DBT-Prolonged Exposure Protocol

Many of my clients experience the lasting and haunting effects of trauma, often alongside challenges such as emotion dysregulation, personality disorders, mood disorders, etc. These symptoms can feel overwhelming, persistent, and deeply intertwined.

To address this complexity, Dr. Melanie Harned developed the DBT Prolonged Exposure (DBT PE) protocol, an evidence-based approach that integrates Prolonged Exposure (PE) therapy within the structure of standard DBT trauma therapy.

This combination allows clients to address both treatment for PTSD and the emotional and behavioral struggles often associated with it.

Prolonged Exposure is the most researched and widely recommended treatment for PTSD, and studies have shown that DBT PE leads to significant reductions of PTSD symptoms, particularly in clients with complex or co-occurring diagnoses.

In short: you don’t have to choose between treating trauma and treating emotional dysregulation. With DBT PE, we can address both.

DBT PE is designed for individuals who struggle with both Post-Traumatic Stress Disorder (PTSD) and significant emotion dysregulation or high-risk behaviors.

This treatment is especially appropriate for people who:

• Have a diagnosis of PTSD or symptoms related to trauma (such as flashbacks, avoidance, or hypervigilance) 
• Experience intense emotions, self-harm, suicidal thoughts, or impulsive behaviors
• Have co-occurring conditions like Borderline Personality Disorder (BPD), mood disorders, or dissociative symptoms
• Are currently, or will be, participating in DBT therapy that also have trauma they want to address in therapy. 

The DBT Prolonged Exposure protocol treats life-threatening behaviors, multiple mental disorders, behaviors that make treatment difficult, and severe impairment in functioning alongside PTSD. DBT PE has been shown to be extremely effective at reducing PTSD.

DBT-PE  helps individuals safely process traumatic experiences while continuing to build emotional regulation and coping skills.  When the individual’s most threatening behaviors are stabilized through DBT, they may begin the PE work.

DBT PE is not a separate program; it’s integrated into your existing individual sessions. Your therapist will shift between standard DBT strategies and DBT trauma therapy exposure work based on your needs and treatment plan.

You’ll gradually confront and process trauma memories and triggers using:

• Imaginal exposure – revisiting trauma memories in a safe, structured way
• In vivo exposure – approaching situations or places you've been avoiding
• Processing – making sense of what you’ve experienced and reducing shame, fear, or helplessness tied to the trauma
   

Throughout the process, you’ll continue using DBT skills like mindfulness, distress tolerance, and emotion regulation to help you stay grounded, safe, and supported between sessions.

The PE portion of treatment typically starts about four months after beginning DBT and lasts 13 weeks. During PE, sessions increase in length to 90 minutes. After the individual has completed PE, sessions will go back to 50 minutes, and the individual will complete the DBT treatment.

Exposure therapy works against the reasons PTSD happens in the first place: avoidance and cognitions (thoughts/beliefs) about the trauma. Understandably, people who have experienced trauma avoid thinking about the trauma and escape situations that remind them of the trauma.

Healing happens by ‘exposure’ to the trauma experience and forming new ways of thinking about the trauma.

DBT prolonged exposure achieves this in two ways:

1. Imaginal exposure – re-telling of the trauma memory out loud in therapy sessions, followed by processing of the experience, particularly thoughts and emotions that came up during the exposure; this works to reduce trauma-related symptoms and to gain new perspectives about what happened.
2. In Vivo exposure – “in real life” exposure of the situations, events, objects that serve as reminders of the trauma that the person usually avoids; this works to reduce avoidance and excessive fear.

 Yes. I offer prolonged exposure treatment alone (without DBT) to individuals who qualify.