Caitlin Cavanagh, LPC & Emily Clifford
Dialectical Behavior Therapy (DBT) is a skills-based approach that, while initially developed for borderline personality disorder, self-harm or for helping with interpersonal conflicts, has been effective in teaching skills to all people, regardless of diagnosis. You might be wondering, ‘what does dialectical even mean?’ The primary idea of dialectics is that there is an opposite of everything, and we tend to be most effective in our lives when we can find balance between these opposites. A good example is balancing the responsibilities of life with the fun events/activities we want to participate in. How does one go about finding this balance? By incorporating information and ideas from both sides of the spectrum. DBT can help you understand how your experiences shape the way you think, feel, behave, see the world and how you utilize information to make decisions in your life. In a complex world filled with multiple daily stressors, it can be hard to find time to challenge or change our own thoughts, feelings, and behaviors; however, DBT can provide you with simple, daily skills that you can implement to make small changes that can have profound and long-lasting effects. DBT can help whether you are struggling with interpersonal relationships, being present in the moment, keeping a calm mind, suicidal ideation, or destructive patterns. We like to inform prospective DBT clients that DBT is beneficial because it allows them to learn and master additional coping skills that will diversify the toolbox they have already developed.
DBT is taught by breaking up the skills into four separate modules- Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. In this blog post, we are going to focus on the first module, mindfulness. We often hear this term used when someone is referring to ‘being present in the moment,’ but being mindful is so much more than that. Mindfulness is the foundation that all the other modules are built from and are considered core skills of DBT. Without mindfulness, learning and implementing the skills for the other three modules is exceptionally difficult. When we are mindful, we can better notice our thoughts without feeling overwhelmed, learn to notice without judgment, avoid acting impulsively, learn to focus on and appreciate fun moments in life, feel calmer and more relaxed, and make more effective and well-informed decisions in our daily lives. Learning and mastering mindfulness skills can help to increase effectiveness in using distress tolerance skills, emotional regulation skills and interpersonal effectiveness skills.
You don’t need a mental health diagnosis to feel anxious, stressed, or overwhelmed. Our brains can fluctuate between various emotional states multiple times throughout the course of just one day. With that said, how can one be ‘present’ or ‘in the moment’ when there are multiple stressors occurring or so many different things to balance? How can we observe, without judgment, what is going on inside and around our own bodies? How much harder is that going to be when we are dysregulated? Tired? Angry? How can we remain objective when our feelings are so subjective? How are we supposed to notice, well, everything? This is what mindfulness helps us to achieve. Mindfulness helps us to learn how to balance our logical brain and our emotional brain by attaining a ‘wise mind’ perspective that helps us to make informed decisions and utilize skills effectively. Please see the diagram below for a visual of wise mind:
We are all human. We are full of unconscious and conscious biases that can impact how we think, feel, and react. Mindfulness can help you to learn how to separate facts from feelings, feelings from thoughts, and feelings and thoughts from opinions. Learning how to better understand your thoughts, feelings, opinions, and biases can help you to be more effective in how you make decisions and balance the complexities of life. When we are in our wise mind, we can allow ourselves to feel all our feelings, but we can still make clear decisions. We can use reason and logic to make informed choices about our behaviors but take our feelings into consideration as well. Below we are going to talk more about specific mindfulness skills that can help you to build mastery in mindfulness and learn to achieve a more balanced, wise mind outlook.
To achieve a wise mind perspective, learning the ‘what’ skills of mindfulness is essential. Like the scientific approach, this set of skills teaches us to Observe, Describe and Participate in order to gather information, best understand a situation and make the most well-informed, planned decisions. When we Observe, we learn to notice both internal events (i.e., body sensations, emotions, urges, thoughts) and external events (what we taste, smell, see, hear, touch). When we Observe, we choose where we want to focus our attention and we learn to allow our observations to come and go, as if they were clouds passing in the sky. When we Describe, we learn to assign descriptors or words to what we Observe. By doing this, it helps us learn to communicate more effectively about what we Observe and helps us to better understand both the internal and external events we are experiencing. Sounds easy, right? Unfortunately, as humans we tend to use judgment when we Describe. We use adjectives or assign value to our thoughts and feelings. It is during this time that we tend to confuse our thoughts and/or feelings with opinions or facts. Being able to separate a thoughts, feelings, facts, and opinions from one another is an essential part of mindfulness. Lastly, when we Participate, we are utilizing the information gathered from Observing and Describing to help us make the most informed choices. This allows us to become more engaged in our experiences and implement the skills we learn effectively.
Imagine you are walking down the hallway at work and a co-worker bumps into you causing you to drop your coffee all over your shirt. They immediately apologize, tell you they were distracted for a moment, and it was a complete accident. They are trying to help clean up the mess and offer to pay for any dry cleaning. However, you lash out. You think they did it on purpose! They are out for you! They don’t like you and this was their way of showing it. Is this really what happened? Have you observed what is happening? What is happening in the environment? What was their tone? What is their body language? Was this an act of aggression or what it simply an accident? When describing a moment or an interaction, we must give words to what we notice, accurately. Thoughts are not feelings and feelings are not always fact. How could we have described this interaction objectively and without judgement? When we gather what we observed, we participate by responding based off the info we gathered that were based on data and fact.
Now that we have learned our ‘what’ skills, let’s talk about the ‘how’ skills of mindfulness. How do we utilize the information gathered from our ‘what’ skills to help us achieve wise mind? We do this through acting non-judgmentally, one-mindfully, and effectively. Below you will find a breakdown of each of these skills and how they are beneficial in helping to achieve a wise mind perspective.
In order to practice being non-judgmental, focusing on the facts is key. It’s important to keep in mind that facts can be proven- we are able to identify the who, what, when and where of a given situation. Common examples of judgmental words include: Good/bad, fair/unfair, smart/stupid, pretty/ugly, etc.). Being able identify and separate facts from opinions or judgments is of vital importance. When we are acting non-judgmentally, we can identify when our opinions may be getting in the way of making an effective decision and we are able to take a step back and focus more on the facts instead of staying stuck in our opinions. While being judgmental is common and normal in communication, it is important to be able to recognize when a judgment may be clouding a situation and to allow yourself to let the judgment roll by (without judging yourself for being judgmental!).
Next, one-mindfully can be practiced by focusing on one thing at a time. By focusing on one thing at a time, we can put away the distractions, observe our experience, gather data, and participate effectively in how we respond. To practice this skill, follow these steps: 1. Focus on one thing at a time, 2. Notice if your mind begins to wander or becomes distracted, 3. Practice re-focusing on that one thing, and 4. Repeat steps 2 and 3 as much as you may need to achieve confidence in using this skill. Sounds simple, right? Although this sounds like a simple concept, putting it into effective practice is tough! Not giving up and maintaining consistency in practicing this skill is essential to gaining mastery. Not allowing yourself to give into feelings of discouragement is important. No one is perfect at using this skill!
Lastly, the skill of being effective literally means doing what works! When we are effective, we are able to utilize the skills we have learned in the most beneficial ways possible. Being able to learn, practice and gain confidence in the other skills will help you to be effective. It is also important to have an idea of what your goals are so you can make effective choices in order to reach those goals.
Emotion is essential in how we form connections and relationships and how we experience life. We need them! Emotions tell us things about our world both internally and externally. But how can we enjoy the beauty that is our lived experience if we cannot navigate the complexities of life effectively? There will always be something we cannot control. There will always be moments we go through life on ‘autopilot’, ignoring or not noticing what is occurring in that moment. At times emotion will take over logic and can lead to undesirable choices; however, being able to balance emotion and logic is key to finding harmony in the decisions we make in our everyday lives. It can help someone healing from trauma. It can help reshape how someone sees themselves or their environment. It can help a couple communicate more clearly and directly. It can help teens struggling with peer interactions in school. It can help a tired single parent who has a hard time seeing the glass ‘half full’ anymore. Mindfulness can even help you navigate online dating, working relationships or contract negotiations. Please keep in mind that being mindful is a skill that requires practice. The more we practice, the easier it becomes! So, we hope this blog has encouraged you to start thinking about your own mindfulness practices and encourages you to begin practicing some of these skills today- there is never a ‘right time’ to start trying them out!
Below you will find a list of some examples of ways to practice different Observe, Describe and Participate skills:
- Skills to practice Observing via connecting your mind with your senses:
Sight:
- Lie on the ground and watch as the clouds pass by in the sky
- Notice the facial expressions and movements of another person (be sure to avoid labeling what you notice- just focus on noticing).
- While walking slowly, stop somewhere with a view, notice the flowers, trees and nature itself that surrounds you.
Sound:
- If someone is talking, listen to the pitch of the voice, to the smoothness or roughness of the sounds, to the clarity or the mumbling of the speech, to the pauses between the words.
- Listen to music, observing each note as it comes and the spaces between the notes. Try breathing the sounds into your body and letting them flow out again on your out breath.
Smell:
- Breathing in, notice any smells around you. Bring something close to your nose and notice the smells. Take it away, and then notice the smells again. Do they linger?
- When eating, notice the aroma of the food; when cooking, notice the aroma of the spices or the other ingredients.
- When bathing, notice the smell of the soap or shampoo.
- When walking outside, notice the aroma of the air; when near flowers, bend down and ‘smell the roses!’
Touch:
- When walking, notice the sensation of walking—your feet hitting the ground and rising up and down. Try this while walking both slow and fast.
- Touch something—the wall, fabric, a tabletop, a pet, a piece of fruit, a person. Notice the texture of what you feel, notice the sensations on your skin. Try touching different types of things and notice the differences between the sensations.
- Focus your attention on the place in your body where you feel tight or tense. Notice what sensations you experience.
Taste:
- Put something in your mouth and notice the taste. Keep it in your mouth, and notice all of the taste sensations.
- While eating a meal, try eating slowly and noticing all of the different flavors.
Other examples of practicing Observing:
- Observing your breath. Notice the pauses in your breathing, the movement of your stomach, the sensations you experience as air enters and exits through your nose.
- Observing thoughts that come in and out of your mind. Notice your thoughts as if they are clouds, coming in and out of your mind. When worries go round and round in your mind, move your attention to the sensations in your body; then, keeping your attention on your body sensations, notice how long it takes for the worries to wash away.
- Imagine your mind is a river, and that thoughts and feelings are boats going down the river. Imagine sitting on the grass, watching the boats go by. Describe or label each boat as it goes by and try not to jump on the boat.
- Keeping your focus on what you are currently doing, gently expand your awareness to include the space around you.
- Take just a moment of your time, and practice ‘nothing-to-do’ mind. Let yourself become completely aware of your present experience, noticing sensations and the space around you.
- Skills to practice Describing:
- While lying on the ground, watch the cloud in the sky as they pass by. Find and describe cloud patterns that you see.
- Find things in nature—a leaf, a flower, drop of water, a pet or other animal. Describe each thing you see in as much detail as possible.
- Describe your feelings as they rise within you: “A feeling of anger is arising within me.”
- Describe as many of your thoughts as you can while feeling a strong emotion.
- Describe your feelings after someone else does or says something: “When you do X, I feel Y.”
- Follow the entrance and exit of air. Say to yourself, ‘I am inhaling and following the inhalation from its beginning to its end. I am exhaling and following the exhalation from its beginning to its end.’
- Skills to practice Participating:
- Dance to music.
- Sing in the shower.
- Throw yourself into what another person is saying.
- Play a sport and throw yourself into that sport.
- Sing along with music you are listening to.
- Go running, focusing only on running.
* Examples taken from Marsha Linehan’s book, “DBT Skills Training Handouts and Worksheets- Second Edition, pgs. 54-59.”