While Dialectical Behavioral Therapy (DBT) was initially developed as a treatment for chronic suicidal individuals diagnosed with Borderline Personality Disorder, it has been proven effective as a treatment for a broad range of issues like substance abuse, depression, PTSD and eating disorders. Here at Columbus Park Eating Disorder Center in NYC, we use DBT-ED which is an adaptation of DBT specifically to address eating pathology. For certain patients, particularly a subset of patients with Binge Eating Disorder and Bulimia Nervosa who use food as a coping method for managing emotion, DBT-ED is our treatment of choice. While DBT has been well-studied as a formal treatment for a wide range of mental health conditions, the skills – and there are dozens of them – happen to be incredibly practical and accessible for any individual who wants to increase self-awareness, effective management of emotion and interpersonal effectiveness.
Over the next few weeks, we will be zeroing in on the four DBT Modules – or skill groupings – and will highlight some of our favorite DBT skills. Let’s begin with an important skill: mindfulness. Due to its efficacy and accessible nature, mindfulness has solidified its position as the foundation of DBT. Research has demonstrated that mindfulness can reduce stress, anxiety, depression and lead to an increased ability to enjoy life. In fact, studies have shown that mindfulness can aid us in activating a part of the brain that promotes happiness, optimism and triggers positive feelings (Harvard Health Publications, 2004). Too often, clients will dismiss mindfulness as an “airy-fairy” concept, or assume it is a form of meditation, disregarding its credibility and misinterpreting its intent. Mindfulness is not utilized in an attempt to escape or push away one’s emotions. Rather, it is a practice that promotes acceptance and experiencing the present in a nonjudgmental way.
Mindfulness has a number of benefits:
Taking Control of Your Mind
Mindfulness practice is focused on staying in the present as opposed to the past (which can be experienced as regret, depression, shame) or the future (often experienced as worry, sadness, etc). Let’s use a metaphor and think of emotions like a speeding car. When your car is speeding (because your mind is elsewhere—you are focused on the past or concerned about the future) a small bump or rock could result in a big crash. When practicing mindfulness, we maintain a manageable speed. By focusing only on the present moment, we are aware of what’s happening within us and around us, enhancing our ability to make safe choices as roadblocks come and go along our route.
Increased Behavioral Control
Mindfulness offers us a window of time between experiencing an emotion and reacting to it, to consider our choices and their potential outcomes. The grounding practice of mindfulness may prevent us from acting on an impulsive urge that could have a negative outcome. Perhaps you can relate to the statement “I didn’t have time to think, I just did” or “I lost control over myself.” Over time, mindfulness will teach you to become more aware of your thoughts and feelings, so you can navigate your world with more clarity, control and balance.
While mindfulness exercises are not utilized in DBT as relaxation techniques, relaxation is often noted as a welcomed side-effect. By holding our attention on one thing at a time, our world does not feel as chaotic or hectic. Mindfulness teaches us to observe the present moment, which can have a calming effect when we choose to observe how we feel on a nature walk, while eating a delicious meal, while soaking in the tub, etc. When we are grounded in the present, as opposed to drifting to the future or thinking about the past, we are better able to enjoy life’s special moments as they arise.
- Take out your toothbrush and toothpaste and start brushing your teeth (your dentist can thank us).
- Now really tune into this activity… fully attend to what you’re doing as you brush. What do you feel, smell, taste, hear? Tapping into all your senses helps you attend to the full experience of the present moment.
- It’s natural for our minds to wander. When this happens, simply notice that your attention has shifted and then gently bring your attention back to the activity itself. This last step requires that we accept our mind has wandered. Try not to judge yourself as having done something wrong if your mind wanders. Staying present, drifting and then returning to the present is what mindfulness is all about!
This mindfulness exercise can be practiced with any activity: walking the dog, painting your nails, riding the subway…. The point is that you’re engaging in an activity with full attention and awareness and that you’re refocusing back to the experience every time your mind begins to wander. Practice is essential. Over time, you’ll strengthen your “mindfulness” muscle and will get better and better at tuning out chatter or distracting (or distressing) content and stay present with the task at hand.
Dijk, Sheri Van. DBT Made Simple: a Step-by-Step Guide to Dialectical Behavior Therapy. New Harbinger Publications, 2013.