What Is DBT-PE
The DBT Prolonged Exposure (DBT PE) protocol was developed by Dr. Melanie Harned specifically to treat PTSD. Many clients seeking my services have experienced various forms of trauma, including sexual, verbal, and physical abuse, peer trauma, relationship trauma, trauma around discrimination and systemic oppression, institutional trauma, and natural disasters. DBT-PE also addresses the challenges faced by highly sensitive individuals whose experiences may have been invalidated by their environment, often leading to heightened emotional distress. Prolonged Exposure therapy was adapted to fit the needs of a client population who experiences complexity in the ways one suffers. DBT with the DBT PE protocol is a comprehensive trauma treatment designed to help the suffering individuals recover from trauma and build lives they experience as worth living.
Treatment Stages and Targets
Stage 1
The first stage is engagement in standard DBT including weekly individual therapy, group skills training, therapist consultation team, and between-session phone coaching. The focus in Stage 1 is on helping you achieve control over life- threatening and other severe behaviors and increasing behavioral skills. Trauma treatment is much more effective and safer when we feel in the driver's seat of our emotions. We also need skills to reduce avoidance and disassociation for the treatment to work.
Stage 2
Once clients feel that they are more in the driver's seat of emotional experiencing we move to Stage 2 to treat trauma.
In order to do so the following criteria must be met:
-
There has been no safety interfering behavior for 2 months and be able to/committed to using skills in the presence of stressors that make you want to engage in self injurious behaviors.
-
No serious behaviors that get in the way of therapy being effective for 2 months (missing sessions, ongoing pattern of not doing homework between session)
-
Able and willing to experience intense emotions without escaping.
-
Treating your trauma is your highest treatment priority
The DBT PE protocol is take place weekly via 90 minute therapy sessions for an average of 12-16 sessions.
Stage 3
This stage of treatment focuses on integration and any residual life problems. This stage is flexible and will vary depending on the individual's needs and goals. Common goals of stage 3 include:
-
Strengthening a Positive self-Concept- after the work in DBT-PE we are working on integration of self-validation and self-compassion.
-
Ending Destructive Relationships and Developing Validating Ones- Following trauma treatment people often experience a shift in their boundaries and limits for how people engage in relationship with them. This goal homes in on the relationships that are aligned with building a life worth living.
-
Engagement in Meaningful Activities and Finding Meaning and Sense of Purpose- PTSD symptoms often rob people of access to functioning and engagement in goals and activities that support with creating fulfillment, confidence, and joy in their lives. We set new goals around what clients would like to work towards.
The Role of Exposure
DBT-PE is an evidence-based therapy that helps patients process their traumatic event(s) and identify the ways in which trauma has changed their behaviors and thought patterns about themselves and their environment. For example, people who have survived trauma may struggle with being in crowded situations or feel the need to engage in safety behaviors such as scanning or sitting with their back to the wall. PE helps patients learn to gradually approach feared situations (that are not objectively dangerous) and tolerate their distress until their fear subsides, giving them more freedom in their day-to-day lives. It does so through supporting in creating new neural pathways via the tool of exposure. There are two types of exposure that we use in DBT-PE:
-
In-Vivo Exposure- This is confronting situations that you avoid in your day-to-day life as a result of PTSD. Many people with PTSD have the experience of their world becoming smaller and smaller. Avoidance of things that prompt anxiety, fear, or shame in the short term, may feel relieving, and it can get in the way of living the life that we want or make life feel more challenging.
-
Imaginal Exposure- Involves coming in contact with the traumatic event in session via sharing the narrative of the traumatic event. By talking about what happened to you, processing the event, challenging shame cycles that arise, and allowing emotions to rise and fall in a supportive environment, the memory becomes less overwhelming and avoided over time.