Sunday, June 14, 2009

Professional Perspective: Dialectical Behavior Therapy & PTSD, Part 1

I met Laura Burlingame-Lee when I stumbled upon her blog, The Other Side of the Couch. I immediately liked her personable voice and her incredibly educated and knowledgeable approach to communicating with those of us on, well, the other side of the couch!

One of her posts referenced Dialectical Behavior Therapy (DBT), something I'd never heard of before. I wrote asking for details and voila! In the spirit of spreading the healing word Dr. Burlingame-Lee wrote this guest post, just for 'Parasites of the Mind'. In the way that DBT combines skills training with therapy I think it's a very interesting approach to healing. Today, Part 1 of a two-part series giving us an overview of DBT - what it is, how to use it, how to develop its skills and how to incorporate it into your recovery process.


Dialectical Behavior Therapy (DBT) is a specific type of behavioral therapy that was developed to treat Borderline Personality Disorder (BPD), a condition where the person involved has chronic feelings of depression, anxiety and suicidality in addition to volatile personal relationships and trouble regulating emotions and mood. The overall goal of DBT is pretty straightforward: to help you create a life worth living.

Ok - a lot of this sounds pretty technical, doesn't it? I have to say, I really hate, despise and abhor the term "personality disorder" because it implies that there is something fundamentally wrong with the person. So, how does this relate to PTSD? There are some mental health professionals and researchers who believe that BPD is actually a chronic, severe form of PTSD. Many, many people diagnosed with BPD have severe and/or chronic trauma in their past and really don't know how to cope with stress, anxiety and/or anger along with ups and downs in relationships. Marsha Linehan, the psychologist who developed DBT, once said that the person with BPD was like a person with 3rd degree burns - extremely sensitive and very easily irritated; the difference was that the problem here was emotional rather than physical.
Some of you, even without BPD, may have or do feel overly sensitive on occasion. PTSD involves its own set of overwhelming, frightening, and anxiety-producing symptoms that DBT skills can help.


DBT is a system that's designed to help a person deal with overwhelming emotions (anger, rage, fear, panic) and urges (self-harm, suicide, harming others) and to increase quality of life by strengthening relationships and increasing the person's ability to cope in general. DBT in its full form includes individual therapy with a DBT-trained therapist and a skills-training group. We'll focus more on the skills training group in most of the post, but I'll give you an overview of the individual therapy as well.


In DBT, individual therapy is more oriented like traditional Cognitive Behavioral Therapy (CBT - we've got a LOT of acronyms here, don't we? J). Individual therapy looks pretty similar to a lot of other types of therapy, with the exception that the individual therapist will work with you on both accepting you as you are and helping you work for change. That sounds a little weird, doesn't it? Like trying to find the balance between two ends of a see-saw, where it seems like both goals are pretty opposite each other. That's what a dialectic is - a situation where you have two things that seem opposite but are both true.

Individual therapy works on this dialectic because nonjudgmentally accepting you as you are is crucial for developing a good relationship, and because working on change is the goal - changing so that you can reduce the things getting in the way of creating a life worth living. The bottom line is that your individual therapist will help you reduce the stuff that's getting in the way of healing and living the life you want, and also help you increase your ability to cope by reinforcing the skills taught in the group and by helping you process the experiences you have in using these skills.


Before you understand what skills training is, it's helpful to know what it's not. DBT skills training is NOT a group designed to explore traumas, examine and process the past, or come to terms with the traumatizing event(s) - this is done with your individual therapist. (This is also why DBT works best when you also work with an individual therapist and/or psychiatrist who is trained in DBT and other supported therapies like CBT.) Ideally, someone with PTSD would use DBT to help her or him cope with the overwhelming emotions and self-harm urges that often accompany PTSD while also working in individual therapy to help understand, come to terms with, and process/heal from the trauma. A combination of DBT skills training groups and a CBT/DBT therapist works really well.

Another misunderstanding of DBT is that it's a quick and easy way to fix symptoms - most of you, I'm sure, know first-hand that dealing with PTSD and its symptoms is practically a full-time job (and I'm NOT saying that in jest - it takes a lot of energy and strength to cope and even more to progress and heal. I have tremendous admiration and respect for all of you who work so hard to overcome what's hurt you. That takes guts!) DBT was designed, believe it or not, to be a long-term therapy - Linehan had her clients sign a two-year contract!

To learn more about practicing DBT skills, why skills training is so effective and what comes after training, check back here next Sunday for Part 2 of Laura's professional perspective.

Laura Burlingame-Lee, Ph.D. is a recent graduate who obtained her doctoral degree in counseling psychology from Colorado State University. She is currently pursuing licensure in this field, and is available to answer questions concerning DBT and a variety of other topics. Laura has had personal and professional experience in dealing with PTSD, Depression, and Anxiety, in addition to extensive clinical training and experience in treating Borderline Personality Disorder and other chronic and severe emotional issues. She completed her internship at the Colorado Mental Health Institute at Ft. Logan in Denver, Colorado and is looking forward to beginning her practice as DBT-trained therapist. She generally works with CBT and DBT, but also brings in mindfulness and spirituality as well as other aspects in order to work holistically with her clients. She can be reached via email at: theothersideofthecouch @

(Photo: Laura Burlingame-Lee)


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tell me something. what happen with the people that never can overcome this situation? which kind of treatment have to follow?

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Reducing Stress said...

I personally try to deal with this everyday by means of Stress and Anxiety meditation methods.