Dialectical behavior therapy (also referred to simply as DBT) was originally developed by Dr. Marsha Linehan, a psychologist and professor at the University of Washington, for people struggling with the symptoms of borderline personality disorder (BPD).
Many people with BPD also have PTSD and vice versa. In addition, although PTSD and BPD are made up of separate symptoms, they also share some features as well. For example, both are associated with difficulties in managing emotion, interpersonal difficulties, and risk for impulsive behaviors. Given this, some researchers are beginning to explore whether DBT may be useful for PTSD. However, before we discuss this research, it is important first to get an understanding of what DBT involves.
What Is DBT?
DBT is considered a cognitive-behavioral treatment, in that it addresses maladaptive thoughts, beliefs and behavior in order to reduce the symptoms of BPD. However, DBT is unique from traditional cognitive-behavioral approaches in that it also places a major emphasis on the acceptance of emotions and thoughts in reducing BPD symptoms. In fact, DBT was one of the first cognitive-behavioral treatments to incorporate mindfulness skills as way of facilitating this acceptance.
DBT is based on the idea that the main problem among people with BPD is difficulty managing emotions or emotion dysregulation. Many of the problem behaviors observed among people with BPD (for example, deliberate self-harm) are thought to arise from this emotion dysregulation.
Emotion dysregulation, according to Dr. Linehan, arises from a combination of biology (such as the tendency to experience emotions intensely) and growing up in an environment where emotions are disregarded or the expression of emotions is punished (also referred to as an invalidating environment). Therefore, DBT presents a number of skills focused on improving emotion dysregulation, as well as reducing problem behaviors that may stem from emotion dysregulation. In particular, DBT teaches people four different types of skills:
- Mindfulness meditation skills
- Interpersonal effectiveness skills
- Distress tolerance skills
- Emotion regulation skills
Exploring the Utility of DBT for PTSD
Just like people with BPD, people with PTSD also experience difficulties managing their emotions. They may also have problems with relationships or engage in self-destructive behaviors, such as deliberate self-harm. Consequently, the skills presented in DBT may also be of great benefit to people with PTSD.
To examine this, a group of researchers at the Central Institute of Mental Health, in Mannheim, Germany, provided 29 women with PTSD from childhood sexual abuse an intensive treatment that combined elements of DBT and traditional cognitive-behavioral approaches to the treatment of PTSD, such as exposure. The joint treatment was referred to as DBT-PTSD.
After three months of treatment, the researchers found that DBT-PTSD resulted in significant reductions in PTSD symptoms, depression, and anxiety. In addition, PTSD symptoms continued to reduce six weeks after completion of the treatment, suggesting that the patients may have learned skills that facilitated continued recovery from PTSD even after the treatment ended.
A Treatment in Need of More Research
Research on DBT-PTSD is in its earliest stages. Studies are still needed to see how DBT-PTSD compares to other cognitive-behavioral treatments for PTSD. However, results are promising. If you are interested in learning more about DBT, there are numerous resources available on Dr. Linehan's Behavioral Tech website, including a database of mental health professionals who have been trained in, and provide, DBT.
Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialecticel behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24, 102-106.