If you’re exploring trauma therapy, you may come across DBT-PE (Dialectical Behavior Therapy–Prolonged Exposure) and EMDR (Eye Movement Desensitization and Reprocessing). Both are well-researched, evidence-based treatments for PTSD and trauma-related symptoms, but they work in different ways & feel very different in practice.

This post is meant to offer a clear, grounded overview of how DBT-PE & EMDR differ, what they have in common, and how each approach supports healing from trauma.

What DBT-PE & EMDR have in common

Before diving into differences, it’s important to know that both treatments share some essential foundations:

They are evidence-based treatments for PTSD and trauma
They do not begin with trauma processing right away
They include early phases focused on:
- History-taking and assessment
- Building a strong therapeutic relationship
- Stabilization and preparation

Preparation phases are not rushed in either model. They take as long as they need to take, because safety, trust, and nervous system capacity are central to effective trauma work.

Where DBT-PE and EMDR differ most is how they conceptualize trauma maintenance and how they facilitate change.

How DBT-PE treats trauma

DBT-PE is a trauma treatment designed for individuals who experience PTSD alongside high emotional sensitivity, intense emotions, complex mental health issues or reactions to trauma, or patterns of avoidance that significantly interfere with life.

At its core, DBT-PE is based on the understanding that: Avoidance maintains PTSD and trauma symptoms, and avoidance is driven by problematic beliefs formed from trauma.

Avoidance can look like:

Avoiding memories, emotions, or bodily sensations
Avoiding places, people, or situations
Avoiding internal experiences through numbing, dissociation, or distraction

While avoidance can bring short-term relief, it ultimately keeps trauma symptoms stuck.

Key Components of DBT-PE

DBT-PE works by systematically reducing avoidance through:

In vivo exposure: Gradually approaching real-life situations that have been avoided
Imaginal exposure: Revisiting and narrating traumatic memories in session
Processing: Making meaning of the trauma and examining how it shaped beliefs about self, others, and the world. Gaining new insight into the trauma.

As avoidance decreases, clients often experience:

Reduced PTSD symptoms
Increased emotional tolerance
Shifts in trauma-related beliefs (e.g., fueling shame, self-blame, danger)
Greater freedom and flexibility in daily life
Less shame, guilt & fear

Preparation in DBT-PE

Preparation in DBT-PE includes skills training, generally drawn from DBT, to help clients:

Regulate intense emotions
Stay present during distress
Navigate urges to avoid or escape

This preparation phase is essential, as it ensures clients have the tools they need to engage safely and effectively in exposure work.

Homework in DBT-PE

DBT-PE does involve active work outside of sessions, which may include:

Practicing skills
Completing in vivo exposure exercises
Listening to recorded imaginal exposures

This structure allows therapy to extend into daily life, where many trauma-maintaining patterns occur. This is how avoidance is targeted.

DBT-PE was developed by Dr. Melanie Harned and her team, building on the work of Dr. Marsha Linehan, the creator of DBT. DBT-PE was developed to be delivered alongside full-fidelity DBT. In the private practice setting, we are delivering therapy grounded in DBT-PE, since clients may or may not be in enrolled in a DBT program alongside the treatment.

How EMDR Treats Trauma

EMDR approaches trauma through the lens of how the brain and nervous system store and process overwhelming, traumatic experiences.

EMDR is based on the idea that traumatic memories can become “stuck” or insufficiently processed, continuing to trigger distress long after the danger has passed.

Key Components of EMDR

EMDR uses bilateral stimulation, most commonly eye movements, but sometimes tapping or tones, to help the nervous system:

Reprocess traumatic memories
Reduce emotional charge and bodily distress
Integrate adaptive information

Rather than focusing primarily on avoidance behaviors, EMDR emphasizes allowing the nervous system to metabolize trauma in a way that restores natural processing.

This approach is often described as working with the brain’s innate healing capacity and is commonly understood through frameworks such as polyvagal theory, which highlights the role of nervous system states in trauma and recovery.

Preparation in EMDR

EMDR includes a dedicated resourcing and stabilization phase, where clients learn ways to:

Establish internal and external safety
Access calming or supportive experiences
Build tolerance for emotional activation

Only when sufficient stability is present does desensitization & reprocessing begin.

Homework in EMDR

In EMDR, most of the intensive work happens in session. While clients may be invited to notice experiences between sessions, utilize resources learned in session & practice grounding strategies, EMDR generally involves less structured homework than DBT-PE.

EMDR was developed by Dr. Francine Shapiro.

DBT-PE vs. EMDR: A Side-by-Side Snapshot

DBT-PE

Targets avoidance that maintains PTSD
Uses in vivo exposure, imaginal exposure, and processing
Emphasizes behavior change & changes negative beliefs
Requires regular homework and between-session practice
Strongly skills-based preparation

EMDR

Targets unprocessed traumatic memories
Uses bilateral stimulation (eye movements, tapping, tones)
Focuses on nervous system reprocessing
Most work occurs during sessions
Uses resourcing and stabilization for preparation

Which One Is Right for You?

There is no universal “better” trauma therapy, only what is best suited to your needs, nervous system, and life context.

Some people prefer the structured, skills-based, action-oriented nature of DBT-PE. Others feel drawn to the experiential, nervous-system-focused approach of EMDR. Many clients benefit from one approach at a particular stage of healing and another later on.

A thoughtful assessment and collaborative discussion with a trained therapist can help determine which approach, or sequence of approaches, may be the best fit for you.

Working With a Therapist Trained in Both Modalities

One important factor in choosing trauma therapy is the training and flexibility of the therapist.

I am foundationally trained in both DBT-PE and EMDR, which means I am able to competently deliver either treatment modality and thoughtfully tailor trauma work to each client’s needs.

Rather than fitting you into a single approach, this allows us to:

Choose the modality that best matches your nervous system, goals, and life circumstances
Adjust pacing and preparation based on what actually supports your sense of safety
Integrate skills, resourcing, and processing in a way that feels cohesive rather than rigid

In practice, this often means collaboratively deciding when to use DBT-PE, when to use EMDR, or how to sequence them over time, depending on where you are in your healing journey.

Final Thoughts

Both DBT-PE and EMDR honor an important truth: trauma healing is not about forcing exposure or reprocessing before you’re ready. Preparation, pacing, readiness and respect for your nervous system are central to both models.

If you’re considering trauma therapy and wondering which approach aligns with you, working with a therapist trained in both can offer added flexibility, nuance, and support as you move toward healing.

DBT-PE vs. EMDR: Understanding Two Effective Approaches to Trauma Treatment

What DBT-PE & EMDR have in common