A comprehensive comparison of Dialectical Behavior Therapy (DBT) and EMDR therapy to help therapists understand when to use each approach for trauma and emotion dysregulation.
DBT and EMDR are both evidence-based treatments, but they address trauma and emotional difficulties from fundamentally different angles. DBT focuses on building skills and regulating emotions, while EMDR focuses on processing traumatic memories directly.
While both can be effective for trauma, they serve different purposes and may be used at different stages of treatment or for different client presentations. Understanding their differences helps therapists choose the most appropriate approach.
DBT is based on the biosocial theory: emotion dysregulation results from biological vulnerability to emotional sensitivity combined with an invalidating environment. Treatment focuses on:
EMDR is based on the Adaptive Information Processing (AIP) model: trauma overwhelms the brain's processing system. Treatment focuses on:
Comprehensive DBT is a multi-component program:
EMDR follows an 8-phase protocol:
DBT addresses trauma indirectly:
EMDR addresses trauma directly:
DBT and EMDR can be effectively combined, often sequentially:
DBT First, Then EMDR: Use DBT to build emotion regulation and distress tolerance skills, establish safety, and stabilize the client. Once stable, use EMDR to process specific traumatic memories. This is a common and effective sequence.
DBT Skills During EMDR: Use DBT distress tolerance and emotion regulation skills during EMDR preparation and between sessions. This helps clients manage the intensity of EMDR processing.
Different Phases: Use DBT for ongoing emotion regulation and interpersonal skills, while using EMDR for specific trauma processing. Both can be active in different aspects of treatment.
Both DBT and EMDR have strong research support:
Strong research support for BPD, suicidal behaviors, self-harm, and emotion dysregulation. Gold standard for BPD treatment. Effective for reducing hospitalizations and improving functioning. Research supports use for trauma when combined with trauma processing.
Strong research support for PTSD and trauma. Recognized by WHO, APA, and VA. Effective for single-incident and complex trauma. Often shows faster results than other trauma treatments. Research supports use for trauma-related symptoms.
Research shows both are effective, with DBT being the gold standard for BPD and emotion dysregulation, and EMDR being highly effective for trauma. When clients have both emotion dysregulation and trauma, sequential or integrated use may be optimal.
PracFlow provides specialized tools for both DBT and EMDR practices: diary cards, skills tracking, protocol documentation, and outcome measurement.