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A dive into dialectical behaviour therapy for trauma

17 November 2023

Mental health
Dialectical behaviour therapy (DBT) is often pigeonholed as a treatment for borderline personality disorder, but did you know it is also effective for people who have experiences of trauma, with or without a diagnosis of borderline personality disorder?

Clinical Psychologist Dielle Horne explains how DBT works and why it is an effective form of therapy for conditions such as post-traumatic stress disorder.

Firstly, what is DBT?

DBT is a type of cognitive behaviour therapy that helps people who have trouble managing their emotions, behaviour and interpersonal conflicts to build a life worth living – that is, create a life that is meaningful to you. The therapy is centred around core concepts of acceptance and change. 

It teaches you skills to cope with life, such as:

  • managing difficult feelings in times of crisis
  • coping with emotions in healthy ways
  • changing damaging behaviour patterns
  • improving relationships with others
  • becoming more present day to day.

The recommended format for the therapy involves group skills training and individual therapy sessions weekly over an extended period to assist with implementing new behaviours and practices that support individuals to reach their goals. 

The four skill components taught in DBT

1. Mindfulness

This skill focuses on being self-aware and paying full attention to the present moment – in and around you – without judgement, reducing worry and increasing inner peace.

In DBT, an additional goal of mindfulness practice is to experience “wise mind”. It’s the state of mind that balances emotion and reason, helping individuals to respond with their values and long term goals in mind, instead of reacting impulsively or ignoring their emotional experiences.

2. Distress tolerance

This skill focuses on learning to manage emotions in stressful situations and avoiding making the situation worse. 

It covers how to cope in times of crises by practicing skills such as, self-soothing techniques, body-based arousal reduction strategies, imagery, encouragement, distraction techniques, improving the moment, thinking of pros and cons and acceptance skills.

3. Emotional regulation

Emotional regulation training focuses on changing emotional experiences by increasing awareness, understanding and skills to manage emotions. In turn, these skills help to change an individual’s relationship with their emotions and help emotion function toward their life-worth-living goals.

4. Interpersonal effectiveness

Interpersonal effectiveness is learning how to deal with conflicting needs in relationships and articulating what you want and need, such as saying ‘no’ to unwanted requests and demands. This includes learning communication skills to be heard, to enhance self-respect and connect more with others. The program also helps in finding the middle ground between both individual and other’s needs during interactions. 

So how is DBT relevant for people who have experienced trauma?

The aftermath of trauma looks and feels different for each individual and these reactions can be very confusing for both the individual who has experienced the trauma and their loved ones. 

Reactions can oscillate from one extreme to the next. For example, feeling an emotion intensely one moment and then feeling void of emotion the next, having racing thoughts and then going blank. 

If you are experiencing the aftermath of trauma, understanding, tolerating and managing these experiences is really challenging. For those who observe these reactions in their loved ones, it can be really challenging to understand what they are going through, causing additional tension and conflict in relationships. 

These challenges and the impact of trauma erode the quality of life of the person experiencing trauma and their loved ones. Adjusting to new realities following trauma can be incredibly painful and often trauma experiences erode ones’ sense of meaning and connections in the world – foundations that underpin ones’ life worth living.

DBT can help individuals to develop skills to understand these seemly contradictory experiences and help to stabilise, self-regulate and build back areas of their life that have been eroded by trauma. For some people, DBT helps them overcome their traumatic experiences and resolve their trauma symptoms as they reach the goal of ‘creating a life worth living’. 

For others, DBT provides strong foundational skills and confidence that assist in undergoing trauma-focused treatments (e.g. eye movement desensitisation and reprocessing (EMDR), prolonged exposure therapy) to directly process and reconsolidate traumatic memories to relieve PTSD symptoms. 

There are a variety of services and treatment types available to treat mental health conditions. We recommend speaking with your health care practitioner or GP to discuss what best suits your needs, or if you are concerned about someone in your life.

Head shot of Dr Dielle Horne
Dielle Horne - Clinical Psychologist

Dielle is a clinical psychologist who has completed a Clinical Psychology Masters and PhD. Dielle has experience working in public health, private and not-for-profit clinical settings. Dielle has completed comprehensive training, and works in the dialectical behaviour therapy (DBT) and radically open dialectical behaviour therapy (RO-DBT) programs. 

Dielle also works across a range of trauma programs at St John of God Health Care and has a special interest in treating sleep difficulties, including trauma related sleep difficulties.