DBT for Post-Traumatic Stress Disorder (PTSD)

Dealing with the aftermath of trauma can feel like an immense emotional burden. Post-traumatic stress disorder (PTSD) is a mental health condition that results from trauma, and it can leave you struggling with flashbacks, difficulty managing relationships, and emotional dysregulation. If you or a loved one is suffering from symptoms of trauma, then Dialectical Behavior Therapy (DBT) for PTSD might be the key.

Here, we’ll explore DBT and PTSD and discuss how this treatment can help, whether it’s PTSD in children or adults.

What is DBT?

Dialectical behavior therapy is a type of psychotherapy (talk therapy) for people who intensely experience emotions. It was originally developed for individuals diagnosed with borderline personality disorder by Dr. Marsha Linehan in the 1980s, but it has since then been used for other mental health conditions as well. DBT is a type of cognitive behavioral therapy that helps people manage their emotions in healthier, more productive ways.

How Can DBT Help Treat PTSD?

PTSD is one of the many mental health conditions that DBT can treat. It has been adapted specifically to treat PTSD, also known as DBT-PTSD.

DBT for PTSD works by using components designed to target and treat emotional dysregulation. When you are emotionally distressed, your brain responds by prioritizing survival and coping. Memories of the response to any trauma are stored and re-opened in response to current distress. When a trigger presents itself, you may respond with uncontrollable crying or even a complete emotional shutdown. You may also react with the fight, flight, freeze, or fawn response.

DBT focuses on developing four coping skills to process such intense emotions: mindfulness, distress tolerance, emotion regulation, and personal effectiveness. Since involuntary and distressing emotions characterize PTSD, these four key areas can be useful for individuals with this condition, whether it’s DBT for teens, children, or adults.

Is DBT Effective for Treating PTSD?

Plenty of research supports the effectiveness of DBT for treating PTSD. Some studies even find it to be superior to CBT in reducing symptoms of complex PTSD [*]. Randomized clinical trials have shown that DBT-PTSD reduces symptoms in 58% of women survivors of child abuse compared to just 41% who were treated with just CBT.

Another study discussed the effectiveness of DBT-PTSD in treating adult survivors of childhood sexual abuse (CSA). Results showed that this treatment method can significantly reduce or eliminate symptoms of CSA-related PTSD [*].

More research shows the effectiveness of DBT on incarcerated youth with histories of trauma and exposure to violence. Here, DBT also acted as a promising method of rehabilitation [*].

DBT Techniques for PTSD

There are several DBT techniques that clinicians help their patients master for the treatment of PTSD.

Mindfulness

The DBT mindfulness skill focuses on learning to increase one’s awareness of the present moment. This may include cues, triggers, and even unwanted feelings. The important part is to be aware of and observe these without judgment.

Emotion Regulation

Emotion regulation skills can help us overcome and effectively manage our emotions. Remember that all feelings are valid, but it is how we choose to respond to them that can be powerful.

Interpersonal Effectiveness

DBT interpersonal effectiveness skills will teach you how to cope with conflict, build healthy relationships, and make decisions that will serve your needs in a healthy and functional way.

Distress Tolerance

Learning how to tolerate stress is an important skill to learn when you deal with PTSD. Distress tolerance is all about tolerating difficult situations so that you do not make it worse. These stressors can be perceived or actual, and you need distress tolerance to manage your emotions in these cases.

Opposite Action

DBT opposite action is a skill that allows you to recognize your personal “action urge” and how it is associated with the emotions you are experiencing. This will help you react differently to the urge and focus on something more positive and productive.

Validation

People with PTSD may question their own reality and what happened to them when the stress and pain are too much. Validation in DBT plays a very important role in the healing process.

How Long Does DBT for PTSD Take?

DBT can take a long time, usually lasting around six months to one year depending on the condition being treated and its severity, among other considerations. Every individual is unique, and mental health conditions can be complex. This may influence how long treatment takes.

Are There Risks Associated with DBT for PTSD?

While DBT is a valuable tool for PTSD, it's important to be aware of some potential drawbacks.

• Emotional intensity. DBT focuses on managing emotions, but sometimes exploring these emotions can lead to feeling overwhelmed or even experiencing flashbacks.
• Time commitment. DBT therapy often requires a significant time investment, including individual sessions and group skills training. This might not be feasible for everyone's schedule or budget.
• Focus on skills. While DBT teaches valuable skills, it doesn't directly address the trauma itself. Some people with PTSD might benefit from additional therapy focused on processing the traumatic event.
• Therapist match. Finding a therapist trained specifically in DBT for PTSD is crucial. A mismatch in the therapist's style or approach could hinder progress.

It's important to discuss these potential risks with a mental health professional to see if DBT is the right fit for you.

Can DBT Be Combined with Other Treatments?

DBT is often seen as a complementary therapy that can be effectively combined with other treatments for PTSD. Combining treatments may be beneficial for the following reasons:

DBT provides valuable skills for emotional regulation and distress tolerance, but it doesn't directly address the trauma itself. Combining it with trauma-focused therapies like Prolonged Exposure (PE) or EMDR can offer a more comprehensive approach.

You can also think of DBT as building a solid foundation of emotional management skills. Other therapies can then build upon this foundation to help you process and integrate the traumatic experience.

Lastly, remember that everyone heals differently. Combining DBT with another treatment allows for a personalized treatment plan that addresses your specific needs and goals.

When is DBT Not Recommended for PTSD?

While DBT for kids, teens, and adults can be a powerful tool for PTSD, there are some situations where it might not be the most ideal first step. Here are some cases where alternative approaches might be considered.

• Severe PTSD. If you're experiencing very intense symptoms like frequent flashbacks, suicidal thoughts, or severe dissociation, DBT might not be the most effective initial treatment. Therapies like Prolonged Exposure (PE) or EMDR are specifically designed to address the core trauma and may be more helpful in stabilizing symptoms before focusing on broader emotional regulation skills.
• Recent suicidal or self-injurous behavior. DBT is typically not recommended for individuals currently engaging in frequent or severe self-harm or suicidal behavior. These situations require immediate intervention and a treatment plan specifically focused on safety and crisis management.
• Limited motivation for skills training. DBT heavily emphasizes learning and practicing skills for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. If you're struggling with low motivation or resistance to engaging in skills training, alternative therapies with a different focus might be more suitable.
• Complex comorbidities. While DBT can address some co-occurring conditions like depression and anxiety, it might not be the most effective approach for complex cases with severe substance abuse disorders, psychotic symptoms, or eating disorders. In these situations, a different treatment plan tailored to address the specific needs of the individual conditions might be necessary.

Remember, these are just some general considerations. The best course of treatment will depend on your unique situation. Consulting with a qualified mental health professional is crucial to determine if DBT is the right approach for you and your specific case of PTSD.

The Bottom Line

There are millions of adults, children, and teens with PTSD that are affected each year. Trauma may take time and plenty of work to process, but treatments like DBT can help significantly. It allows you to address the emotional dysregulation that often comes with trauma, giving you the fundamental skills to move forward and have a peaceful and fulfilling life. Remember, when in doubt, always contact a licensed and skilled mental health professional for treatment.

For more DBT resources, check out our collection of DBT worksheets.

References:

1. Bohus M, Kleindienst N, Hahn C, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse. 22 July 2020.
2. Steil R, Dyer A, Priebe K, et al. Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. 4 February 2011.
3. Fasulo S, Ball J, Jurkovic G, et al. Towards the Development of an Effective Working Alliance: The Application of DBT Validation and Stylistic Strategies in the Adaptation of a Manualized Complex Trauma Group Treatment Program for Adolescents in Long-Term Detention. July 2015.