DBT Skills for Self-Harm: Mindfulness

This is part I in a series about learning and using dialectical behavior therapy skills like mindfulness for self-harm. 

Dialectical behavior therapy (DBT) is a type of treatment that teaches patients how to regulate their emotions and respond to distress through skills training. It has proved to be especially effective in people struggling with self-harm and other self-destructive, maladaptive behavior. 

What Are DBT Skills for Self-Harm?

Though DBT can seem complicated at first glance, DBT skills training is essentially composed of four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. 

Together, these skills teach patients how to recognize and honor their emotions, regulate their intensity, and respond to them without the use of maladaptive coping mechanisms.

Today, we will be taking a look at mindfulness in DBT. 

Mindfulness as a DBT Skill for Self-Harm

Mindfulness is considered a core component of DBT. It is, in many ways, its foundation, and a building block for the other four DBT modules. 

Mindfulness is the intentional act of living with awareness in the present moment. It is about acceptance of the present and of all the thoughts, feelings, behaviors, and impulses that that present contains without judgment or rejection. 

The main goals of mindfulness are to help patients reduce suffering, experience reality as an active participant, and empower them to feel more in control of their mind. 

While mindfulness can be practiced anytime and anywhere, core mindfulness in DBT emphasizes the practice of three core mindfulness skills: wise mind, “what” skills, and “how” skills.

'Wise Mind' and States of Mind Skill

According to DBT theory, there are three states of mind that a person can be in at any given time: reasonable mind, emotional mind, and wise mind. 

The reasonable mind is cool, rational, and task-focused, and excludes personal values and feelings. The emotional mind is governed by moods, emotions, and urges, and excludes facts and logic. The wise mind is the compromising middle path between the two, acknowledging both reason and emotion, and is considered the ideal state of mind.

'What' Skills

The “what” skills in DBT are taught through three actions: observe, describe, and participate. The goal of these skills is to help patients achieve greater awareness of their internal state. 

To observe, simply notice and recognize thoughts, feelings, sensations, what you see, what you hear, etc. Pay attention, but do not push anything away or hold onto anything.

To describe, put words and labels on your observations, focusing on the “who," "what," "when," and "where.” Aim for factual accuracy and avoid interpretation. Thoughts and feelings are just thoughts and feelings — not reality. 

Finally, to participate, become present in the moment without self-consciousness. Throw yourself into the moment, into your current activity, remain spontaneous and flexible, and act from wise mind.

'How' Skills

The “how” skills in DBT are: nonjudgmentally, one-mindfully, and effectively. 

Nonjudgmentally means to see and accept without evaluating as good or bad. Acknowledge differences and the consequences of certain behaviors or events, but not the differences and consequences themselves. 

One-mindfully means to practice focus and attention by doing one thing at a time and letting go of distractions to bring yourself back to the present moment.

Effectively means acting from our goals instead of from our judgments. It requires acting in a way that is appropriate for the reality of a given situation instead of one we wish we were in. 

The objective of mindfulness in DBT is to develop enough awareness in order to act according to goals and values, free from the controlling forces of both disconnected logic and overwhelming emotion. 

Sources

1. Arnold, T., “Core Mindfulness: Dialectical Behavior Therapy (DBT).” Goodtherapy.org, January 23, 2008.
2. Linehan, M., “Mindfulness Handouts: Handouts for Goals and Definitions.” DBT Skills Training Handouts and Worksheets, Second Edition, 2015.