DBT for Complex PTSD
A multicomponent program to treat the sequelae of interpersonal violence during childhood and adolescence.
Dialectical behavior therapy for complex posttraumatic stress disorder (DBT-PTSD) was tailored to treat adult PTSD following interpersonal violence such as childhood sexual abuse, including patients with borderline personality disorder (BPD). Most of these patients show severe problems in emotion regulation, self concept, memory processing and social interaction. Therefore DBT-PTSD merges evidence based modules to target these core domains: DBT principles; trauma-specific cognitive and exposure based techniques; compassion focused interventions; and behavior change concepts. The treatment program was initially conducted and evaluated as a three month residential program but is also applicable under outpatient conditions (40 sessions).
From a DBT perspective, PTSD-typical dysfunctional behaviors can predominantly be understood as strategies to avoid or escape from trauma-associated primary emotions like powerlessness, threat, anxiety, disgust, humiliation, or sexual arousal. Corroborated by dysfunctional cognitive assumptions, dysfunctional behaviors such as self-injury, suicidal ideation, dissociation, or intoxication and dysfunctional secondary emotions such as shame, guilt, self-hatred, or chronic anger, develop over time into inappropriate self-concepts which strongly impair quality of life.
DBT-PTSD primarily aims to help patients a) revise their fear of trauma-associated primary emotions, b) question whether secondary emotions like guilt and shame are appropriate, and c) radically accept trauma facts in order to establish a life worth living.
Prof. Dr. Martin Bohus
Full Professor of Psychosomatic & Psychotherapy
Scientific Director Institute for Psychiatric and Psychosomatic Psychotherapy
Central Institute of Mental Health, J5:
68159 Mannheim, Germany
DBT-PTSD is structured in a stepwise manner:
- During the first five weeks, patients learn to identify their typical automatic escape behaviors (actions, cognitions, and emotions) using individualized functional analyses. They further learn to use respective DBT skills to control these behaviors. Staff helps the client to utilize these skills during daily training sessions.
- During exposure sessions (week 6 to 10), the therapist provides close support to help the client avoid escape strategies, to re-experience trauma associated primary emotions, and to determine the appropriateness of these emotions in the reality of the past versus the present The therapist controls the current level of aversive tension and applies anti-dissociative skills as required. The exposure protocol allows the patient to control the pace and intensity of memory activation and balances the vividness of trauma memories with the awareness of being in the (non-dangerous) present (skills assisted exposure). Following therapist-guided exposure sessions, patients are asked to listen to the audio-taped sessions on a daily basis and to strictly avoid the identified escape strategies. If patients tend to dissociate, they are encouraged to use anti-dissociative skills like exercising on a stepper while listening to the tapes.
- During the last two weeks, treatment mainly focuses on radical acceptance of trauma-related facts and on relevant psychosocial aspects including work, partnerships, and sexuality.
Safety, acceptance and effectiveness of DBT-PTSD have been evaluated within pre-post studies and randomized controlled studies at the Central Institute of Mental Health, University of Heidelberg. The data revealed that the treatment program is highly acceptable (dropout-rates < 10%) and save and effective (PDS; CAPS effect sizes > 1.5).
The workshop will provide an introduction to DBT-PTSD: Prerequisites, treatment targets, and structure of the treatment; basic principles and rules; treatment modules: emotion regulation skills, mindfulness group therapy, discrimination training, cognitive interventions and moderated exposure.
Some of the interventions will be demonstrated with video-tapes. Training will be provided via roll-plays.
The aims of this workshop
To understand the basic psychosocial and neurobehavioral principles of complex PTSD; to learn the structure and principles of DBT-PTSD; to learn the major therapeutic interventions of DBT-PTSD; Regain your live after trauma; Work with your traumatized body; Develop a sense of meaning; Work with maladaptive dysfunctional cognitions; Work with emergency problems and crisis generating behaviour
Prof. Dr. Martin Bohus
Education and Training
1985 - 1988: Research scientist at the Department of Immunology, University of Freiburg
1988 - 1992: Clinician, Department of Psychiatry of the University of Freiburg
1992: Speciality in psychiatry and psychotherapy
1992- 2002: Senior physician, Department of Psychiatry of the University of Freiburg
1992 -1996: Director of interdisciplinary priority program: Vulnerability Marker for Major Depression
2000 - present: Director of interdisciplinary priority program: Neurobiological Aspects of Borderline Personality Disorder
2000 - 2003: Leading scientist of the Freiburg/Bale Center in the frame of the Borderline Personality Disorder Research Foundation.
2001: Habilitation for psychiatry and psychotherapy
2001: Call for full professorship at the Central Institute of Mental Health, University of Mannheim, Germany
2003 - present: Associated professorship at the University of Arts at Karlsruhe, Germany
2012 - 2017: Visiting Professorship University of Antwerp, Belgium
2018 - 2019: Visiting Professorship Harvard University, Boston, MA, USA
Chair (C4) in Psychosomatics and Psychotherapy, University of Heidelberg , Director, Dept. of Psychosomatics and Psychotherapy, Central Institute of Mental Health, Mannheim; President of the European Society for the Study of Personality Disorders (ESSPD); Vice-President of the International Society for the Study of Personality Disorder (ISSPD); Chair of Linehan Institute SPM;
Psychotherapy development and outcome research, psychopathology and treatment of affective dysregulation, pain perception in borderline personality disorders, emotional learning, dissociative features.
2003: Established Investigator Award - Borderline Personality Disorder Research Foundation, New York;
2003: Research Award - International Society for the Investigation and Teaching of Dialectical Behavioral Therapy, Boston;
2004: Psychotherapy Award of the German Association of Psychiatry, Psychotherapy and Neurology;
2005: Outstanding Research Award International Society for the Investigation and Teaching of Dialectical Behavioral Therapy, Washington;
2009: Hamburger Award for Personality Disorders;
2015: Edwards Lecture, University of Washington, USA; Stanton Lecture, Harward Medical School, Boston, USA.
- Speaker of the Clinical Research Group 256: Pathomechanisms of Emotion Regualtion in Borderline Personality Disorder (DFG; 2012-2018)
- Learning and brain plasticity in borderline personality disorder with and without comorbid posttraumatic stress disorder. (DFG; 2003-present)
- Ambulatory Monitoring in Borderline Personality Disorder (DFG 2002-2004);
- Evaluation of a stepped care treatment program for social phobia (DFG 2004-2007);
- Epidemiological Investigations on Borderline Personality Disorders.(BPDRF 2002-present);
- Neurobiology and Genetics of Affect Regulation (Ministry of Baden Wuerttemberg 05-09);
- Cognitive and Emotional Mechanisms of Pain Regulation (BMBF 2006-2008);
- Vulnerability markers for affective psychosis. (Ministry of Science and Art, Baden-Württemberg 92-96);
- G-protein expression in bipolar disorders. (Sander Foundation. 94-95);
- Studies on the effectiveness and mode of action of Dialectic Behavioral Psychotherapy for borderline disorders in in-patients (DFG 97-00);
- Neurobiological aspects of borderline personality disorders (Ministry of Science and Art, Baden-Württemberg 00-01);
- Startle response in patients with borderline personality disorders (DFG 00-02);
- Basic clinical research on borderline personality disorders (BPDRF, 2000-02), 6 industry – funded psychopharmacological projects