DBT Prolonged Exposure (DBT-PE) for Trauma and PTSD
Schedule a ConsultationWhat Is DBT-PE?
DBT Prolonged Exposure (DBT-PE) is an evidence-based trauma treatment developed specifically for individuals who have both a significant trauma history and significant emotion dysregulation. It was created by Dr. Melanie Harned at the University of Washington to address a gap in standard trauma treatments: most evidence-based approaches for PTSD assume the client is already emotionally stable enough to engage with trauma processing. For clients with self-harm, suicidal ideation, or BPD, that assumption does not hold.
DBT-PE addresses this by integrating Prolonged Exposure therapy within the structure of comprehensive DBT. Clients first build DBT skills and achieve behavioral stability before trauma processing begins. This makes it safe to engage with traumatic memories without destabilizing the client's overall functioning.
Who DBT-PE Is Designed For
DBT-PE is appropriate for clients who:
- Have a diagnosis of PTSD or significant trauma-related symptoms
- Also struggle with emotion dysregulation, self-harm, or suicidal ideation
- Are already participating in or beginning comprehensive DBT
- Have not responded to standard trauma treatments due to emotional instability
It is most commonly used with adults, though it is available for older adolescents in appropriate clinical circumstances.
How DBT-PE Works
Trauma processing does not begin immediately. Clients complete a period of standard DBT focused on reducing life-threatening behaviors and building consistent skills use. Readiness is assessed based on specific behavioral criteria, not an arbitrary timeline.
Once readiness criteria are met, DBT-PE sessions are added to individual therapy. Processing includes in-session imaginal exposure, in vivo exposure to avoided situations, and continued DBT skills use to manage emotional intensity throughout.
As trauma symptoms reduce, the focus shifts to consolidating gains, addressing any remaining avoidance, and integrating the work into the client's broader DBT treatment goals.
DBT-PE vs Standard Trauma Therapy
Standard Prolonged Exposure therapy is highly effective for PTSD in clients who are emotionally stable. For clients with BPD, chronic self-harm, or active suicidal ideation, standard PE can be contraindicated or premature. DBT-PE was developed specifically to make evidence-based trauma treatment accessible to this population by building the stabilization structure first.
| Standard PE | DBT-PE | |
|---|---|---|
| Best for | Emotionally stable clients with PTSD | PTSD with self-harm, BPD, or emotion dysregulation |
| Requires DBT | No | Yes — DBT foundation comes first |
| Trauma processing | Begins immediately | Begins after stabilization criteria are met |
| Evidence base | Strong for stable presentations | Strong for high-risk, dysregulated presentations |
EMDR at EBT Collaborative
In addition to DBT-PE, our clinicians offer Eye Movement Desensitization and Reprocessing (EMDR) for clients whose clinical presentation is suited to this approach. EMDR is an evidence-based trauma treatment that uses bilateral stimulation to support the brain's natural processing of distressing memories. Your clinician will discuss which trauma treatment approach is the best fit for your specific presentation during the assessment.
Trauma Treatment at EBT Collaborative
We offer DBT-PE at our locations across Tennessee, Florida, Virginia, New York, Pennsylvania, and Delaware. Telehealth is available throughout each state we are licensed in. Visit our locations page to find the office nearest you.
Visit our billing page for information on accepted insurance and fees.
Start Trauma Treatment
A clinician can assess whether DBT-PE or another trauma approach is the right fit for you.
Schedule a Consultation
“Trauma treatment is not about erasing the past, but helping you move forward with less pain.”
