Changes in Trauma-Related Emotions Following DBT-PTSD in Survivors of Childhood Abuse

Görg, N., Böhnke, J. R., Priebe, K., Rausch, S., Wekenmann, S., Ludäscher, P., Bohus, M., & Kleindienst, N. (2019). Changes in Trauma‐Related Emotions following treatment with Dialectical Behavior therapy for posttraumatic stress Disorder after childhood abuse. Journal of Traumatic Stress, 32(5), 764–773. https://doi.org/10.1002/jts.22440

Summary by: Alma Aldema

Introduction

I’ll start by highlighting why this study matters. PTSD isn't just about fear, it also involves deep emotional responses like shame or guilt, especially in cases of childhood trauma. Treatments like PE and EMDR are great for reducing classic PTSD symptoms, but they may not fully resolve these more complex emotional reactions. That’s where DBT-PTSD comes in, it's specifically designed to address both the core symptoms and these emotionally driven aspects of CPTSD.

Study Aims

The study had three aims: first, to measure whether emotions like shame, guilt, and disgust changed after treatment. Second, check if these changes were independent of improvements in PTSD symptoms. And third, to see how many participants reached emotion levels like those in people without PTSD.

Method

The intervention was an intensive, structured 3-month DBT-PTSD program delivered in a residential setting. It combined standard DBT elements—like emotion regulation and mindfulness—with trauma-specific techniques. One key feature was skills-assisted exposure, which helped prevent dissociation during trauma processing. The treatment also directly targeted negative self-beliefs and worked toward helping participants accept their traumatic experiences as part of their past, not their identity.

Participants

It's important to note that this was a relatively small and specific sample—mostly women with PTSD related to childhood abuse, and many had additional diagnoses like depression or borderline personality disorder (BPD). This makes the sample clinically relevant for complex PTSD, but it also limits how widely we can generalize the findings to other trauma populations.

Measures

To evaluate change, the researchers used simple but effective tools. Emotions were rated using 0–100 scales, asking participants how intensely they felt specific emotions when thinking about their trauma. PTSD symptoms were measured using the DTS, a well-established and reliable measure. Finally, they compared the participants' outcomes to a nonclinical reference group—people with similar trauma histories but without PTSD—to see if emotional levels normalized after treatment.

Analysis

The analysis was designed to test not just whether emotions changed, but whether those changes went beyond general PTSD improvement. By using MANOVA, the researchers could isolate the emotional shifts that weren’t simply side effects of PTSD symptom relief. They also used clinical significance benchmarks to see if participants reached emotional levels comparable to those without PTSD.

Results

The results showed significant improvements across most trauma-related emotions. By the end of treatment, a substantial proportion of participants reached nonclinical levels for these emotions, most notably, 76% for guilt and 69% for shame. These are very meaningful changes, especially considering the severity and persistence of these emotions in complex PTSD.

When we look at effect sizes, the largest improvements were seen in guilt, shame, fear, helplessness, and disgust. Interestingly, anger and sadness did not show significant change, which may suggest those emotions are either more complex or require different interventions.

Finally, radical acceptance—which is a core goal in DBT-PTSD—also increased significantly, with a large effect size. And it’s important to note that even after controlling PTSD symptom reduction, improvements in emotions like guilt and shame remained significant. That tells us this therapy doesn't just help with symptoms—it helps people emotionally process the trauma on a deeper level.

Discussion

This study highlights that DBT-PTSD has a distinct impact on trauma-related emotions, particularly guilt and shame—likely because it addresses them directly through exposure and cognitive work. Anger may be more complex, possibly serving an adaptive role in reframing blame. Radical acceptance improved, but for many, it remained a challenge. As for limitations, there was no active treatment control group, the sample was relatively small, and we don’t know if these gains were maintained long-term.