TF-DBT is a new, evidence-based advancement of standard DBT for patients with borderline personality disorder and/or complex PTSD. TF-DBT combines proven DBT with targeted trauma treatment and takes into account the effects of repeated traumatic relationship experiences on alarm reactions, self-image, and behavior. In a large multicenter study, it was significantly superior to standard DBT in reducing self-harm and improving BPD-specific psychopathology.
The AWP Freiburg will offer TF-DBT courses for the first time in 2027.
How can TF-DBT be learned?
The AWP Freiburg offers two training pathways for learning TF-DBT.
The TF-DBT Update Course is designed for experienced DBT therapists who have already completed the fundamentals of standard DBT. Over the course of three two-day seminars, they will learn the new theoretical models, the trauma-focused interventions, and the practical application of TF-DBT.
The TF-DBT Basic Training is designed for therapists who have not yet completed any DBT training. The twelve-day training program combines all the essential fundamentals and interventions of standard DBT with the full spectrum of the newly developed TF-DBT. Through an integrated curriculum, participants acquire both the competencies of classical DBT and the specific trauma-focused treatment methods of TF-DBT.
The workshops cover the theoretical model, the structure of the therapy, and key practical interventions. Using case studies, exercises, and numerous video demonstrations, participants learn to recognize trauma-associated alarm networks and self-concepts, prepare for and conduct exposure sessions, apply skills in a targeted manner, and guide patients on their journey from coming to terms with the past to living a fulfilling life.
Here you will find a questionnaire that you can use to assess for yourself which courses seem like a good fit for you.
What is Trauma-Focused DBT (TF-DBT)?
Trauma-Focused Dialectical Behavior Therapy (TF-DBT) is an evidence-based advancement of standard DBT for patients with borderline personality disorder and/or complex post-traumatic stress disorder (cPTSD). At the same time, it represents a logical evolution of DBT-PTSD, whose effectiveness has been demonstrated in several randomized trials. While DBT-PTSD focused primarily on treating the consequences of sexual trauma, TF-DBT expands the concept of trauma to include repeated interpersonal trauma in general. In addition to sexual and physical violence, this includes, in particular, emotional abuse, neglect, humiliation, abandonment, invalidation, and other chronic interpersonal stresses during childhood and adolescence.
TF-DBT combines the proven principles, treatment structures, and change strategies of standard DBT with systematic trauma-focused treatment. In doing so, it takes into account research findings from recent years showing that repeated traumatic and transactional interpersonal experiences play a central role in the development and maintenance of borderline personality disorder. The focus is not on individual traumatic events, but rather on the long-term interactions between distressing relational experiences, emotional dysregulation, problematic behavior, and the reactions of the social environment.
In particular, repeated traumatic experiences during childhood and adolescence can leave characteristic traces not only at the neurobiological level—such as in the limbic systems involved in emotion and stress processing—but also at the psychological level. These include hypersensitive alarm reactions, stable negative self- and world-views, and difficulties in dealing with intimacy, control, shame, guilt, disgust, and moral injury.
At the core of TF-DBT is the assumption that these consequences do not exist in isolation from one another but are organized into interconnected emotional networks. These include trauma-associated alarm networks, self-concepts, and behavioral patterns. At the beginning of therapy, these connections are mapped out in an individualized trauma model together with the patients and form the basis for further treatment.
TF-DBT follows a clearly structured treatment plan consisting of four therapy phases:
Therapy Phase 1 – Understanding and Preparation
At the outset, patients learn to better understand and control problematic behaviors. Together, an individualized trauma model is developed that explains the connections between traumatic experiences, arousal networks, self-concepts, and problematic behaviors. At the same time, mindfulness, skills, and Wise Mind strategies are built up to create sufficient safety and behavioral control for trauma processing.
Therapy Phase 2 – Trauma Processing
In the second phase, the central trauma-associated alarm networks are addressed using structured exposure techniques. The goal is not to relive the trauma, but to establish new inhibitory learning processes. Skills, Wise Mind imagery, and mindfulness help patients remain capable of acting during exposure and to have new, corrective experiences.
Therapy Phase 3 – Reorientation
After processing the traumatic memories, the focus increasingly shifts toward the future. Trauma-associated assumptions about oneself and the world are transformed, grief processes and moral wounds are addressed, and new values, life goals, and relationship patterns are developed. The goal of this phase is to build a life worth living and filled with meaning.
Therapy Phase 4 – Integration and Conclusion
In the final phase, the changes achieved are consolidated for the long term. Relapse prevention, booster sessions, and the application of new skills in daily life help to permanently stabilize therapeutic progress.
TF-DBT is primarily intended for patients with borderline personality disorder and/or complex PTSD. It is also suitable for people in whom trauma-related disorders, severe emotional dysregulation, self-harm, dissociative symptoms, and chronic interpersonal difficulties are closely intertwined. TF-DBT consistently adheres to the hierarchy and dialectical approach of standard DBT: Acute risks and behavior that jeopardizes treatment are addressed as a priority, without unnecessarily postponing the processing of traumatic experiences.
The effectiveness of TF-DBT was examined in a large multicenter randomized trial in direct comparison with standard DBT (Vonderlin et al., 2025; Vonderlin et al., in preparation). The results showed that TF-DBT was significantly superior to standard DBT both in terms of reducing self-harm and in terms of improving borderline-specific psychopathology. This marks the first evidence-based advancement of DBT that fully preserves its proven foundations while systematically addressing the consequences of repeated interpersonal trauma.
