Mindfulness Mindfulness is one of the core ideas behind all elements of DBT. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional contemplative religious practice, though the version taught in DBT does not involve any religious or
metaphysical concepts. Within DBT, it is the capacity to pay attention, nonjudgmentally, to the present moment; about living in the moment, experiencing one's emotions and senses fully, yet with perspective. The practice of mindfulness can also be intended to make people more aware of their environments through their five senses:
touch,
smell,
sight,
taste, and
sound. Mindfulness relies heavily on the principle of
acceptance, sometimes referred to as "radical acceptance". Acceptance skills rely on the patient's ability to view situations with no judgment, and to accept situations and their accompanying emotions. This causes less distress overall, which can result in reduced discomfort and symptomology.
Acceptance and change The first few sessions of DBT introduce the dialectic of acceptance and change. The patient must first become comfortable with the idea of therapy; once the patient and therapist have established a trusting relationship, DBT techniques can flourish. An essential part of learning acceptance is to first grasp the idea of radical acceptance: radical acceptance embraces the idea of facing situations, both positive and negative, without judgment. Acceptance also incorporates mindfulness and emotional regulation skills, which depend on the idea of radical acceptance. These skills, specifically, are what set DBT apart from other therapies. Often, after a patient becomes familiar with the idea of acceptance, they will accompany it with change. DBT has five specific states of change which the therapist will review with the patient: pre-contemplation, contemplation, preparation, action, and maintenance. Precontemplation is the first stage, in which the patient is completely unaware of their problem. In the second stage, contemplation, the patient realizes the reality of their illness: this is not an action, but a realization. It is not until the third stage, preparation, that the patient is likely to take action, and prepares to move forward. This could be as simple as researching or contacting therapists. Finally, in stage 4, the patient takes action and receives treatment. In the final stage, maintenance, the patient must strengthen their change in order to prevent relapse. After grasping acceptance and change, a patient can fully advance to mindfulness techniques. There are six mindfulness skills used in DBT to bring the client closer to achieving a "wise mind", the synthesis of the rational mind and emotional mind: three "what" skills (observe, describe, participate) and three "how" skills (nonjudgementally, one-mindfully, effectively).
Distress tolerance The concept of distress tolerance arose from methods used in person-centered,
psychodynamic,
psychoanalytic,
gestalt, and/or
narrative therapies, along with religious and spiritual practices. Distress tolerance means learning to bear emotional discomfort skillfully, without resorting to maladaptive reactions. Healthier coping behaviors are learned, including intentional self-distraction, self-soothing, and 'radical acceptance.'
Emotion regulation Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and
labile. They can be angry, intensely frustrated, depressed, or anxious. The theory holds that intense emotions are conditioned responses to distressing experiences, which serve as the conditioned stimuli. Emotional regulation skills are taught to help patients modify their conditioned responses. Dialectical behavior therapy skills for emotion regulation include: • Learning how to understand and name emotions: the patient focuses on recognizing their feelings. This segment relates directly to mindfulness, which also exposes a patient to their emotions. • Identify obstacles to changing emotions • Changing unwanted emotions: the therapist emphasizes the use of opposite-reactions, fact-checking, and problem solving to regulate emotions. While using opposite-reactions, the patient targets distressing feelings by responding with the opposite emotion. • Reducing vulnerability: the patient learns to accumulate positive emotions and to plan coping mechanisms in advance, in order to better handle difficult experiences in the future. • Increasing mindfulness to current emotions • Taking opposite action • Applying distress tolerance techniques • Managing extreme conditions: the patient focuses on incorporating their use of mindfulness skills to their current emotions, to remain stable and alert in a crisis.
Interpersonal effectiveness The three interpersonal skills focused on in DBT include
self-respect, treating others "with care, interest, validation, and respect", and
assertiveness. The dialectic involved in healthy relationships involves balancing the needs of others with the needs of the self, while maintaining one's self-respect. ==Tools==