Treatment with the DBT approach for trauma victims: the treatment method that is unknown in Israel

Debori Habib-Hadari is an expert in trauma treatment and runs the DBTEACH Institute, which deals with the treatment of trauma victims and trains therapists in the field of trauma with the DBT approach. the big ones

Since the events of October 7, there has been a dramatic increase in the demand for therapists specializing in trauma and sexual trauma treatment. Dvori Khadi-Habiv, a certified therapist in social work and psychotherapy and an expert in trauma treatment and dialectical behavioral therapy (DBT), talks about the advantages of a therapeutic approach based on research and results that is not widespread enough in Israel, but may be very significant in successfully dealing with mental crises like the ones we are witnessing recently .

“Dialectical behavioral therapy is a real novelty in the world of therapy,” explains Khadri-Habib. “He combines a deep and dynamic understanding of life traumas and difficult life events in understanding emotional regulation difficulties in many people.” According to her, the regulation difficulties are expressed in different ways – for one as depression, for the other as anxiety, and for the third in different addictions to cannabis, food, or alcohol, as a way to regulate the vulnerable feelings that reside permanently in us. Difficulty in emotional regulation is a concept that comes to describe a state of emotional flooding and emotional storm that we experience in relation to an external event or in relation to an internal drama that takes place within us. We all experience emotional storms but not all of us were equipped in our childhood with effective tools to calm and regulate ourselves when we are overwhelmed.

The war left deep scars in the souls of many in Israel, from direct victims to those who experienced secondary traumatization. “The last year has been filled with pain, bereavement, loss, anxieties and hardships in various circles,” describes Khadi-Haviv. “I meet people at the clinic who were functioning well, and the wounds of the war awakened old wounds and thus disrupted their daily conduct.” She describes patients who have trouble sleeping, suffer from vague anxiety, and lose interest in activities they once enjoyed. Some of them also had early sexual traumas. Many people who have dealt with mental distress and who have already achieved stability in their lives, and also people who have never dealt with mental health, find that the ground is falling from under them. Their basic beliefs in good and bad are being undermined, basic functions in parenting, relationships and work, which once did not require special effort, become particularly challenging.

The institute also treats many teenagers and the picture on the ground regarding this age group is very bleak. Many teenagers carry with them years of functional instability since the Corona era and the adjustment difficulties of that time are exacerbated and intensified with the last year since the Seventh of October. Immense loneliness, high anxiety, loss of interest in things that used to be enjoyed and social reduction and depression are a small part of the characteristics of the teenagers I meet. And when there is no answer that provides relief, drug use, alcohol consumption, eating disorders and self-harm become a sign of trying to self-treat in the absence of help. Many adolescents who in the past were helped by normal psychological treatment to balance are referred when their condition worsens to hospitalizations, for psychiatric consultation that directs them to treatment with the DBT approach. The growing need for treatments poses a significant challenge to the mental health system. “The demand for therapists in the field has doubled and tripled,” says Khadri-Habib. However, she emphasizes that the main challenge is not only in the number of therapists, but also in the type and quality of the treatment and the therapist, and this is where the DBT method comes into play.

The DBT method, developed in the late eighties by Professor Marsha Linehan, offers an innovative approach to trauma treatment. “The method is psychological therapy focused on goals and results,” explains Khadri-Habib. “He allows the patient to understand where he came from and what is the wound he carries with him.” “The patient learns to ask what emotional needs were not met in his/her childhood and what tools he/she had to use to protect himself/herself.” Hafiri-Habib emphasizes the uniqueness of the treatment and says: “The DBT method is not satisfied with ‘venting feelings’ or identifying the task of ‘what needs to be done’. The uniqueness of the treatment is the success in creating a strong therapeutic relationship between the therapist and the patient that allows the patients to successfully deal with the difficulties and obstacles along the way to drive change.” She adds that the treatment combines practical behavioral tools, where at the end of each meeting with the therapist, the patient continues to practice the change at home, thus assimilating the change.

The studies show that the majority of patients who come for treatment with the DBT method have gone through an average of six failed treatments that did not work before. “In the United States, today this is the most common and agreed-upon treatment for the treatment of military veterans in the United States and the world, for soldiers who have returned from service in war zones, and who suffer from post-trauma, as well as for victims of complex trauma,” Hafiri-Habib points out. “This population also includes patients who experienced childhood Abuse, violence and physical, verbal or sexual aggression over time, something that harmed their normal development.”

Despite the proven effectiveness of the method, DBT is still not sufficiently recognized in Israel. “About three years ago, we established the Israeli Association for the Treatment of DBT with the hope that the treatment that was a treatment “only for the rich” will become accessible to many populations, and the goal is to make it financially accessible to the entire population,” Hafiri-Habib says. “With great joy I see the change taking place. More and more psychiatrists are recommending the treatment, and more mental health centers are adopting it. However, the change is relatively slow at a time when we are experiencing the need for a large increase like the one we are experiencing in Israel in 2024. But there are still not enough people From the ranks you get to know the treatment.”

The biggest concern, according to her, is a wave of trauma victims who do not receive a proper and high-quality response, and are not treated as required, which may cause chronic trauma. Many times patients come to tell about anxiety and depression, and suddenly during the treatment cases of sexual abuse appear for the first time. If in the first place the patient did not come to a therapist who specializes in the treatment of sexual trauma, then this situation leaves the therapist helpless and knowing how to touch the trauma. It does not provide the patient with the correct solution.

In the DBT method, there is a distinction between emotional work that enables initial stabilization, basic rehabilitation of daily functioning skills, reduction of risk situations, treatment of symptoms that disrupt life and functioning such as anxiety, dissociation, flashbacks, avoidance and reduction in daily functioning. And only then when stability is achieved and the treatment relationships are well based on trust in the patient’s therapist and the treatment can one carefully touch upon the processing of the trauma and the achievement of other life goals related to the patient’s well-being.

Khadri-Habib also describes exciting cases of success: “A particularly painful moment is meeting a 40-year-old woman who describes how for years since the age of 17 she has been treated by psychologists and psychiatrists without any real benefit, and how 3 months after starting the DBT treatment, something suddenly begins to move and change.” She adds: “For the first time she manages to ask ‘what happened to me?’ And not to label herself as a depressive whose fate is determined. “The therapy teaches five basic skills: listening, validation, resistance to adversity, regulation of emotions and interpersonal effectiveness. “These skills become a second language for the patient in dealing with a variety of symptoms,” explains Khadri-Habib.

“The question ‘What happened to me?’ (Compared to what my diagnosis is) is a more important question that should be asked in the treatment room. It affects the perception of myself and the way I think, understand and am ready to enter into the processes of rehabilitation and healing.” According to her, this approach is less labeling and fixing the patients, and greatly affects the ability to grow out of trauma towards recovery. Khadri-Habib calls for increased awareness of DBT treatment in Israel: “The more we manage to make the method accessible and spread, the better we will be able to provide a better response to the growing distress in the Israeli public, especially following the events of October 7.” She believes that the DBT method offers enormous potential for changing the face of mental health in Israel, and calls on therapists and the general public to get to know and learn about the method.