Mindfulness 101: The What and How Skills

As Eastern practices infuse into Western medicine, mindfulness is becoming popular and is widely utilized in dialectical behavior therapy (DBT).  Mindfulness is an ideal skill set that supports active listening and enhances the clarity of thoughts, potentially yielding more authentic and precise questions and feedback. 

               

At its core, Linehan’s mindfulness is the fusion of Zen meditation and “Western contemplative thought” (Linehan, 1993, p. 144).  It integrates attention and heightened awareness techniques with emotion regulation and distress tolerance by involving the “what” and “how” skills of mindfulness.    

The activities of mindfulness, the “what” skills, are to observe, describe and participate.  Observation is the back seat perception of one’s immediate environment without labels or judgments.  Description is the verbal acknowledgment of what is observed internally and externally and equally cognitively and behaviorally.  Participation is akin to Csíkszentmihályi’s positive psychology concept of flow and is “entering completely into the activities of the current moment, without separating oneself from ongoing events and interactions” (Linehan, 1993, p. 146). 

The ways to practice them are the “how” skills: taking a nonjudgmental stance, focusing your thoughts on the here and now, and “using skillful means,” also termed “being effective,” to respond to one’s internal and external environments.  These concepts are the foundation for urge surfing (Linehan, 1993). 

               

DBT Training Wrap Up from May 2013

This week has been as much fun as summer camp!  It was intense to work with Shari Manning and Karyn Hall for a week.  I am kind of bookish, so it was a perfect fit for a graduate student who is eager to learn and apply...and run with the big dogs in the treatment world. 

When I arrived at Menninger for the training, I had barely slept and didn't need to with such anticipation and excitement.  I was one of the first to arrive, so I had a moment to look around the room and soak in the reality of the moment- here I am as a student- surrounded by some of the top practitioners and clinicians in mental health.  I had my binder and was ready to go. 

Before the introductions, Karyn smiled at the group and led the first mindfulness.  Observe is the first core mindfulness skill, so it was the perfect place to start.  When you practice mindfulness, you do so with your eyes open, so that you are fully present and aware of your environment.  The target was to track the thoughts, as one would track the clouds moving across the sky.  In Observe, there are no labels, judgments, or words assigned to what you see or think.  The goal is to just notice the thought and let it go.  

I watched my thoughts.  With each breath, I let go of the expectations that had filled my mind with wonder in the car and still lingered as I sat.  I was sitting in my chair and began to realize that this is real- the day has finally come and I am here to embrace it and to live in it. 

I let go of the comparison of being less experienced, realizing we all have different areas of specialty and understanding.  "Comparison is the thief of joy" - Theodore Roosevelt.  And he is right.  From the moment I realized and accepted that I was "enough," the tension in my shoulders left and I could be fully present. 

Remember, all we have is this moment.  Live in it.

Dialectical View of Dealing with Expectations

A sense of being a failure, one who falls short of expectations, can be seen in so many populations, not just individuals with borderline personality disorder.  There are several perspectives about expectations.  The expectations we hear can come from the words we speak to ourselves, the direct words we hear from others, and the wordless comments that we perceive from others.  

Trying to live up to expectations can take the fun out of life.  For the client, her expectations for herself could be too grandiose to accomplish.  The expectations we hear from others may create dissonance, in the pursuit of trying to meet the expectations of others and trying to be yourself.  The expectations she perceives from others may be the result of mind-reading.  

So what do we do with these expectations?  We have many options, like weighing the facts, the What Skills of Mindfulness (observe and describe), chain analysis, and finding the kernel of truth.  

Let's start with Observe and Describe.  Observe, Describe, and Participate are the three What Skills of Mindfulness.  Observing is just noticing without attaching words, judgments, or meaning.  Describing is adding words to the observations, while still maintaining a one-minded, effective, nonjudgmental stance.  We'll talk about Participate in a later post, but generally Participate means whole-heartedly diving into an activity; I have heard others say that Participate is a similar concept to Mihaly Csikszentmihalyi's Flow. 

Let's go to weighing the facts.  In this context, it's a little on the Reasonable Mind side of Wise Mind; focusing on the facts can draw us out of Emotion Mind.  Questions could include: Who was talking?  What was said?  We're looking for the actual words, not interpretations.  What is the context of the discussion?  When did the discussion start?  We're looking for this most recent, specific discussion; try not to dig in the pain of the past.

Chain analysis is a key process in DBT, as the roots of DBT are in behavioral analysis and cognitive behavioral therapy.  Essentially, chain analyses link the triggering event to the emotions, perceptions, actions, and consequences.  More will be coming about chain analyses.  

Last, finding the kernel of truth involves dialectical thinking.  There are many ways to view an event.  In looking at the stated expectations from another person, try to see her perspective.  What does she see?  What is she saying?  Take these questions into consideration, especially when trying to find the dialectic.  Find what your Wise Mind knows to be true.  Now integrate these concepts.