If you’re reading this, I’m going to take a wild guess: you’re curious about how trauma is treated through the lens of Dialectical Behavior Therapy (DBT). Maybe you’re a clinician wanting to learn more about applying DBT to trauma, or perhaps you’re someone who has experienced trauma and is searching for ways to cope, heal, and grow. Either way, welcome.
If you’re a mental health professional, I encourage you to check out webzines like Applying DBT to the Treatment of Trauma: Trauma Explained and Dialectical Behavior Therapy in the Treatment of Trauma — excellent resources for diving deeper into this work.
If you are not a mental health professional, this piece was written especially with you in mind. While some of the concepts may be technical, the goal is to provide accessible and useful information for anyone interested in understanding and coping with trauma. That said, please be mindful as you read — this content may be activating for some. If you feel you need support, we encourage you to reach out to our intake department at 312.809.0298 or visit https://www.wildflowerllc.com/request-appointment/.
What Is Trauma?
You’ve probably heard the term “trauma” used in many contexts—on social media, in therapy conversations, and increasingly in everyday language. But what does it really mean?
Trauma refers to the psychological, emotional, and physical response to deeply distressing or disturbing events. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening, with lasting adverse effects on functioning and well-being (SAMSHA, 2024).
Trauma can be a single incident—like a car accident, medical emergency, or natural disaster. This is called acute trauma. Trauma can also be ongoing or repeated over time, known as chronic or complex trauma. Examples include childhood abuse, domestic violence, or long-term exposure to poverty or discrimination.
Common Trauma Responses: Fight, Flight, Freeze, and Appease
You’ve likely heard of the “fight or flight” response—the body’s instinctive reaction to danger. But there are actually four common trauma responses:
- Fight: Confronting the danger—yelling, hitting, or asserting control
- Flight: Escaping or avoiding—leaving situations, running away, or overworking
- Freeze: Shutting down — dissociating, going numb, or feeling paralyzed
- Appease: Trying to calm or placate others to avoid conflict—people-pleasing, masking true emotions
Think of these responses like gas and brake pedals for your nervous system. To get a little technical here: the autonomic nervous system, particularly the vagus nerve (which branches into dorsal and ventral pathways), plays a key role in regulating these responses (Porges, 2009). Whether we accelerate into high-alert panic or slow down into numbness, our nervous system is working hard to keep us safe, even if it doesn’t always feel that way.
Trauma and the Window of Tolerance
When we experience trauma, especially if it’s unprocessed or ongoing, our body keeps the memory stored in our nervous system. This idea is popularized in the book The Body Keeps the Score by Bessel van der Kolk (2014). Trauma literally becomes “trapped” in the body, affecting our ability to stay present, think clearly, and feel safe.
Enter the Window of Tolerance (WOT)
Coined by Dr. Dan Siegel (1999), the Window of Tolerance describes the optimal zone of arousal where a person is able to function effectively. When we are inside our window, we feel calm, alert, and able to manage emotions. When we’re outside of it, we enter states of:
- Hyperarousal (above the window): Anxiety, panic, irritability, anger, racing thoughts
- Hypoarousal (below the window): Numbness, disconnection, exhaustion, depression
We are all born with different-sized windows, influenced by genetics, temperament, trauma history, and mental health. The more trauma we’ve experienced—especially without supportive intervention—the narrower our window becomes. When your window is narrow, life starts to feel smaller too. Everyday challenges can quickly feel overwhelming, and even minor stressors can lead to shutdown or overwhelm.
How DBT Can Help: Skills for Expanding the Window
So how can we expand the Window of Tolerance and start feeling more grounded and resilient? That’s where DBT comes in.
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy developed by Dr. Marsha Linehan (1991). It was originally created to treat individuals with Borderline Personality Disorder and chronic suicidality, but it has since been adapted for many other issues—including trauma (Görg et al., 2019).
DBT blends acceptance and change strategies. It teaches practical, actionable skills across four main modules:
- Mindfulness – Being present in the moment, nonjudgmentally
- Distress Tolerance – Surviving emotional crises without making things worse
- Emotion Regulation – Understanding and managing intense emotions
- Interpersonal Effectiveness – Navigating relationships and asserting needs while maintaining self-respect
DBT also uses the Subjective Units of Distress Scale (SUDS), a 1–10 self-rating system to measure distress in the moment. Think of it like a thermometer that helps you figure out where you are emotionally and what tools might help you return to your Window of Tolerance.
Matching DBT Skills to Levels of Distress
Here’s how DBT skills align with the different states of arousal:
Hyperarousal (e.g., panic, racing thoughts, extreme anxiety)
When you’re “above” your window:
- Distress Tolerance skills like TIPP (Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation) can rapidly reduce physiological arousal
- Mindfulness skills like “observing and describing” or “wise mind” help re-anchor you to the present moment
Example: You just had an argument and feel your heart racing. You run your hands under cold water (T from TIPP) and do deep breathing (P) to bring your nervous system down.
Inside the Window (e.g., regulated, calm, present)
This is the ideal time to build insight and skills:
- Mindfulness helps increase self-awareness and notice early signs of distress
- Interpersonal Effectiveness allows you to practice setting boundaries or asking for help
- Emotion Regulation builds resilience through strategies like opposite action or checking the facts
Example: You notice mild anxiety before a work presentation. You practice “opposite to emotion action” by standing tall, looking forward, and speaking slowly.
Hypoarousal (e.g., numbness, shutdown, depression)
When you’re “below” your window:
- Emotion Regulation skills like “opposite to emotion action” can activate you when you feel immobilized
- Mindfulness practices like grounding (e.g., 5-4-3-2-1 technique) reconnect you to your body and surroundings
- Distress Tolerance can help with motivational challenges by validating your experience without judgment
Example: You feel disconnected and unable to get out of bed. You start by naming five things you see, four things you hear, and three things you can touch.
DBT Skills Don’t Replace Therapy—But They Are a Start
While DBT skills areincredibly useful tools, it’s important to remember that these skills are not a substitute for actual therapy—especially when it comes to trauma. Trauma-informed therapy offers a safe space to process painful memories and develop a personalized healing plan.
That said, DBT skills can help in the moment, offering short-term relief and long-term resilience. Practicing them consistently can help widen your Window of Tolerance, allowing you to engage more fully with your life—even in the face of past wounds.
Final Thoughts
Trauma doesn’t define you, but it does live in the body. When left unaddressed, it shrinks your world. But healing is possible. With awareness, compassion, and the right tools, you can learn to navigate trauma responses and feel more grounded in your everyday life.
Whether you’re a clinician seeking new strategies or someone on a personal journey toward healing, DBT offers a structured, compassionate roadmap. It teaches us how to validate where we are and gently move toward where we want to be.
And remember: you don’t have to do it alone.
If you’re looking for support, please reach out to our team by calling 312-809-0298 or visiting www.wildflowerllc.com/request-appointment.
References:
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking Penguin.
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
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064. doi:10.1001/archpsyc.1991.01810360024003
Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine, 76 Suppl 2(Suppl 2), S86–S90. https://doi.org/10.3949/ccjm.76.s2.17
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York, NY: The Guilford Press.Substance Abuse and Mental Health Services Administration. (2024). Trauma and violence. U.S. Department of Health and Human Services. https://www.samhsa.gov/mental-health/trauma-violence
