Congratulations on your new book, Treating Trauma in Dialectical Behavior Therapy! Dialectical Behavior Therapy (DBT), is a type of cognitive behavioral therapy that focuses on “acceptance and change.” It helps people learn to tolerate distress, regulate their emotions, and modify unhealthy behaviors. How is DBT helpful in treating clients with post-traumatic stress disorder (PTSD)?

Many clients with PTSD engage in life-threatening behaviors and have multiple severe comorbid conditions such as personality disorders, dissociative disorders, and substance dependence. For these types of high-risk and severe clients with PTSD, DBT can help to achieve the critical goals of safety and stability. In particular, DBT is an effective way to help clients with PTSD gain control over life-threatening and other severe behaviors by teaching them skills to better tolerate and regulate emotions and improve their relationships..

Treating Trauma in Dialectical Behavior Therapy presents the DBT Prolonged Exposure (DBT PE) protocol, the first structured and research-tested method of treating PTSD within DBT. Can you explain—in layman’s terms—what DBT PE is?

Although DBT can help clients with PTSD achieve control over self-destructive behaviors and improve coping skills, it is not typically effective in treating PTSD itself. Additionally, these high-risk clients are often excluded from PTSD treatments due to their severity. To address this gap, I developed DBT PE, which is based on Prolonged Exposure therapy (PE), an evidence-based treatment for PTSD, and has been adapted to meet the needs of this client population. DBT PE is a structured protocol that is designed to be integrated into DBT to treat PTSD once clients have achieved the safety and stability necessary to engage in trauma-focused treatment. The overall goal of the combined DBT and DBT PE treatment is to enable high-risk and multi-problem clients with PTSD to have all of their trauma-related problems addressed in one comprehensive treatment.

The third part of your book breaks down the DBT PE protocol into specific sessions. Can you briefly discuss how a therapist might use these session guidelines in their own work with clients?

In DBT PE, each session has a clear structure and therapists are expected to deliver the treatment strategies in a certain order while tailoring their delivery to fit the needs of each client. Therefore, the book includes chapters that describe exactly what to do in each session of DBT PE, making it easier for therapists to learn to deliver. The book also includes session checklists that can be used to guide therapists in delivering DBT PE during actual sessions.

The appendix includes 35 reproducible handouts, including client handouts, therapist forms, and session checklists. Can you highlight one or two that you think will be especially useful to therapists?

DBT PE includes many client handouts that are used during treatment. A few of my favorites are the psychoeducational handouts describing traumatic invalidation and its impact as well as a dialectical framework for understanding reactions to trauma. These handouts are designed to capture the common trauma experiences and reactions of clients who receive DBT PE, many of which extend beyond those that are typically addressed in other PTSD treatments. Therefore, clients often find these handouts to be both validating and helpful in better understanding their own experiences.

Lastly, we would love to learn a little bit more about you on a personal level! When you are not working, what do you do for fun? Now that your book is out, is there a project that you are excited to work on next (a presentation, a workshop, writing another book, etc.)?

Now that this book is done, I am actively working on working less! I am a mother of two teenagers who keep me busy and active outside of work. In my free time, I love to enjoy the beautiful nature of the Pacific Northwest by hiking, camping, paddleboarding, and cross-country skiing. I also lived overseas when I was young and developed a love for travel that has taken me to 5 continents and most U.S. states so far. I have really missed traveling during the pandemic and am looking forward to more adventures soon!

See all titles by and read more about Melanie S. Harned on her author page!