DBT for Trauma: Mindfulness, Emotional Regulation, and the 5 Dilemmas

United States Department of Homeland Security

Since trauma overactivates the sympathetic and parasympathetic nervous systems, clients dealing with trauma encounter 5 basic dialectical dilemmas: dissociation vs hypervigilance, paralysis vs explosivity, numbness vs emotional overwhelm, impulsivity vs rumination, and passivity vs aggression.
The DBT skills of mindfulness, distress tolerance, emotion regulation, dialectical thinking, and interpersonal effectiveness help clients find the balance between each of these polarities.
Since unprocessed trauma is stored somatically, trauma work starts with mindfulness of the body. Mindfulness refers to both awareness and acceptance of the present moment.
This skill is especially important since clients with PTSD are frequently stuck in both the past and the future simultaneously (another dialectical dilemma), whereas healing occurs in the present.
Mindfulness skills are foundational since you can’t manage your thoughts, feelings, reactions, and relationships if you can’t be aware of—and accepting of—each of these dynamics.
The RAIN acronym helps clients apply mindfulness concepts as simple, concrete reminders to recognize, allow, investigate, and nurture.