Applications of dialectical behavior therapy to the treatment of complex trauma‐related problems: When one case formulation does not fit all
Abstract
In this article, the authors take the perspective that effective treatment of complex trauma‐related problems requires, in the absence of empirically supported treatments, a reliance on theory, idiographic assessment, and empirically supported principles of change. Dialectical behavior therapy (DBT; M. M. Linehan, 1993) is used to demonstrate the applicability of this approach to the treatment of multiproblem, heterogeneous populations in general. Two case studies are presented that highlight the utility of DBT principles to complex trauma‐related problems specifically.
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Direct treatment of trauma is reserved for when a patient has the skills to effectively tolerate intense emotional re-experiencing.
“Wagner, Rizvi, and Harned (2007) highlight that while trauma symptoms may initially be targeted to the extent that they contribute to life-interfering behaviors (e.g.NSSI), direct treatment of trauma is reserved for when a patient has the skills to effectively tolerate intense emotional re-experiencing.”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
Around two-thirds of individuals with BPD have experienced physical or emotional abuse in childhood.
“Wagner, Rizvi, and Harned (2007) estimated that around two-thirds of individuals with BPD have experienced physical or emotional abuse in childhood”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
An even higher percentage of individuals with BPD report trauma in adulthood.
“and an even higher percentage report trauma in adulthood”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
Effective treatment requires two foci: current factors that maintain the dissociative behavior with development of emotion regulation skills and exposure to current cues for negative emotion, and in vivo and imaginal exposure to the index trauma undertaken after the individual has learned skills to manage negative affect.
“The authors note that effective treatment requires two foci: (1) current factors that maintain the dissociative behavior and the associated development of emotion regulation skills and exposure to current cues for negative emotion; and (2) in vivo and imaginal exposure to the index trauma, which is undertaken after the individual has learned skills to manage negative affect”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
PTSD, BPD, and nonsuicidal self-injury commonly co-occur in community and clinical samples.
“PTSD, BPD, and nonsuicidal self-injury (NSSI) commonly cooccur in community and clinical samples”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
The factors involved in the initial development of a problem behavior may differ from the factors that maintain a problem behavior.
“As Wagner, Rizvi, and Harned (2007) highlight, the factors involved in the initial development of a problem behavior may differ from the factors that maintain a problem behavior.”
From Transdiagnostic applications of DBT for adolescents and adults (2015) · cites this paper as Wagner, Rizvi, and Harned (2007)
Cites
Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.5.715 · Cited by 1,444 · see citing works
Dialectical behavior therapy for borderline personality disorder
Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.2.022305.095229 · Cited by 704 · see citing works
Editorial comments: complex developmental trauma
van der Kolk, B. A., & Courtois, C. A. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20046 · Cited by 139 · see citing works
Rizvi, S. L., & Linehan, M. M. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80071-9 · Cited by 93 · see citing works
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Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision
International Society for the Study of Trauma and Dissociati (2011) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2011.537247 · Cited by 374 · see citing works
Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20617 · Cited by 205 · see citing works
Is emotional abuse as harmful as physical and/or sexual abuse?
Dye, H. L. (2020) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-019-00292-y · Cited by 167 · see citing works
Transdiagnostic applications of DBT for adolescents and adults
Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2015.69.2.111 · Cited by 112 · see citing works
Self-Acceptance Group Therapy: A Transdiagnostic, Cognitive-Behavioral Treatment for Shame
Schoenleber, M., & Gratz, K. L. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.05.002 · Cited by 31 · see citing works
Nonpathologizing trauma interventions in abnormal psychology courses
Hoover, S. M., Luchner, A. F., & Pickett, R. F. (2016) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2016.1103109 · Cited by 6 · see citing works
- Authors
- Wagner, A. W., Rizvi, S. L., & Harned, M. S.
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2007-08
- Volume
- 20
- Issue
- 4
- Pages
- 391-400
- ISSN
- 0894-9867
- 1573-6598
- Cited by
- 54
- References
- 4
- Language
- en
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