Dialectical Behavior Therapy – Prolonged Exposure (DBT-PE)
Integrated trauma treatment for co-occurring PTSD with BPD or emotion dysregulation. Combining DBT skills with trauma processing from Stanford-trained experts.
What is DBT-PE?
When PTSD and Emotion Dysregulation Co-Occur
DBT-Prolonged Exposure (DBT-PE), developed by Melanie Harned, PhD, is a specialized, integrated treatment designed for individuals who have both PTSD and BPD or difficulties with emotion regulation. Many trauma survivors struggle not only with trauma symptoms but also with overwhelming emotions and self-destructive behaviors that can interfere with standard trauma treatments. DBT-PE combines the emotion regulation and distress tolerance skills from Dialectical Behavior Therapy with the trauma processing power of Prolonged Exposure. At Summit Psychotherapy Center, our team is trained in DBT-PE through Stanford’s DBT Trauma Team, where our clinicians are founding members. DBT-PE ensures you have the skills to manage difficult emotions before, during, and after trauma processing—making trauma treatment both safer and more effective for those with co-occuring BPD or emotion dysregulation.
How DBT-PE Works: A Phased Approach
Building Skills Before Processing Trauma
Phase 1: DBT Skills Building
Before trauma processing begins, you learn essential DBT skills including mindfulness, distress tolerance, and emotion regulation. These skills become your toolkit for managing the difficult emotions and behavioral urges that arise during trauma work.
Phase 2: Prolonged Exposure
Once you have adequate emotion regulation skills, you begin PE trauma processing – revisiting trauma memories through imaginal exposure and facing avoided situations through in vivo exposure.
Phase 3: Continued Skills Application
Throughout PE and after, you continue using and refining DBT skills to manage emotions, maintain safety, and integrate what you’ve learned into your daily life.
Integrated Throughout: Safety Planning
DBT-PE includes robust safety planning and crisis management strategies. Your therapist monitors emotion dysregulation and ensures you’re managing well throughout treatment.
Who is DBT-PE For?
Is DBT-PE Right for You?
DBT-PE may be the right treatment if you:
Have both PTSD and BPD or emotion dysregulation difficulties
Experience intense emotions that feel overwhelming
Have tried standard PE or CPT but found it too distressing
Have co-occurring BPD or BPD traits with PTSD
Engage in self-harm or have suicidal ideation alongside trauma symptoms
Need skills to manage emotions before trauma processing
Have difficulty tolerating distress without engaging in impulsive actions
Struggle with relationships alongside trauma symptoms
Have been told you need to “stabilize” before trauma treatment
Want integrated treatment rather than sequential approaches
Are willing to commit to longer treatment (24+ weeks)
Need both validation and active trauma processing
DBT-PE vs.
Standard PE
Key Differences from Standard Prolonged Exposure
DBT-PE differs from standard PE in important ways:
Skills First
Building emotion regulation skills before trauma processing (PE starts trauma work immediately)
Longer Duration
24+ weeks vs. 8-15 weeks for standard PE
Safety Emphasis
More focus on safety planning and crisis management
Emotion Regulation
Explicit teaching of skills to manage emotions following exposure
Broader Focus
Addresses both trauma and emotion dysregulation simultaneously
Validation and Change
Balances validation with change
Complex Presentations
Designed for those with co-occurring difficulties
Phased Approach
Ensures readiness before trauma processing begins
What to Expect in DBT-PE Treatment
Your Integrated Treatment Journey
Assessment and Pre-Treatment (Sessions 1-4)
Understanding your trauma history, emotion regulation difficulties, and treatment goals. Expectations and commitment setting. Creating a personalized safety plan.
DBT Skills Phase
Learning mindfulness, distress tolerance, and emotion regulation skills. Practicing these skills in daily life and preparing for trauma processing.
Trauma Processing Phase
Beginning imaginal exposure to trauma memories and in vivo exposure to avoided situations, while continuing to use and refine DBT skills.
Integration and Maintenance
Consolidating gains in both trauma recovery and emotion regulation. Planning for continued skill use and relapse prevention.
Why Choose Summit for DBT-PE?
Stanford DBT Trauma Team Expertise
Summit Psychotherapy Center offers exceptional DBT-PE expertise as founding members of Stanford University’s DBT Services Team. Our clinicians are trained in both comprehensive DBT and trauma-focused treatments including PE. We developed expertise in integrating these approaches for complex presentations where trauma and emotion dysregulation co-occur. Our team understands that many individuals with trauma have been told they need to “stabilize” before trauma treatment—DBT-PE provides a pathway to address both simultaneously. We provide the validation, safety, and skill-building needed alongside powerful trauma processing.
Ready to Address Both Trauma and Emotion Dysregulation?
DBT-PE offers an integrated approach for those who need both emotion regulation skills and trauma processing. Our Stanford-trained specialists are here to guide you through this integrated comprehensive treatment.