How We Treat

DBT Prolonged Exposure (DBT-PE)

Clinically reviewed by Eleanor Cummins, LMSW, October 2026. Eleanor is a graduate of the Columbia School of Social Work’s DBT intensive training lab, in collaboration with Behavioral Tech. She has also completed training in DBT Prolonged Exposure with its developer, Melanie Harned.

Some people spend years getting very good at surviving their trauma without ever getting to treat it. They learn to ride out the panic, keep self-harm urges at bay, and steer around anything that might bring the memories back. That is real progress. It is also exhausting, and it leaves trauma in the driver’s seat, deciding where you can go and who you can be.

We believe you deserve more than coping. You deserve a way through the trauma itself, at a pace that keeps you safe. That belief is why The Counseling Center Group offers DBT Prolonged Exposure (DBT-PE), a structured, evidence-based trauma therapy for post-traumatic stress disorder (PTSD) that pairs the stabilizing skills of Dialectical Behavior Therapy with a proven method for processing traumatic memories. Our DBT-PE clinicians are trained in both, so when you are ready for trauma work, you do not have to start over with someone new.

What Is DBT-PE?

DBT-PE is an adaptation of standard Dialectical Behavior Therapy designed to treat PTSD in people who also struggle with intense emotions, self-harm, or suicidal urges. Once a client is stable, it adds a structured Prolonged Exposure protocol to DBT, so trauma is treated directly instead of only managed.

Psychologist Melanie Harned, PhD, developed the DBT Prolonged Exposure protocol at the University of Washington, within the research program led by Marsha Linehan, the creator of DBT. Standard DBT is highly effective at helping people gain control over dangerous behaviors and regulate their emotions. For many trauma survivors, though, the PTSD underneath is still there once that stability is in place: the flashbacks, the nightmares, the constant scanning for danger.

DBT-PE was built to close that gap. Clients keep every mode of standard DBT running, including individual therapy, skills group, and between-session coaching, and add exposure-based trauma processing on top. The approach draws on Dialectical Behavior Therapy, Cognitive Behavioral Therapy, and Prolonged Exposure, of the most researched PTSD treatments available and one of the therapies recommended in the American Psychological Association’s Clinical Practice Guideline for PTSD.

Why Does CCG Offer DBT-PE?

CCG offers DBT-PE because we believe no one should have to choose between staying safe and healing from trauma. Many trauma programs turn away people with self-harm or suicidal urges. DBT-PE gives them a path: build stability inside DBT, then treat the trauma with the same team. That is why we trained our clinicians to deliver it in house.

The same principles that shape all care at CCG shape how we deliver DBT-PE.

It is personalized. Your clinician builds the exposure plan around your memories, your triggers, and your goals. No two hierarchies look the same.
It is evidence-based. We deliver the protocol the way it was tested, and our clinicians consult as a team every week to hold that standard.
It is goal-oriented. We measure PTSD symptoms throughout treatment using the PCL-5, so you can see what is changing instead of guessing.
It is time-limited. The trauma-processing phase has a clear start and finish, usually three to four months.
It is built on fit. If the connection with your therapist ever feels wrong, we will match you with another clinician at no additional cost.

How Does DBT-PE Work?

Stage 1: Building Safety and Skills

The first stage of DBT-PE is standard DBT. You and your therapist start with anything that threatens your safety or derails treatment, such as self-harm, suicidal urges, or repeated crises. At the same time, you learn DBT’s four core skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Skills like TIPP, opposite action, and radical acceptance become the tools you lean on later, when exposure work stirs up strong emotions.

Much of this stage is about noticing. You learn to identify emotions earlier, recognize the patterns in how you react, and reach for a skill before a spike turns into a crisis. You move on to Stage 2 when you and your therapist agree you are ready: harmful behaviors are under control, you can use skills when urges hit, and treating PTSD has become your top priority.

Stage 2: Processing the Trauma With Prolonged Exposure

This is the core of DBT-PE. In weekly sessions that run 90 to 120 minutes, your therapist guides you through two kinds of exposure.

Imaginal exposure means revisiting a traumatic memory in your mind and describing it out loud, then talking through what came up with your therapist.

In vivo exposure means gradually approaching real-life situations, places, or activities you have been avoiding because they remind you of what happened.

Facing these memories and reminders in a controlled setting teaches your brain and body that they are no longer dangerous. Over time, the fight, flight, or freeze response they trigger begins to fade. In research, clients completed the protocol in about 13 sessions on average, which is why this stage usually takes three to four months. Your DBT skills group and individual sessions continue the whole time.

Stage 3: Building a Life Beyond Trauma

Once PTSD symptoms improve, the last stage turns to what trauma left behind. For some clients that is shame or guilt. For others it is relationship patterns, or plans that were shelved for years. Treatment shifts toward the life you want to build next, whether that means going back to work, repairing a relationship, or learning to trust your own judgment again.

Is DBT-PE The Right Therapy for me?

DBT-PE is the right therapy for adults who have PTSD and also struggle with emotional dysregulation, self-harm, suicidal urges, or borderline personality disorder. It is built for people whose symptoms make standard trauma therapy feel unsafe or out of reach, and who want to treat the trauma directly rather than just manage it. DBT-PE is best for:

Adults with PTSD or a significant trauma history, including people who feel constantly on guard or are easily set off by trauma triggers
People with borderline personality disorder or BPD traits alongside trauma
Clients with a history of self-harm or suicidal behavior who need stability before trauma work
People already in DBT who have stabilized but still have flashbacks, nightmares, or avoidance
Anyone who has tried talk therapy and still feels stuck reliving the past

DBT-PE may not be the best fit if:

You are in crisis right now. Call or text 988 (Suicide & Crisis Lifeline) or call 911. You and your therapist can talk about DBT-PE once you are safe.
Your trauma symptoms are not paired with emotional dysregulation or self-harm. EMDR, Accelerated Resolution Therapy (ART), Reconsolidation of Traumatic Memories (RTM) Protocol, or standard Prolonged Exposure may get you there faster.
You want a brief, two- or three-session intervention. DBT-PE is a structured, multi-month commitment.

DBT-PE also helps with the problems that tend to co-exist with trauma, including anxiety, depression, substance use, and relationship conflict. By combining Dialectical Behavior Therapy, Cognitive Behavioral Therapy, and Prolonged Exposure, it treats the trauma and the patterns built around it, which is how people create lasting change in their lives.

How Does DBT-PE Compare to Other Trauma Therapies?

The biggest difference is who each therapy is built for. EMDR, ART, and standard Prolonged Exposure help many people with PTSD, but much of the research behind them excluded people with recent self-harm or suicidal behavior. DBT-PE was designed and tested specifically for that group, and it treats the emotional dysregulation and the trauma together.

Approach	How it treats trauma	Typical length	Best for
DBT-PE	DBT skills first, then imaginal and in vivo exposure while DBT continues	Trauma phase of about 3 to 4 months, after a DBT stabilization stage	PTSD with self-harm, suicidal urges, BPD, or severe emotional dysregulation
Standard DBT	Builds skills and behavioral control; does not directly process trauma memories	Often 6 to 12 months	Emotional dysregulation, BPD, self-harm without a PTSD focus
Prolonged Exposure (PE)	Imaginal and in vivo exposure without the DBT framework	Commonly 8 to 15 sessions	PTSD in clients who are already stable
EMDR	Recalls traumatic memories while using bilateral stimulation	Often 6 to 12 sessions for a single-event trauma	Specific traumatic memories, single-incident trauma
Accelerated Resolution Therapy (ART)	Eye movements combined with imagery rescripting	Often 1 to 5 sessions	Specific memories, clients who want a brief treatment

Not sure which fits? Our intake team matches you based on your history and goals, and you can switch approaches if another one serves you better. You can also see every way CCG treats trauma.

What Does the Research Say About DBT-PE?

Research shows DBT-PE substantially reduces PTSD in high-risk clients. In a 2014 randomized controlled trial, 80% of women who completed DBT with the DBT-PE protocol no longer met criteria for PTSD, compared with 40% of those who received DBT alone.

The trial, led by Melanie Harned with Marsha Linehan and published in Behaviour Research and Therapy, studied women with borderline personality disorder, PTSD, and recent suicidal or self-injuring behavior. That is the group most often told they are “not ready” for trauma treatment. Participants who received DBT-PE were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT alone. Adding exposure did not make symptoms worse, which is the fear most clients (and many clinicians) bring to this work. The study was small, with 26 participants, and larger trials are underway.

Waiting has a cost. Untreated PTSD and borderline personality disorder can cause problems in relationships, work, and physical health, and raise the risk of depression and substance use. Starting treatment sooner gives you more of your life back sooner

DBT Prolonged Exposure (DBT-PE) FAQs

What are the benefits of DBT-PE?

The main benefit of DBT-PE is that it treats PTSD directly while keeping you safe. It reduces flashbacks, nightmares, and avoidance, and it teaches DBT skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness that keep working long after treatment ends.

The skills carry over into everyday stress, conflict, and decision-making, which is why clients often describe feeling more capable in parts of life that have nothing to do with the trauma.

Who can benefit from DBT-PE?

DBT-PE benefits adults with PTSD who also live with intense emotions, impulsive behavior, self-harm, or suicidal urges that make trauma triggers hard to manage. It is especially well suited to people with borderline personality disorder and to anyone who wants a structured, evidence-based approach that builds coping skills alongside trauma processing.

It is also a strong fit for people who have been told they are “too unstable” for trauma therapy elsewhere. DBT-PE was designed with that experience in mind.

How does trauma affect mental health?

Trauma is one of the strongest drivers of mental health conditions. A single event or long-term exposure to abuse or danger can disrupt a person’s sense of safety and emotional control, leading to PTSD, anxiety, depression, and complex trauma. Left untreated, these symptoms strain relationships and make daily life harder to manage.

Trauma keeps the nervous system on alert. Flashbacks, nightmares, hypervigilance, and avoidance are the body trying to prevent something that already happened. That is why treatment that addresses the memory itself, not just the symptoms, tends to produce lasting change. The National Institute of Mental Health provides a detailed overview of PTSD symptoms and risk factors. To see how CCG treats trauma with other approaches, visit our trauma therapy page.

How does DBT-PE help individuals with PTSD?

DBT-PE helps people with PTSD in two ways. DBT skills give you the ability to handle the strong emotions trauma memories bring up, and Prolonged Exposure lets you face those memories and avoid reminders gradually, in a controlled setting, until they lose their power to overwhelm you.

Avoidance is what keeps PTSD going. Every time a memory or reminder is pushed away, the brain learns it is still dangerous. Exposure reverses that learning, and DBT skills make it possible to stay with the process long enough for it to work.

Is DBT-PE a long-term solution, or is it meant for short-term relief?

DBT-PE is a time-limited treatment built for long-term results. The trauma-processing phase usually lasts three to four months, and the goal is lasting remission of PTSD, not temporary relief. The DBT skills you learn along the way stay with you after therapy ends, so you keep the gains.

That combination (a defined treatment window with durable outcomes) is central to how CCG approaches care: short-term where possible, goal-oriented throughout, and focused on the life you are building next.

How long does DBT-PE take?

The DBT-PE protocol averages about 13 weekly sessions of 90 to 120 minutes, or roughly three to four months. Total treatment runs longer because DBT-PE begins with standard DBT to build stability, and how long that first stage takes depends on your symptoms and skills when you start.

Is DBT-PE safe if I have a history of self-harm or suicidal thoughts?

Yes. DBT-PE was designed specifically for people with PTSD and a history of self-harm or suicidal behavior. Trauma processing starts only after you and your therapist agree you are stable, and DBT skills and coaching continue throughout, so safety is built into every stage. In research, adding DBT-PE lowered suicide attempts and self-injury compared with DBT alone.

What is the difference between DBT and DBT-PE?

Standard DBT teaches skills to manage emotions and stop harmful behaviors, but it does not directly process trauma memories. DBT-PE adds a Prolonged Exposure protocol once those skills are in place, so PTSD symptoms are treated at their source. DBT-PE is delivered inside a full DBT program, not in place of one.

Can I do DBT-PE online?

Yes. CCG offers DBT-PE by secure telehealth in the states where our DBT-PE trained clinicians are licensed, and in person at select offices. Virtual sessions follow the same protocol, and your therapist helps you plan in vivo exposure practice in your own surroundings, which can make it easier to bring progress into daily life.

Does insurance cover DBT-PE?

CCG is an out-of-network provider. Many PPO plans with out-of-network benefits reimburse part of the cost of therapy, and our team can provide the documentation you need to submit a claim. Contact your insurer to confirm your benefits, or ask our intake team to help you check.

Ready to Start DBT-PE?

Trauma shaped part of your story. It does not get to write the rest of it. If you have spent years managing symptoms and are ready to treat what sits underneath them, we will match you with a DBT-PE trained clinician and help you decide whether this is the right place to start. You do not need to be sure DBT-PE is the answer before you reach out. That is what the first conversation is for.

Sources and Further Reading

Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of DBT with and without the DBT Prolonged Exposure protocol. Behaviour Research and Therapy.
Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder.
University of Washington, The DBT Prolonged Exposure Protocol (information sheet).
National Institute of Mental Health, Post-Traumatic Stress Disorder.
American Psychological Association, Clinical Practice Guideline for the Treatment of PTSD.
Psychology Today, DBT Prolonged Exposure: A Transformative Approach to Healing
CCG: DBT-PE in Washington, DC.
CCG: How Effective Is DBT?

We Can Help.

If you or a loved one can benefit from DBT Prolonged Exposure (DBT-PE), we are here to help.