Welcome to Mindfulness as applied in Dialectical Behavior Therapy

Kate Zinaman Doucet, MEd, MS, LPC www.dbtforteensandadults.com [email protected] (337) 344-9400 349 Doucet Road, suite 209 Lafayette, LA 70503 Mindfulness is

 the repeated effort of bringing the mind back to awareness of the present moment, without judgment and without attachment.

 the practice of observing thoughts, emotions and urges rather than acting on them in the moment.

 a way to increase nonjudgmental awareness and improve attentional control.

 needed to make use of the other DBT skills.  for clinicians as much as for clients.

 presented in a secular format.

Distinction between Meditation and Mindfulness

As described by Marsha M. Linehan, “Meditation is the practice of mindfulness by attending to, gazing, watching or contemplating something, while sitting or standing quietly.” It is formal practice.

 Sitting quietly, focus on breath

 Sitting quietly, focus on internal experience

 Sitting quietly, focus on external surroundings

 Moving slowly, focus on one activity

(ex: eating meditation, walking meditation)

Meditation is Mindfulness

but Mindfulness is not necessarily Meditation.

For some people, meditation is counter-therapeutic.

Marsha Linehan, p.175, DBT Training Manuel:

“It is very important to help participants let go of expectations about breathing. Expecting breaths to become slow or deep… or expecting to relax or feel differently while practicing can induce panic responses and actually interfere with experiencing wise mind…

For many, a focus on breath alone allows their mind to generate trauma memories, ruminating thoughts, and traumatic and/or painful images. Extreme emotion and/or dissociation may be the result. Others get agitated immediately when they focus on their breathing…

For others, difficulties with attention or with sitting or standing still can make prolonged attention to breathing very difficult. (These difficulties)… are the principal reason why DBT does not require meditation… for individuals who cannot tolerate it.”

Those same people can be Mindful now, by focusing on each activity with full awareness as they live it.

Benefits of Regular Mindfulness Practice

 Increased emotional regulation.

 Increased activity of brain regions associated with positive emotion.

 Increased sense of well-being.

 Decreased depression and risk of depression reoccurrence.

 Decreased anger and emotional irritability.

 Decreased anxiety.

 Decrease in both distractive and ruminative thoughts and behaviors.  Enhanced immune response.

 Improvements in coping with pain and depressive symptoms in people with chronic pain.

 Decreased cardiopulmonary and gastrointestinal symptoms.

DBT Core Mindfulness Skills:

 States of Mind

Emotion Mind, Rational Mind, Wise Mind

 What Skills

Observe, Describe, Participate  How Skills

Nonjudgmentally, One-Mindfully, Effectively

States of Mind Rational Wise Emotion

Mind Mind Mind

What Skills

Observe

 Pre-verbal

 Outside yourself with all 5 senses  Inside yourself – thoughts, emotions and physical sensations

 Develop “Teflon mind” - metaphors

 Don’t push away feelings

Describe

 Put words on the experience

 Without Interpretation

 Only observable facts

Participate

 To experience fully

 To distract as a means of coping

Find “flow moments” no matter what the activity is.

How Skills Nonjudgmentally

 Non-evaluative as opposed to moving from negative to positive or balancing judgments.

 Emphasis on consequences of behaviors

 Accurate discrimination of one thing from another.

One-Mindfully

 Not thinking about the past or the future.

 Not ruminating about current negative emotions, thoughts.

 Not with attention divided among more than one task.

Effectively

 Know what your goal is.

 React to the actual situation rather than what you wish it would be.

 Know what will and won’t work, when to play by the rules and how to be savvy about people.

 Sacrifice a principle to achieve a goal when necessary. Other perspectives on mindfulness to be presented very briefly in DBT Skills Group, in an advanced skills class or in individual work.

Spiritual Perspective – for those who are uncomfortable with the connection to Buddhism and/or anyone who will benefit from connecting mindfulness to their faith beliefs.

Balancing Doing Mind with Being Mind

Doing Wise Being

Mind Mind Mind

Walking the Middle Path – finding the synthesis between opposites. Resources

 There’s an app for that! DBT Mindfulness Tools found in the app store.

For clinicians

 DBT Skills Training Manual, Second Edition, Oct. 20, 2014 by Marsha M. Linehan, PhD, ABPP, specifically Chapter 7.

 DBT Skills Training Handouts and Worksheets, Second Edition, Oct 21, 2014 by Marsha M. Linehan, PhD, ABPP, specifically pp 45-107.

 DBT Skills Manual for Adolescents Nov 20, 2014 by Jill Rathus, PhD and Alsc L. Miller, PsyD, specifically Chapter 6 and pp. 267-278.

Self-Help

 Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life, Mar 1, 2012 by Sheri Van Dijk, MSW, specifically Chapter 1.

 Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy, 2013 by Blaise Aguirre, MD and Gillian Galen, PsyD.