Dialectical behavioral therapy
Carrying on with our therapy for trauma survivor posts, we will be exploring dialectical behaviour therapy and its uses in trauma informed therapy.
DBT was originally developed to help patients who were suffering from symptoms of borderline personality disorder (BPD). However in recent years BPD has shown to be closely related to CPTSD, sharing issues within interpersonal relationships, impulsivity and a difficulty in managing or identifying emotions.
DBT has links and great similarities to cognitive behavioral therapy as it focuses on changing poorly formed thoughts, behaviours and personal beliefs as a way to alleviate trauma symptoms. In addition to this, DBT emphasizes an individual accepting their emotions or thoughts through mindfulness exercises.
As individuals of complex interpersonal trauma and childhood developmental trauma can face difficulties in identifying their emotions, DBT provides survivors with various skills in order to help them navigate their emotions. Each skill DBT provides links with a survivors emotional management and safety and so an individual completing DBT will work through mindfulness, relationship skills, identifying and regulating emotions as well as working through distress tolerance skills and resilience.
In terms of trauma, DBT has begun to be recognised as being effective in treating symptoms associated with this. It has become more recently researched in terms of trauma and the term DBT- PTSD has surfaced with regards to a modified approach to this therapy. DBT-PTSD is still in its infancy in terms of research and validation and more studies are required in order to test the effectiveness of this model. Most research that I have found investigating DBT and it's effectiveness is in treating BPD not PTSD and even fewer with relations to complex interpersonal trauma or childhood developmental trauma.
However from the research that I have been able to gather, DBT for PTSD has been reviewed as effective in increasing emotional acceptance and reducing retraumatization. Researchers have however stated that there is a lack of established evidence based treatment which are tailored to the needs of patients suffering complex or childhood trauma (Priebe et al., 2012).
DBT-PTSD is said to aid a survivor of trauma to analyse their emotional and psychological needs; teaching survivors to control their behaviour. However for many survivors who have found themselves in some way within another toxic dynamic, their behaviours are caused by reliance on 4F responses due to retraumatization. DBT in this case is ineffective and requires either patient or therapist awareness in order to successfully navigate.
Individuals who have suffered interpersonal trauma or childhood developmental trauma require a period of stabilization prior to starting trauma therapy. This is not always possible as personal situations differ greatly from survivor to survivor. For those who are able able to obtain a stable period; DBT successes are seen to be considerably higher.
DBT has received criticism due to its narrow target base. Individuals who have survived complex trauma or childhood developmental trauma also have high incidences of experiencing a secondary mental health disorder such as; eating disorders, Addiction and personality disorders. These types of multifaceted issues have not been taken into account during DBT. As DBT was constructed to aid borderline personality disorder, it very often misses associated disorders that commonly go hand in hand with multiple trauma.
Due to this, the DBT-PTSD PE model was developed by Dr Melanie Harned in order to attempt to treat clients with complex trauma who also have additional mental health issues. Again, in its infancy - more research is required in order to extensively validate this model.
There is currently no official register of DBT therapists in the UK and many individuals find accessing DBT to be extremely difficult. The NHS are currently trialling DBT in some areas of the UK, but this can be hard to access due to long waiting lists and catchment areas.