Mindfulness and DBT

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Everybody’s inner world is as unique as their fingerprints. DSM-V diagnoses are helpful, as Therapist says mostly for insurance companies, but diagnoses do not define us. However, there are some methods for dealing with emotional issues that are effective for a broad spectrum of people. The most effective way, aside from individual therapy and medication, that I have encountered is DBT (Dialectical Behavior Therapy). DBT was developed by Marsha Linehan in the ’80s as a way of combining her study of mindfulness and Zen Buddhism with an effective way to manage emotional distress, particularly for people with BPD who account for a staggering 20% of all psychiatric hospitalizations (a conservative estimate) even though only 2% of the population actually meets BPD criteria. What she discovered was that Borderline patients didn’t respond to the typical forms of treatment available at the time because emotional pain was so severe as to make learning new behaviors virtually impossible. By integrating Mindfulness into her treatment plan, she discovered that people responded positively and those with severe distress could begin to learn new skills. Jon Kabat-Zinn was working around the same time with patients with severe chronic pain and began teaching Mindfulness as a method of pain management (MBSR: Mindfulness Based Stress Reduction). In both cases, severe sensations were tempered by learning to be mindful. (Here are some DBT FAQs from the Linehan Institute.)

What does it mean to be mindful?

Mindfulness is intentionally focusing in the present moment and accepting what is in that moment without evaluating it as good or bad (Germer 2004).

(Koons, Cedar R.. The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT (p. 7). New Harbinger Publications. Kindle Edition.)

Evidence shows that mindfulness reduces emotional pain by bringing our attention into the present moment and helping us focus on what is real in the moment (Grossman et al. 2004). As we will see…strong emotions produce powerful urges to act before we think. When we focus mindfully, we are building in a brief pause before we act. Within that pause we can actually recognize that we have a choice about how to act, rather than being slaves to our emotions and their urges.

(Koons, Cedar R.. The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT (p. 8). New Harbinger Publications. Kindle Edition.)

Mindfulness skills allow us to be in the present moment while carrying on with the business of life. In meditation we set aside time from daily activities to focus exclusively on a particular practice. To meditate you must be mindful, but being mindful does not require that you meditate.

(Koons, Cedar R.. The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT (p. 11). New Harbinger Publications. Kindle Edition.)

Linehan says that Mindfulness is the core DBT skill upon which all the others are dependent. She describes Mindfulness as follows:

‘Mindfulness’ is the act of consciously focusing the mind in the present moment without judgment and without attachment to the moment. When mindful, we are aware in and of the present moment. We can contrast mindfulness with automatic, habitual, or rote behavior and activity. When mindful, we are alert and awake, like a sentry guarding a gate. We can contrast mindfulness with rigidly clinging to the present moment, as if we could keep a present moment from changing if we cling hard enough. When mindful, we are open to the fluidity of each moment as it arises and falls away. In ‘beginner’s mind,’ each moment is a new beginning, a new and unique moment in time. We can contrast mindfulness with rejecting, suppressing, blocking, or avoiding the present moment, as if ‘out of mind’ really did mean ‘out of existence’ and ‘out of influence’ upon us. When mindful, we enter into each moment. 

(Linehan, Marsha M. DBT Skills Training Manual: Second Edition. (p. 152))

I have personally found Mindfulness practice to be the single most helpful tool that I have learned. My therapist uses a technique call MBCBT (Mindfulness Based Cognitive Behavioral Therapy). We focus a lot on meditating, on being present in the moment, on tolerating negative emotions, and restructuring behaviors once I’ve become aware of them. I have a habit of dissociating in stressful times, which means that I become detached from reality in either a gentle or severe way depending on the level of stress I’m undergoing. (See this wiki article for more info on what dissociation is.) It can be severely uncomfortable and disorienting. A couple weeks ago when I was sick, I experienced severe dissociation. I was so separated from myself and reality that nothing felt right or good. I didn’t even feel like I was in my own body. But because I have DBT skills under my belt, I was able to recognize what was happening and engage in skills practice to try and ground myself.

My first step is to take a few deep breaths and really just focus on how the air moves through my body so that I become aware of my own corporeality. It helps to close my eyes. This is not an easy step, especially when everything feels like invisible fire ants are crawling around my head, but the longer I breathe, the better it gets. Then I can tell myself, OK, this is a moment, these are feelings and I have to be in touch with it to accept it and get through it. When I’m dissociated, I back off into a world that’s 50 feet away from reality. It’s like being in a video game watching your character in the 3rd person. Sometimes I can’t even hear what people are saying because I am so far away. But by taking a step with Mindfulness, I can get closer to reality. Once I know I still exist, I know that the moment will pass and the emotions will change. This makes tolerating the situation easier (not easy).

What I’ve taken to doing on a daily basis, when I can’t bring myself to formally meditate, is to use an app called Breathe that sends me an alert every so often so I have to stop what I’m doing (or do both if need be) and take deep breaths for however long I set the timer for (1-5 minutes). It’s like a little mini-meditation. Just focusing on breathing is such a powerful way to calm the brain and body, to ground you in the present moment.

There is a lot more to mindfulness and DBT, which I will probably touch on later. DBT Skills are useful for everyone regardless of diagnosis. Mindfulness in particular is applicable to every stressful situation, so if you try one thing today, this week, whatever, try taking time out of your day to be present, to breathe, to accept reality for what it is without judgment and who knows, you might just feel better.

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