DBT Therapy for PTSD

Living with post-traumatic stress disorder (PTSD) brings certain challenges such as fears, anxiety, and difficulty with relationships. To make matters worse, effective treatment options are rather limited. There are anti-anxiety medications and antidepressants that can help with managing the symptoms, but nothing has been designed to treat PTSD. Therapy is similar. Some therapeutic treatment has been created with PTSD in mind such as eye movement desensitization and reprocessing (EMDR) therapy. However, very few clinicians have been trained in these specialized therapy options.

However, a type of therapy can be effective even if it hasn't been structured specifically for PTSD. After spending time going through typical cognitive behavioral therapy in individual sessions and group sessions, I was left feeling that I wasn't getting anywhere. In the group setting, topics were addressed that had nothing to do with PTSD or my struggles. The individual sessions seemed aimless and more often than not, lacked any insight that could help in my day-to-day struggles.

Then, I learned about a type of therapy called dialectical behavior therapy (DBT). DBT was created for people with borderline personality disorder which was previously considered to be untreatable. Borderline personality disorder is in no way related to posttraumatic stress disorder. They are completely different disorders even though borderline personality disorder can stem from trauma. Still, I found the DBT therapy to be the best therapy for PTSD.

DBT is all about equipping individuals with skills that they can use in their daily lives to help overcome the symptoms of their psychological disorders. Though it was designed for borderline personality disorder, it has been used for anxiety disorders, addiction, depression, bipolar disorder, and eating disorders. When participating in DBT therapy, the person must commit to attending group sessions and individual therapy sessions. During the group sessions, the focus is on learning the different skills. It is not a group of people sitting around talking about their childhoods or current conflicts. Though personal stories enter into the sessions, these are in relation to the skills being taught and learning how to apply them.

If you have PTSD, you may have experienced times when you feel overwhelmed with memories, fear, or other difficult thoughts and feelings. The intensity of these episodes can vary, but they often interfere with the ability to relate to others and work or home life. When I start to feel myself getting wrapped up in the negativity or fear from the PTSD, I pull out my list of DBT skills and see which ones may help me at that moment.

These skills are ways to cope with stress, change negative thinking, and communicate effectively. Mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation are the categories of DBT skills. Mindfulness skills help the person stay in the moment rather than getting caught up in ruminating. Opposite action and build mastery are two emotion regulation skills that I have found especially helpful. Build mastery involves doing things that make you feel competent and is essential for building a life worth living. For me, this often involves working on my art or poetry. Numerous activities can be used for this skill like hobbies, cooking or baking, learning a new language, or whatever the person feels good about practicing. Opposite action is a refusal to give in to emotionally driven behavior such as retreating to bed when feeling upset and doing something more productive and proactive instead.

Dialectical thinking is an understanding that things are not black and white. Two seemingly opposing views can both be true.

Examples related to my personal struggle with PTSD:

I tend to be afraid of people, but I want to be more social and a better friend.

I am most comfortable alone in a room where I feel safe, but being secluded limits my satisfaction with life.

I can be proud of my progress and recognize ways I want to change and grow.

Those examples point out areas where I can use a DBT skill to overcome my symptoms and expand my personal experiences. One of the best parts of the group sessions was hearing from others about how they applied the skills in their lives. These examples helped give me ideas of how to use the skills to deal with the anxiety and fear.

Not all skills have been helpful for me. I use what works. This therapy requires work. Not only did I have to attend therapy three hours a week, but there was homework and a form to fill out daily called a diary card. I have completed the therapy now, and I'm glad that I forced myself to put forth the effort to learn the skills and attend the sessions. I feel better equipped to handle the ups and downs of PTSD with DBT skills.