Dialectical Behavior Therapy-Prolonged Exposure Protocol (DBT-PE)

What is dialectical behavior therapy-prolonged exposure protocol?

Dialectical Behavioral Therapy Prolonged Exposure (DBT-PE) was developed specifically to treat post-traumatic stress disorder (PTSD) among high-risk and multi-diagnostic individuals receiving Dialectical Behavioral Therapy (DBT). DBT-PE is based on an adaptation of Prolonged Exposure (PE) therapy, a highly effective treatment that helps to reduce anxiety and fear in people experiencing trauma-related symptoms, including PTSD. The integrated protocol is intended for adolescents and adults with trauma-related symptoms and/or a diagnosis of PTSD, who require stabilization prior to engaging in trauma-focused PTSD treatment. The goal of DBT-PE is to help individuals reduce the frequency and severity of trauma-related symptoms, while simultaneously building lives they experience as worth living. 

What does DBT-PE treatment entail?

DBT-PE utilizes a stage-based approach to address the numerous concerns experienced by those suffering with severe, high-risk, and complex trauma-related symptoms. Stage 1 of DBT-PE treatment focuses on aiding individuals in achieving stability and developing skills needed to safely and effectively engage in DBT-PE treatment. After this first stage of treatment, Stage 2 consists of directly addressing trauma-related symptoms/PTSD via exposure based strategies, using the DBT-PE protocol. Stage 2 typically lasts for 3 to 4 months and consists of building understanding and motivation to engage in future exposures, as well as engagement in exposure-based strategies and relapse prevention planning. To begin stage 2 of DBT-PE, individuals must meet specific readiness criteria, including abstinence from all life-threatening behaviors for 2 months and willingness to complete exposure homework. After completing stage 2, individuals may enter stage 3 of treatment, which addresses any ongoing problems that remain after treatment of PTSD.

How does DBT-PE work?

A major factor that maintains symptoms associated with PTSD and prevents recovery is the avoidance of trauma-related thoughts and situations. While avoidance decreases distress in the short-term, it actually prolongs and intensifies trauma reactions in the long-term. The DBT-PE protocol aims to help individuals stop avoidance behaviors, via exposure to trauma-related stimuli, in order to promote desensitization and eventual recovery. To accomplish this, two types of exposure are utilized: In vivo exposure and imaginal exposure.

 

  • In vivo exposure involves confronting avoided situations “in real life.” Therefore, individuals are gradually exposed to feared stimuli they have been avoiding in a safe, controlled environment.

    Research demonstrates that in vivo exposure is highly effective in reducing excessive fears and behavioral avoidance after trauma.

  • Imaginal and reprocessing exposure involves revisiting the traumatic experience in one’s imagination and describing it out loud during therapy sessions, along with processing the trauma-related emotions and thoughts that are elicited by the imaginal exposure.

    Empirical research suggests that imaginal exposure is effective in reducing trauma-related symptoms. Further, revisiting one’s trauma narrative helps in organizing and making sense of past traumatic events, as well as gaining new perspectives, as trauma survivors continue to persevere.

“Sometimes the very thing you’re most afraid of doing is the very thing that will set you free.”

— Jasmine Lamb