Dialectical Behavior Therapy for Early Life Trauma

Co-occurring borderline personality disorder (BPD) with posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) are severe and disabling psychiatric sequelae of early trauma. While the emergence of evidence-based treatments such as dialectical behavior therapy (DBT) and prolonged exposure (PE) improved treatment for BPD and PTSD individually, treatment gaps remain for individuals with co-occurring BPD and PTSD as well as CPTSD. DBT prolonged exposure (DBT+PE) and DBT for PTSD (DBT-PTSD) combine skills training to enhance emotional, behavioral, interpersonal, and attentional stability with prolonged exposure to support engagement and processing required for effective PTSD treatment. DBT+PE improves PTSD remission rates and suicide rates to a greater degree than standard DBT. DBT-PTSD shows higher rates of remission from PTSD and reliable recovery than cognitive processing therapy in patients with BPD symptoms and complex PTSD related to severe and chronic childhood physical and sexual abuse. DBT+PE requires the completion of standard DBT and adequate management of suicidality and self-harm to foster safety in tolerating the intense emotions expected in prolonged exposure. DBT-PTSD provides psychoeducation about trauma and its effects, promoting mindfulness, compassion, anti-dissociation, and emotion regulation skills training prior to exposure treatment. While DBT+PE follows standard prolonged exposure procedures, DBT-PTSD focuses on processing primary trauma-related emotions such as powerlessness, fear, and disgust, as well as subsequent traumatic invalidation encountered when attempts were made to share the traumatic experience with others. Both treatments also emphasize rebuilding life outside of treatment following exposure, using DBT skills and a focus on goals and values to provide an alternative path to a corrective experience to recover from PTSD.