Dialectical Behavior Therapy (DBT) for PTSD

Dialectical behavior therapy (DBT) was originally developed to help people struggling with the symptoms of borderline personality disorder (BPD).

Many people with BPD also have PTSD, and vice versa. Although people with PTSD and BPD have different symptoms, they share some of the same problems, such as:

• Difficulty managing emotions
• Interpersonal problems
• High risk of impulsive behavior

You won't be surprised then, to discover that some researchers have also explored whether DBT may help people with PTSD.

What Is DBT?

DBT, considered a cognitive behavioral therapy (CBT), focuses on changing poorly formed thoughts, behaviors, and beliefs as a way of reducing a person's BPD symptoms. However, DBT differs from traditional CBT. How? By also emphasizing acceptance of the person's emotions and thoughts. In fact, DBT was one of the first CBT treatments to use mindfulness skills to help achieve this acceptance.

DBT is based on the idea that the most important problem among people with BPD is difficulty managing their emotions (also called emotion dysregulation). Many of the problem behaviors of people with BPD (for example, deliberate self-harm) are thought to arise from problems they have managing their emotions.

Emotion-management problems stem from a combination of:

• Biology (such as a person's tendency to experience emotions intensely)
• A childhood environment where emotions were ignored or where expressing them was punished

Therefore, DBT focuses on improving emotion-management problems and the problem behaviors that they cause. Therapists who provide DBT use and teach four different types of skills:

• Mindfulness meditation skills
• Interpersonal effectiveness skills
• Distress tolerance skills
• Emotion regulation skills

Exploring the Usefulness of DBT for PTSD

The skills used in DBT, originally developed for people with BPD, may also greatly benefit people with PTSD.

Just like people with BPD, people with PTSD have problems managing their emotions. They may also have problems with relationships or engage in self-destructive behaviors, such as deliberate self-harm.

To explore whether DBT might be effective in people with PTSD, a group of researchers at the Central Institute of Mental Health in Mannheim, Germany, treated a group of women who had PTSD (from childhood sexual abuse) using an intensive treatment that combined DBT and traditional CBT approaches to PTSD treatment, such as exposure. The joint treatment was referred to as DBT-PTSD.

After three months of treatment, the researchers found that DBT-PTSD significantly reduced the women's PTSD symptoms, including depression and anxiety. In addition, the women's PTSD symptoms were still improving six weeks after they completed the treatment, suggesting that they may have learned skills during the study that helped them continue to recover from PTSD after the treatment ended.

Why More Research Is Needed

Research on DBT-PTSD is still ongoing, but the studies that have been done show a great deal of promise. More studies are needed to explore how DBT-PTSD compares to other CBT treatments for PTSD.

One study comparing the use of dialectical behavior therapy for PTSD to cognitive processing therapy (CPT) found that while both led to significant improvements, DBT achieved significantly higher symptoms remission rates.

Another study looked at a DBT-PTSD treatment program for complex PTSD stemming from childhood abuse and found that the treatment was both safe and effective in residential and outpatient settings.

If you're interested in learning more about DBT, a number of resources are available on Dr. Marsha Linehan's Behavioral Tech website, including a database of mental health professionals who have been trained in, and can provide, DBT.