Mindfulness and Trauma Treatment: Dialectical Behavioral Therapy

I think I first encountered the term Mindfulness in 2000 at a workshop presented by Marsha Linehan, Ph.D. on Dialectical Behavioral Therapy (DBT).  DBT was primarily developed to work with those diagnosed with borderline personality disorder (BPD), a form of complex PTSD as I conceptualize such things. Mindfulness is the core skill of DBT and can be applied to help trauma survivors learn non-reactivity to thoughts and emotions. As such, it is highly applicable to trauma treatment.

In DBT, mindfulness practice is designed to help you learn how to experience a state Linehan calls “Wise Mind”. This is the same state others may call being centered, true self or authentic self. Wise mind refers to the state in which your emotions and your thoughts work together so that informed choices are possible, even when your life and/or circumstances are difficult. You’re in wise mind when you can meet each moment of life as it is, not as you would have it be, and respond to it effectively. Everyone has the capacity to experience this but trauma may have gotten in your way.

In Linehan’s Skills Training Manual for Treating Borderline Personality Disorder (1993), there is a clear explanation of mindfulness, as well suggestions for practice. This is a great practical resource for clinicians working with complex trauma survivors, not just those formally diagnosed with BPD. Linehan breaks mindfulness into six specific skills. I will elaborate on these and their application to treating trauma in upcoming posts.

Given the context of an ineffective family environment that often goes hand in hand with complex trauma, many trauma survivors need to learn skills and develop basic capacities that have been missing or lacking since childhood. These are the things the trauma therapist will focus on in phase one of trauma treatment. The lack of capacities like emotional regulation and frustration tolerance understandably make daily life more difficult. Grounding and mindfulness are emotion management tools that can come in handy here.

I feel like the following passage from the Mindfulness and Psychotherapy blog captures what I see as one of the hallmark goals of this stabilization phase of trauma therapy: to increase the individual’s ability to tolerating sitting with the range and extent of their feelings. Elisha Goldstein, Ph.D. writes:

Daniel Siegel, M.D., author of many books the most recent being Mindsight, describes that we all have “a window of tolerance.” The heart of working with trauma is to get to a point where the emotional reaction from the trauma memory is no longer overwhelming. We can learn to ride the edge of this window and allow ourselves to look onto the emotional and physical distress associated with the memory with “nonjudgmental awareness.” While it seems counterintuitive, we want to very carefully bring the trauma into awareness so we can eventually change our relationship to it. This is challenging and takes practice and skilled support.

This is what you, with the support of a trained trauma therapist, can accomplish in the beginning of trauma treatment.

Kathleen Young Psy.D.

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8 Responses to Mindfulness and Trauma Treatment: Dialectical Behavioral Therapy

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  2. Pingback: Mindfulness and DBT: “What” Skills | Dr. Kathleen Young: Treating Trauma in Chicago

  3. Say says:

    I know that this is quite a late response, but I just wanted to comment on this as someone has found incredible value in DBT. I actually first encountered DBT (as a client) because I needed help with my eating disorder. The treatment center closest to me is DBT-based. All of the clinical staff – including dietitians, nurses, etc. – are trained in DBT, so everyone is equipped to help clients use DBT skills to deal with the challenges of eating disorder recovery. The therapist that I continue to see there has also proven herself to be incredibly adept and helpful in addressing my history of trauma and the ptsd resulting from it. Though DBT is only part of what we do, having her help me learn, practice, and effectively use the DBT skills (mindfulness is both a skill and it encompasses the other skills of emotion regulation, distress tolerance, and interpersonal effectiveness) has also been really beneficial in terms of decreasing my ptsd symptoms as well as the e.d. symptoms.

    • Hi Say.

      It is never too late to comment! 🙂

      Thanks for sharing your positive experience with DBT. I imagine it helps readers to hear a range of perspectives. I am glad you have found such a good fit for you!

  4. Pingback: Reader Question: Treating Emotional Numbness | Dr. Kathleen Young: Treating Trauma in Tucson

  5. kimisis says:


    Do you see DBT as teaching skills to cope with trauma or as healing trauma? I suspect there´s a big difference between the two.
    And another question, do you think EMDR is an effective treatment for resolving the often underlying trauma and insecure attachment in BPD? If so, do you think there should be more focus on trauma processing in the treatment of BPD than there currently seem to be?

    • Great questions!

      I see DBT skills based interventions as part of phase one of trauma treatment, addressing the need for safety and stabilization. Without that work trauma processing itself is often too destabilizing. In addition, when dealing with complex trauma, DBT skills can also help to heal some of the damage done, for example developing the ability to regulate emotions and tolerate distress.

      I have not had experience using EMDR to address insecure attachment, I’d be interested in hearing from those who have. I think EMDR can be very helpful in processing trauma in phase tow of treatment, after skills that will make that work possbile (and not retraumatizing!) are in place.

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