Running a Trauma-Focused DBT Program
United States Department of Homeland Security
Key Points
- The primary purpose of TF-DBT is to provide the necessary stabilization and self-regulation to proceed with deeper trauma work.
- Clinicians should be trained in top-down and bottom-up models of trauma treatment.
- DBT consists of four components: group sessions, individual sessions, between-session support, and the consultation team.
- DBT sessions generally open and close with mindfulness exercises.
- The following exercises are especially conducive to trauma work: heart-focused breathing, the safe place, the container, and the body scan
- The DBT hierarchy of treatment priorities is: suicidal thoughts and behaviors, treatment-interfering behaviors, quality-of-life behaviors, and skills training.
- DBT has four phases of treatment: crisis stabilization, emotion stabilization, general stabilization, and building a life worth living
Materials Downloads
DBT for Trauma Online Training
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Transcript
Greetings, and welcome to the second video in our review of trauma-focused DBT. In this video we will review the main components of DBT treatment. So, for example, what to prioritize when there are multiple competing needs at the same time, how to structure a typical DBT session, the phases of treatment, and the difference between top-down vs bottom-up processing. So let’s get started.
Okay. So as you recall, DBT teaches skills to help clients stabilize and self-regulate. However, DBT alone is not designed to resolve the intrusive or re-experiencing symptoms of trauma such as memories or nightmares and flashbacks. So if you recall, We spent a lot more time in a previous module talking about the symptoms of trauma. The entire purpose of trauma-focused DBT is to provide the necessary stabilization and self-regulation to then proceed with deeper trauma work, which will help resolve some of those intrusive and re-experiencing symptoms that we just mentioned. So the deeper trauma work is going to come outside of DBT itself. This will come from other models that are designed specifically for trauma processing. But the purpose of TF-DBT is to help clients get to that point where they’re stable enough and have enough skills, enough resources, to be able to benefit from those models.
Linehan, M. M. (2014). DBT skills training manual (2nd ed.). Guilford Publications.,Reutter, K. (2019). The dialectical behavior therapy skills workbook for PTSD: Practical exercises for overcoming trauma and post-traumatic stress disorder. New Harbinger Publications.
TF-DBT recommends being fully trained in at least one trauma model that is primarily top-down and another model that is predominantly bottom-up. So models of trauma processing can be roughly categorized into models that are either top-down or bottom-up. So top-down models of trauma processing are more cognitive and more verbal in nature, whereas bottom-up models are more somatic in nature. Some clients benefit more from a top-down approach. However, many clients respond much better to a bottom-up approach. And in my own personal experience, I would say most clients benefit from a combination of both top-down and bottom-up approaches. And the reason for that is because trauma affects all parts of the brain and all parts of the body, right? So both top-down and bottom-up approaches can be useful in targeting the various symptoms of trauma.
Linehan, M. M. (2014). DBT skills training manual (2nd ed.). Guilford Publications.,Reutter, K. (2019). The dialectical behavior therapy skills workbook for PTSD: Practical exercises for overcoming trauma and post-traumatic stress disorder. New Harbinger Publications.