has three stages of treatment. Every client is different, and the DBT- PE protocol allows for flexibility in the number of necessary sessions to address PTSD, complex trauma, and the many side effects of these conditions. As the name suggests, DBT-PE relies on exposure to certain situations that are feared or avoided due to their relationship to the client’s trauma. This can be difficult for clients, so we begin with several (usually 2-3) sessions devoted strictly to pre-exposure therapy. This involves talking through expectations for the next two stages of treatment and helping the client feel safe and stable before moving forward.
Next, we’ll begin the exposure part of the DBT-PE protocol. The client and therapist engage in two forms of exposure: Imaginal and in vivo exposure. Imaginal exposure is what it sounds like. Clients imagine a situation that is triggering or related to their trauma. They describe it aloud for the therapist. Then, in partnership with their therapist, clients process the emotional, cognitive, and physical responses to the imaginal exposure.
When clients feel ready, the therapist will challenge them to begin in vivo (in life) exposure. It’s important to understand this exposure does not mean clients need to confront the sources of their trauma or relieve the experience. This is not recommended treatment and can be extremely harmful. Instead, in vivo exposure is all about reclaiming the parts of your life you have avoided, feared, or felt too shameful to engage with as a symptom of your trauma. In vivo exposure is usually done outside of the therapist’s presence as a kind of homework assignment to help individuals begin applying what they’re learning in DBT-PE sessions to their real lives.
Finally, clients dedicate the last few DBT-PE sessions to consolidating everything they’ve been learning and creating a relapse prevention plan. Once the client completes this protocol, they’ll move on to stage 3, which is a return to comprehensive DBT plans to address any remaining concerns, work through new difficulties that arise during the DBT-PE protocol, or set plans to achieve specific goals.
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