This is the second of a series of posts regarding my experiences of Dialectical Behaviour Therapy (DBT) in response to some conversations I’ve had on Twitter where people have been rather negative about it. Today’s post is one that deals with an aspect of DBT that I have found incredibly helpful – mindfulness.
Mindfulness underpins every module and aspect of DBT. In my DBT programme, the skills group would repeat 2 weeks of mindfulness sessions each time between the other modules (distress tolerance, emotion regulation and interpersonal effectiveness).
Mindfulness has been life changing for me and that is not at all an exaggeration. However, when I started DBT I was, to say the least, somewhat sceptical of it. Mindfulness seemed a bit ‘out there’, something new age hippies would engage in, not something that would sit well with me at all. I knew though that DBT has been shown to help people with a diagnosis of BPD and this was the first time I had been allowed therapy after years of being turned down for being “too high risk”. This was my chance and I grabbed it with both hands and desperately clung on – even through aspects of the therapy I thought were a bit odd. I am so glad I did!
Mindfulness is often mistakenly thought to be meditation alone – sitting breathing and trying to achieve a Zen-like state; achieving a state of relaxation or emptying the mind of thoughts. This is not mindfulness. Quite simply, mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to things as they are” (Williams, Teasdale et al). In DBT the emphasis is on being able to develop awareness particularly of thoughts, feeling, emotions without judging the experience or yourself for the experience or feelings. It gives an individual a choice whether to and how to react.
From what I can gather, and rather surprisingly to me, I took to mindfulness quite naturally and ingrained this quickly in my daily life, something that other group members struggled with. Perhaps it is why I have found it so useful. To start with, I would do guided breathing meditations for very short periods of time and gradually increased the length. I found that the awareness cultivated in these sessions gradually, automatically transferred to my daily life – being aware of thoughts, feelings, sensations and judgments in the meditations made me more aware of these when they arose throughout my day.
There’s a particular mindfulness meditation I find helpful. It is the mountain meditation. You can find guided versions of it on the internet. I love how I can see myself as a stable presence (mountain) amongst turmoil – such as a climate of depression, the winds, rains, storms of difficult emotions, anxiety and the experiences of hypomania. I am fully present and stable whilst the difficulties are there around me.
In addition to formal meditation practice, I would purposefully practise informal mindfulness – taking time to be in the moment when doing small everyday tasks such as drinking a cup of tea, having a shower, brushing my teeth etc. This has extended to me noticing experiences when out and about – a walk in the park or the hills for example. These practices have enhanced my life, allowed me to fully enjoy positive experiences rather than rush through them. Being able to fully participate in positive experiences creates emotional wellbeing and a fuller life.
Mindfulness has been helpful in other ways. When I find I am becoming overwhelmed, or just generally in my day-to-day life, I remind myself to do one thing at a time, which is “one-mindfully” on the DBT skills card that has to be filled in daily during DBT. In this day and age being able to multi-task is seen as key. In fact, it has been shown that we are quite poor at this and it doesn’t enhance effectiveness at all. Doing a task mindfully means that proper attention is paid to a task and it is completed to the best degree.
In DBT distress tolerance, distraction isn’t about just mindlessly watching a film, reading a book etc, it is about doing a task to distract in a mindful manner. In the past when told to distract I would be doing a distraction activity whilst still thinking about the distressing thoughts and emotions. DBT requires the distraction activity be done mindfully – paying attention to the activity and fully participating in it. I found this made (and still makes) a distraction activity in the midst of distress much more effective.
However, mindfulness brought up uncomfortable experiences. I have for years been trying to suppress emotions, distressing experiences (both past and present) and thoughts through alcohol, disordered eating, self-harm and suicide attempts. Mindfulness requires that an individual turn towards these and experience them. This terrified me and I only started doing this after my mindfulness practice had been established for about a year. I did this very gradually, turning towards minor distressing or uncomfortable experiences. Now I am able to do it for greater distress. However, turning towards an uncomfortable emotion, thought, judgment does not mean becoming swept up and entangled in a distressing or difficult experience; it is being able to observe, neither pushing away or becoming entangled. During one of the emotion regulation DBT skills group I taught I tried to engage the group in a mindfulness of emotions exercise but this did not prove possible. Again, during a recent Mindfulness for Stress course I completed via Breathworks, participants were hesitant at doing so. It is natural to turn away and should always be done in a way that is safe for an individual.
Mindfulness of my thoughts and emotions has meant that I recognise and engage (not entangle) with them. Prior to DBT and mindfulness practice, I didn’t know what I was experiencing and I would suddenly find myself at crisis point, distressed to the point of self harm or suicide and not understanding how that had happened. I would be frustrated when the crisis team would ask what had ‘triggered’ the self harm. I honestly wouldn’t know and they wouldn’t believe nor accept this. I now recognise my emotions, thoughts, judgments coming and going through the day. When I find myself distressed, I am able to recognise why and how and I have a choice – to go with my catastrophising or other habitual and unhelpful thought patterns or I can step back, experience this safely.
Mindfulness is referred to as a practice. This is important to stress. I still find myself entangled in experiences and emotions at times but there is always a moment of mindfulness when I recognise this and my awareness allows me not to slide into full-on crisis. Mindfulness isn’t about perfection. It is a lifelong habit and practice, a continuing path of learning.
Mindfulness is something that everybody can benefit from, whether they have mental health problems or not. I’m a convert. I’ve just been accepted by Breathworks onto their teacher training programme – although the next available introductory module course isn’t until September 2014 because it is so popular. I am keen to help other people set up practice and gain the benefits of mindfulness. I have a short list below of some books that I have found helpful – there are many available. As a start point though I would recommend the book by Prof Williams & Danny Penman:
Aldina, S. Mindfulness for Dummies (2010)
Germer, C. The Mindful Path to Self-Compassion (2009)
McKay, M. Wood, J. Brantley, J. The Dialectial Behavior Therapy Skills Workbook (2007)
Williams, M, Teasdale, J. Segal, Z & Kabat-Zinn, J. The Mindful Way through Depression (2007)
Williams, M. & Penman, D. Mindfulness: A Practical Guide to Finding Peace in a Frantic World (2011)