Dialectical-Behavior Therapy - Prolonged Exposure (DBT-PE) was developed for individuals suffering with PTSD, who could benefit from prolonged exposure therapy, but are not yet equipped with effective skills for managing painful emotional states. One way clients with PTSD typically learn to manage painful emotions is through avoidance. Unfortunately, while avoiding reminders of trauma can provide relief from distress in the short-term, it tends to prolong emotional suffering over time. In fact, avoidance (e.g, avoidance of trauma memory, avoidance of environments that are similar to location of trauma, etc.) has been identified as one of the factors maintaining PTSD symptoms. This is, in part, because avoidance strategies block new learning from occurring. Exposure strategies focus on guiding clients through approaching feared trauma related stimuli (that are uncomfortable for client due to trauma history, but are objectively safe). It is through this exposure experience, that clients learn and find out for themselves what happens when they refrain from avoiding feared situations (often learning that the situation was uncomfortable, but safe).

While highly effective, exposure therapy (approaching trauma related stimuli rather than avoiding), typically stirs up high levels of distress. With repeated exposure, clients habituate and emotional distress becomes easier to tolerate. However, for some clients the initial stages of treatment can feel intolerable. This is especially so when clients lack effective emotion regulation skills. Therefore, in DBT-PE, the Dialectical Behavior Therapy phase of the treatment protocol focuses on establishing a toolbox of healthy coping skills. These skills are designed to help clients stay connected to meaningful experiences in life (e.g., prolonged exposure therapy) even when they become emotionally painful. In DBT-PE, clients enter the exposure phase of therapy and begin addressing trauma once they have exhibited the ability to tolerate heightened distress levels.