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DBT Prolonged Exposure (DBT PE) for Trauma and PTSD

DBT Prolonged Exposure, or DBT PE, is a PTSD treatment that is added to Comprehensive DBT. It is based on Prolonged Exposure therapy, one of the most studied treatments for PTSD, and adapted for people in DBT who also live with the effects of trauma [1][2]. It was developed by Dr. Melanie Harned, and its first published study was co-written with Marsha Linehan, who created DBT [1].

At North Texas DBT Associates, trauma treatment takes place in individual DBT therapy. If you are seeking trauma treatment or have been diagnosed with PTSD, DBT PE is how we bring PTSD treatment into your weekly sessions once you are ready.

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Why trauma treatment and DBT belong together

Many people who come to DBT also have PTSD. Standard PTSD treatment guidelines and studies have often turned away people with recent suicidal behavior or self-harm, so they were frequently told to get “stable” first and never offered trauma treatment at all [2]. DBT on its own does not usually target PTSD directly, and in Harned’s trial only about a third of people who had DBT without the DBT PE protocol no longer met criteria for PTSD [2].

DBT PE was built to close that gap. It lets you treat PTSD in the same program, while keeping the safety structure of DBT around you [1][2].

What is prolonged exposure?

Prolonged Exposure (PE) helps you face trauma-related memories, feelings and situations you have been avoiding, gradually and with support [11][12]. The U.S. Department of Veterans Affairs calls PE one of the most effective types of treatment for PTSD, and standard PE usually takes 8 to 15 weekly sessions [11]. The American Psychological Association’s clinical practice guideline for PTSD recommends it [12].

How DBT PE works

DBT PE follows a stage-based approach [5]:

  • Stage 1: safety and stability. Standard DBT helps you get control of the most dangerous and disruptive problems first, such as suicidal behavior and self-harm.
  • Stage 2: PTSD treatment. Once you are ready, your therapist adds the DBT PE protocol to your individual therapy.
  • Stage 3: building the life you want. Work continues on the problems that remain after PTSD is treated.

Like standard PE, DBT PE uses three main parts [2]:

  • In vivo exposure. Gradually approaching safe situations, places or activities you have been avoiding because they remind you of the trauma.
  • Imaginal exposure. Revisiting the memory of the trauma, out loud, with your therapist.
  • Processing. Talking through what came up, including beliefs about guilt, blame and shame that keep PTSD going.

DBT PE adds DBT strategies to keep the work safe. You rate urges to harm yourself before and after each exposure task, your therapist addresses problems such as dissociation as they arise, and the protocol is paused if self-harm returns [2].

When are you ready for DBT PE?

In Harned’s research, people started DBT PE once they met six readiness criteria [2]:

  1. Not at imminent risk of suicide.
  2. No suicide attempts or self-harm in the past two months.
  3. Able to control self-harm urges when faced with cues for them.
  4. No serious behavior that gets in the way of therapy.
  5. PTSD is your highest priority, and you want to treat it now.
  6. Able and willing to feel intense emotions without escaping them.

In that trial, most people who stayed in DBT and still had PTSD reached readiness, on average after about five months of DBT [2]. Your therapist will work through these criteria with you; reaching them is part of the treatment, not a test you pass or fail.

What sessions look like

In Harned’s trial, people had either one longer weekly session (90 minutes of DBT PE and 30 minutes of DBT) or two weekly sessions with the same therapist, alongside the DBT skills training group [2]. People who completed the protocol did so in about 13 DBT PE sessions on average, and the length was guided by ongoing assessment of their PTSD and goals [2].

What the research shows

DBT PE has a small but consistent body of research. Most studies so far are pilot trials, many with women who had PTSD, borderline personality disorder and recent self-harm, and the authors say larger trials are needed [2][3].

  • First study, 2012. Among 13 women, 71% of those who completed the DBT PE protocol no longer met criteria for PTSD after treatment. There was no sign that the protocol increased self-harm urges or behavior [1].
  • Randomized trial, 2014. Among people who completed treatment, 80% who received DBT with DBT PE no longer met criteria for PTSD, compared with 40% in DBT alone. People who completed the DBT PE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-harm than those in DBT alone [2].
  • Daily life, 2018. Adding DBT PE did better than DBT alone at improving social adjustment, health-related quality of life and overall functioning [4].
  • Community clinics, 2021. In four public mental health agencies, 71% of people who completed DBT PE showed reliable improvement in PTSD, compared with 31% of people who received DBT only, with no worsening of self-harm or use of crisis services [3].
  • What people prefer. When given the choice, about three in four people with PTSD and borderline personality disorder preferred DBT combined with prolonged exposure over either treatment alone [6].
  • Across studies. A 2024 meta-analysis found that PTSD-focused versions of DBT, including DBT PE, had moderate effects on PTSD symptoms compared with control groups [9].
  • Veterans. VA programs that combine full-model DBT with prolonged exposure have reported large reductions in PTSD symptoms, first in a pilot of 33 veterans and then among 180 veterans in an intensive outpatient program [7][8].

Research on prolonged exposure more broadly has found that other conditions, such as depression and anxiety, tend to improve along with PTSD or stay the same, rather than getting worse [10].

Who DBT PE may help

DBT PE may be a fit if you are an adult in DBT, or considering DBT, and trauma is still shaping your life through nightmares, flashbacks, avoidance, shame or feeling constantly on guard. It was designed for people whose PTSD sits alongside other serious problems, such as suicidal thoughts, self-harm, intense emotions or borderline personality disorder, who are often turned away from trauma treatment elsewhere [1][2][13].

DBT PE at North Texas DBT Associates

Find out if DBT PE is right for you

The way to know is to talk it through with us. Call (817) 214-7200 or send us a message, and we will arrange a full intake and assessment with one of our clinicians.

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Frequently asked questions

What does DBT PE stand for?

Dialectical Behavior Therapy Prolonged Exposure. It is the DBT Prolonged Exposure protocol for PTSD, set out in Harned’s treatment manual, Treating Trauma in Dialectical Behavior Therapy [13].

Do I need a PTSD diagnosis?

DBT PE was built to treat PTSD. If you are seeking trauma treatment but have not been diagnosed, your intake and assessment will look at whether PTSD is present and which treatment fits.

Will talking about my trauma make things worse?

Exposure is hard work, and strong emotions are expected. In the studies above, DBT PE did not increase self-harm urges or behavior, and it is only started once you have the skills and stability to do it safely [1][2][3].

How long does DBT PE take?

In Harned’s 2014 trial, people who completed the protocol did so in about 13 sessions on average, within a year of DBT [2]. Your timeline depends on your own treatment.

Is DBT PE the same as DBT-PTSD?

No. DBT-PTSD is a different treatment developed by Martin Bohus and colleagues in Germany [14]. Both combine DBT with trauma-focused work.

Can I do DBT PE without the rest of DBT?

No. DBT PE was designed and tested as part of Comprehensive DBT [2][13], and at North Texas DBT Associates it is offered only to clients in our Comprehensive DBT program. If you are already seeing a trauma therapist elsewhere, we can talk through the options at intake.

What does it cost?

Current fees, including intake fees, are on our fees page.

Related reading

The four parts of Comprehensive DBT

Not sure which level of care fits? Read about DBT-informed treatment or go back to What is DBT?

Take the next step

Call (817) 214-7200, email info@ntxdbt.com, or use our contact form to request an intake. Our team will answer your questions and help you decide on the right next step.

Contact Us
Call (817) 214-7200

In crisis? Call or text 988 to reach the 988 Suicide and Crisis Lifeline, free and confidential at any hour. If you are in immediate danger, call 911.

Sources

  1. Harned, M. S., Korslund, K. E., Foa, E. B., and Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol. Behaviour Research and Therapy, 50(6), 381-386. https://doi.org/10.1016/j.brat.2012.02.011
  2. Harned, M. S., Korslund, K. E., and Linehan, M. M. (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7-17. https://doi.org/10.1016/j.brat.2014.01.008
  3. Harned, M. S., Schmidt, S. C., Korslund, K. E., and Gallop, R. J. (2021). Does adding the Dialectical Behavior Therapy Prolonged Exposure (DBT PE) protocol for PTSD to DBT improve outcomes in public mental health settings? A pilot nonrandomized effectiveness trial with benchmarking. Behavior Therapy, 52(3), 639-655. https://doi.org/10.1016/j.beth.2020.08.003
  4. Harned, M. S., Wilks, C. R., Schmidt, S. C., and Coyle, T. N. (2018). Improving functional outcomes in women with borderline personality disorder and PTSD by changing PTSD severity and post-traumatic cognitions. Behaviour Research and Therapy, 103, 53-61. https://doi.org/10.1016/j.brat.2018.02.002
  5. Harned, M. S., Gallop, R. J., and Valenstein-Mah, H. R. (2018). What changes when? The course of improvement during a stage-based treatment for suicidal and self-injuring women with borderline personality disorder and PTSD. Psychotherapy Research, 28(5), 761-775. https://doi.org/10.1080/10503307.2016.1252865
  6. Harned, M. S., Tkachuck, M. A., and Youngberg, K. A. (2013). Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD. Journal of Clinical Psychology, 69(7), 749-761. https://doi.org/10.1002/jclp.21943
  7. Meyers, L., Voller, E. K., McCallum, E. B., Thuras, P., Shallcross, S., Velasquez, T., and Meis, L. (2017). Treating veterans with PTSD and borderline personality symptoms in a 12-week intensive outpatient setting: findings from a pilot program. Journal of Traumatic Stress, 30(2), 178-181. https://doi.org/10.1002/jts.22174
  8. Schachter, Michal, Voller, Andrews Wiebusch, Kaler, and Marquardt (2026). Effectiveness of combined dialectical behavior therapy and prolonged exposure in an intensive outpatient program for veterans. Psychological Services. https://doi.org/10.1037/ser0001060
  9. Prillinger, K., et al. (2024). A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. European Journal of Psychotraumatology, 15(1), 2406662. https://doi.org/10.1080/20008066.2024.2406662
  10. van Minnen, A., Zoellner, L. A., Harned, M. S., and Mills, K. (2015). Changes in comorbid conditions after prolonged exposure for PTSD: a literature review. Current Psychiatry Reports, 17(3), 549. https://doi.org/10.1007/s11920-015-0549-1
  11. U.S. Department of Veterans Affairs, National Center for PTSD. Prolonged Exposure (PE) for PTSD. https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
  12. American Psychological Association. Clinical Practice Guideline for the Treatment of PTSD: Prolonged Exposure (PE). https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure
  13. Harned, M. S. (2022). Treating Trauma in Dialectical Behavior Therapy: The DBT Prolonged Exposure Protocol (DBT PE). Guilford Press. https://www.guilford.com/books/Treating-Trauma-in-Dialectical-Behavior-Therapy/Melanie-Harned/9781462549122
  14. Bohus, M., et al. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: a randomized clinical trial. JAMA Psychiatry, 77(12), 1235-1245. https://doi.org/10.1001/jamapsychiatry.2020.2148