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Dialectical Behavior Therapy (DBT) and the Treatment of Trauma-Related Problems
Martin Bohus, MD, Melanie Harned, PhD and Amy Wagner, PhD
Recorded on October 12, 2016
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Dialectical Behavior Therapy (DBT; Linehan, 1993) is a comprehensive, cognitive-behavioral treatment with strong empirical support for the treatment of suicidal and self-injurious behaviors, particularly among individuals meeting criteria for borderline personality disorder (BPD). Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis in this client population and often maintains or exacerbates many of the high-risk and severe problems exhibited by clients receiving DBT. Accordingly, DBT includes a variety of strategies for addressing PTSD and trauma-related problems. Treatment targets vary depending on the level of disorder and corresponding stage of treatment, with Stage 1 focusing on achieving control over life-threatening and other severe behaviors, Stage 2 directly targeting PTSD and other trauma-related problems (e.g., severe shame, dissociation), Stage 3 addressing remaining problems in living, and Stage 4 aiming to increase the capacity for joy and freedom.
The presenters will provide an overview of DBT’s approach to treating trauma-related problems, including a description of the stages of treatment, levels of disorder, and associated treatment strategies. Ways in which the principles and strategies of DBT can be applied to common trauma-related problems will be addressed. In addition, two recent developments in using DBT to treat PTSD will be discussed. The first is the DBT Prolonged Exposure (DBT PE) protocol, which is based on Prolonged Exposure therapy and is intended to provide a structured method of targeting PTSD during Stage 2 of DBT (Harned, Korslund, & Linehan, 2014; Harned, Korslund, Foa, & Linehan, 2012). The second is an adaptation of DBT designed for the treatment of PTSD related to childhood sexual abuse (DBT-PTSD; Bohus et al., 2013; Steil, Dyer, Priebe, Kleindienst, & Bohus, 2011). The general structure and procedures of both approaches will be presented along with data supporting their efficacy. In addition, clinical considerations for determining which individuals with PTSD are appropriate for these DBT approaches will be discussed.
- Describe DBT’s stage-based approach to treating PTSD and trauma-related problems.
- Explain when and how the DBT PE protocol can be used to treat PTSD in Stage 2 of DBT.
- Outline the treatment phases and strategies used in DBT-PTSD.
About the Instructors
received his M.D. at Freiburg Medical School and did his residency in Psychiatry and Neurology at Freiburg Medical School. He made his specialty in Psychiatry and Psychotherapy and in Psychosomatic Medicine. Since 2003 he holds the chair of Psychosomatic Medicine and Psychotherapy, Heidelberg University and is Medical Director at the Central Institute of Mental Health, Mannheim. He received several awards for psychotherapy research. He is board member of the German Association of Psychiatry DGPPN, President of the European Society for the Studies of Personality Disorders (ESSPD), president of the German Association for DBT and Chair of the International Strategic Planning Meeting for Dialectical Behavior Therapy (SPM). He was president and Initiator: 1st International Congress on Borderline Personality Disorder, Berlin 2010 and since 2012 he is spokesperson of the Clinical Research Unit “Mechanisms of Disturbed Emotion Processing in BPD”. He has currently published 250 articles and book chapters, mainly on mechanisms of psychotherapy, borderline personality disorders and PTSD.
Melanie Harned, PhD, ABPP
is a Research Scientist in the Department of Psychology at the University of Washington where she is the Research Director of Dr. Marsha Linehan’s Behavioral Research and Therapy Clinics. She has been Principal Investigator on several NIMH-funded grants aimed at developing and evaluating a protocol to treat PTSD during Dialectical Behavior Therapy (DBT). Dr. Harned also currently works as the Director of Research and Development for Behavioral Tech, LLC as well as the Director of Behavioral Tech Research, Inc. In these positions she develops and evaluates methods of disseminating and implementing evidence-based treatments into clinical practice. She also regularly leads trainings nationally and internationally on DBT and the treatment of PTSD during DBT.
Amy W. Wagner, PhD
is clinical staff with the PTSD Clinical Team at the VA Portland Health Care System, Associate Professor at Oregon Health & Science University, and she provides clinical consultation to the Portland DBT Institute and DBT practitioners in the community. Primarily through Behavioral Tech, LLC, she has provided well over 100 trainings in DBT nationally and internationally and has particular interest in applications of DBT to trauma-related problems.