DBT Protocols for Prolonged Exposure Therapy (DBT-PE)
Treating Trauma with Structure, Compassion, and Courage
“We have to learn how to embrace and cradle our own suffering and the suffering of the world, with a lot of tenderness.” – Thich Nhat Hanh
The DBT Protocols for Prolonged Exposure Therapy (DBT-PE) were developed by Dr. Melanie Harned and adapted from the foundational work of Dr. Edna Foa in Prolonged Exposure (PE) Therapy. Dr. Harned designed DBT-PE specifically for individuals who experience complex trauma, chronic invalidation, and higher-risk behaviors that may have made other trauma therapy unsafe or ineffective in the past.
DBT-PE is a structured, evidence-based trauma treatment, supported by growing clinical research, and designed to help clients face painful memories in a safe, measured, and empowering way.
When is DBT-PE Appropriate?
DBT-PE is introduced during Stage 2 of standard DBT treatment, only after a client has successfully reduced or eliminated self-injurious and life-interfering behaviors. Typically, this follows a period of skills development and preparation in DBT-based individual therapy. Clients must have foundational mastery of core mindfulness, distress tolerance, and emotion regulation skills in order to safely process trauma-related material without destabilization.
Why DBT-PE Works
At its core, DBT-PE recognizes that trauma responses persist due to avoidance, both of external reminders and internal experiences (thoughts, sensations, memories). When a person avoids their trauma, the emotional pain often deepens and the beliefs a person has come to accept about themselves and the world as a result of their traumatic experiences (e.g., “I’m not safe,” “It was my fault,” “I’ll never be okay”) remain unchallenged. DBT-PE helps to break that cycle
This model directly targets the emotional and cognitive patterns that keep people stuck, while reinforcing the client’s ability to tolerate distress, build mastery, and their story with greater self-compassion and agency.
Two Types of Exposure in DBT-PE
DBT-PE includes two primary forms of exposure, with each designed to reduce avoidance and increase emotional strength:
In Vivo Exposure
This involves gradually confronting real-life situations that are feared but objectively safe. For example, a person who avoids crowds due to a past traumatic event might work toward re-entering public spaces at a manageable pace. This helps retrain the nervous system to assess safety more accurately.
Treatment Duration and Format
DBT-PE sessions are 90 minutes in length, allowing ample time for both exposure and processing. The full treatment typically lasts 8 to 13 sessions, depending on the client’s progress, goals, and readiness. Each phase is structured and paced collaboratively to ensure safety, transparency, and respect for the client’s window of tolerance
For more information on the DBT-PE protocols, please visit: https://dbtpe.org/treatment-overview