When I talk to people who are interested in starting therapy at Inner Solutions™, a common remark that I hear from those who have endured traumatic events is that they say that they tried participating in trauma treatment, and it made their distress worse. From there, often the therapists who were delivering the trauma treatment will make a recommendation to try dialectical behaviour therapy (DBT).
Why is this experience so common? The answer has to do with the nature of what trauma treatment brings up for people. One of the main objectives in trauma treatment is to get folks to experience memories of the traumatic event and feel the emotions related to the event. Over time, this leads to corrective experiences whereby the brain begins to recognize that while the actual traumatic event threatened their physical or emotional well-being, the memories and emotions themselves are not dangerous. This approach to treating trauma works really well for the majority of people.
There’s just one problem with this approach – some folks feel their emotions much stronger than the average person does, and for these emotionally sensitive humans, exposing to emotions related to their trauma is incredibly painful, and their brains don’t know how to naturally process these emotions so that the feelings start to decrease in intensity on their own. For these folks, once they start trauma treatment, it’s like they are left with an open wound that will not close. This leads to increased suffering, and the intensity of emotions can influence impulsive behaviours to occur that function to bring down the emotional distress quickly (i.e., substance use, self-harm, etc.), but create more consequences in the long run.
So – why is DBT recommended for those who find that trauma treatment escalated their distress?
DBT takes a staged approach to treatment – it is structured in a way that gradually builds emotion regulation skills and addresses issues in a systematic manner, and makes sure that the skills needed to work on deep-rooted issues are in place before moving forward in the treatment. DBT therapists theorize that folks with emotion dysregulation can benefit from learning skills to tolerate and regulate their emotions, as often their emotions are simply so biologically intense that it’s difficult to regulate without doing something intentional to modulate them. Once these skills are acquired, then therapy focuses on strengthening this new skillset and making sure that it generalizes to all areas of their life, so that they are confident in their ability to regulate their emotions.
Once both client and therapist have solid evidence that there is a capability of experiencing and regulating emotions, then the option to re-enter trauma treatment is offered. Because there has been so much emphasis on acquiring and strengthening emotion regulation skills prior to re-commencing trauma treatment, generally at this point when trauma treatment is tried again, it goes a lot smoother than the first time, and leads to more successful outcomes.
While trauma treatment can seem like a scary endeavour, it’s a vital part of therapy for anyone who is experiencing emotional and behavioural suffering that is rooted in their past adverse experiences. Completion of trauma treatment leads to living a life with more emotional freedom, being able to enjoy life once again, and feeling more resilient to be able to face any future challenges.
References:
Harned, M. (2022). Treating Trauma in Dialectical Behavior Therapy: The DBT Prolonged Exposure Protocol (DBT PE). New York: The Guildford Press.
Linehan, M.M. (1993). Cognitive Behavior Treatment of Borderline Personality Disorder. New York: The Guildford Press.