1st Edition

Treating Trauma in Dialectical Behavior Therapy The DBT Prolonged Exposure Protocol (DBT PE)

By Melanie S. Harned Copyright 2022

    Many DBT clients suffer from posttraumatic stress disorder (PTSD), but until now the field has lacked a formal, tested protocol for exactly when and how to treat trauma within DBT. Combining the power of two leading evidence-based therapies--and designed to meet the needs of high-risk, severely impaired clients--this groundbreaking manual integrates DBT with an adapted version of prolonged exposure (PE) therapy for PTSD. Melanie S. Harned shows how to implement the DBT PE protocol with DBT clients who have achieved the safety and stability needed to engage in trauma-focused treatment. In a convenient large-size format, the book includes session-by-session guidelines, rich case examples, clinical tips, and 35 reproducible handouts and forms that can be downloaded and printed for repeated use.

    I. Background
    1. The Development and Foundations of DBT PE
    2. The Target Population
    II. Stabilization and Preparation
    3. Setting the Stage for DBT PE in Pretreatment
    4. Achieving Safety, Stability, and Skills in Stage 1
    5. Building Motivation for DBT PE
    6. Determining Readiness for DBT PE
    7. Preparing to Start DBT PE
    III. The DBT PE Protocol
    8. Session 1
    9. Session 2
    10. Joint and Family Sessions
    11. Session 3
    12. Intermediate Sessions (Sessions 4+)
    13. The Final Session
    IV. Troubleshooting and Tailoring Treatment
    14. Troubleshooting Problems
    15. Targeting Specific Trauma-Related Emotions
    16. Working with Different Trauma Types
    17. Treating Diverse Populations
    V. Next Steps
    18. Stage 3 and Beyond
    Appendix A. DBT PE Client Handouts
    Appendix B. Therapist Forms
    Appendix C. Session Checklists
    Appendix D. Measures


    Melanie S. Harned, PhD, ABPP, is Coordinator of the DBT Program at the VA Puget Sound Health Care System and Associate Professor in the Department of Psychiatry and Behavioral Science and Adjunct Associate Professor in the Department of Psychology at the University of Washington. Dr. Harned previously served as Research Director of the Behavioral Research and Therapy Clinics at the University of Washington, Director of Research and Development for Behavioral Tech, and Director of Behavioral Tech Research. Her research focuses on the development and evaluation of the DBT Prolonged Exposure protocol (DBT PE), as well as methods of disseminating and implementing this and other evidence-based treatments in clinical practice. She regularly provides training and consultation nationally and internationally in DBT and DBT PE, and has published numerous articles and book chapters.

    "On rare occasions, a work comes along that expands our basic assumptions, elevates our practice, improves client outcomes, and advances the field substantively. Harned’s DBT PE manual is just that work. DBT PE is a game changer for clients with trauma histories who need DBT, granting providers the ability to formally target PTSD. With a meticulously crafted rationale; precise, principle-based guidelines for conducting exposures; DBT-infused processing; targeted applications for numerous trauma types and populations (including adolescents, who thrive with her approach); and instructive handouts and worksheets, this manual is a brilliant addition to the field."--Jill H. Rathus, PhD, Department of Psychology, Long Island University Post; Cognitive Behavioral Associates, Great Neck, New York

    “Harned has done a masterful job integrating DBT with PE and has conducted a body of research providing strong empirical support for this PTSD treatment. The manual thoroughly presents the theoretical underpinnings of DBT PE. It provides assessment guidelines, criteria for readiness for DBT PE, session procedures, and troubleshooting help. Harned describes how to work with clients after the final session of DBT PE, including ongoing exposure, relapse prevention, and Stage 3 DBT. A single case beautifully demonstrates implementation of DBT PE from beginning to end. This well-written treatment manual is suitable for trainees learning DBT PE as well as for very seasoned trauma therapists who wish to learn how to treat complex, high-risk patients with an effective, evidence-based treatment.”-- Elizabeth A. Hembree, PhD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania

    "The DBT PE protocol has been demonstrated to improve emotion regulation and reduce self-injurious behaviors in patients with severe PTSD who are not able to benefit from PE on its own. This comprehensive, eagerly awaited manual provides the details and logistics of DBT PE, with all necessary worksheets and session guidelines. Harned describes how the protocol was developed in a stepped manner to ensure safety and efficacy, providing a model for those involved in treatment development. This manual is an excellent fit for any setting where providers and clinical students in training are working to build on the foundations of DBT and/or PE to work effectively with highly comorbid and distressed patients. Harned does an excellent job of synthesizing the complexities of caring for these patients with validation, support, effective intervention, and empathy."--Sheila A. M. Rauch, PhD, ABPP, Mark and Barbara Klein Distinguished Professor in Psychiatry and Deputy Director, Emory Healthcare Veterans Program, Emory University School of Medicine

    "Harned seamlessly integrates principles and protocols of PE into standard DBT--the synthesis is elegant as well as practical, clear as well as compassionate, behaviorally specific while allowing for flexibility. This highly readable manual walks therapists step by step through treatment of individuals who are haunted by traumatic memories and trapped in self-destructive patterns. Harned’s persistent optimism and encouragement will bolster the resolve of therapists and clients at a loss for what to do about trauma and PTSD. Most important, DBT PE has been shown to be amazingly effective. Every psychotherapist working with traumatized, difficult-to-treat populations should consider applying DBT PE to help their patients find lives of freedom and meaning."--Charles R. Swenson, MD, Department of Psychiatry, University of Massachusetts Medical School

    "Treatment of PTSD in individuals who are suicidal is a conundrum for therapists; there has been little research to guide us. This book lays out for clinicians a route--with evidence behind it--for helping those with PTSD and suicidal behavior to achieve a life worth living. It is a rare treat to find a clinical manual that is this clear and well written. This book will become a well-loved resource on many clinicians’ bookshelves, and I foresee using it frequently with my own trainees, especially those on internship or at the postdoctoral level."--Debra Kaysen, PhD, ABPP, Department of Psychiatry and Behavioral Sciences, Stanford University-