DBT - Distress tollerance overview
Dialectical Behavior Therapy (DBT): Core Mindfulness
Dialectical behavior therapy or DBT is an offspring of cognitive behavior therapy that incorporates Eastern meditative practices. The dialectic comes from the synthesis of opposites, particularly acceptance and change that is a tenet core to the DBT philosophy. We accept ourselves as good enough, and we recognize the need for all of us change and grow. These two concepts could seem contradictory, but through the persuasive dialogue, or dialectic, we can understand the seemingly opposing truths side by side.
DBT is taught as a series of skills in four modules: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. The first of these modules is core mindfulness, and as the name implies it is the foundation of DBT. Core mindfulness is based in Eastern Zen philosophy, and it includes Western contemplative practices. Mindfulness is an awareness of thoughts, feelings, behaviors, and behavioral urges. By learning mindfulness, we are empowered to be in charge of ourselves in a different way. It has been proven that awareness assists in emotional regulation. As we understand ourselves, we accept ourselves and change ourselves. It is a practice of attention and intention.
In DBT core mindfulness begins with the concept of states of mind. According to the theory, there are three states of mind that we are all in at varying times: wise mind, logical mind, and emotional mind. Wise mind is the ideal state of mind that we strive for from which to make our decisions. The other two states of mind combine to form wise mind. Logical mind is the state of mind that people use when doing math, reading a map, and various other concrete tasks. It is described as the “cool” state of mind that we use to deal with empirical facts. The last state of mind is emotional mind. Emotional mind is the state of mind in which we feel the depth of our emotions and act from an emotional state. In an extreme, this state of mind would be used if we reacted impulsively out of anger without regard to consequences. This is considered the “hot” state of mind.
Wise mind is the state of mind in the middle of both logical and emotional mind. In wise mind, we are aware of our feelings, and we decide how to act in a way to honor our feelings and goals. In wise mind if we were angered, we would acknowledge our feelings and act in a way that would not create negative consequences for ourselves.
Learning to be more aware of feelings and internal states is a valuable therapeutic process in DBT. These skills are taught through the “what” skills of core mindfulness: observe, describe, and participate. “The goal is to develop a lifestyle of participating with awareness; an assumption of DBT is that participation without awareness is characteristic of impulsive and mood dependent behaviors”. We use all three parts of the skill until a new behavior is learned, then we can choose the appropriate parts of the skill to use more selectively. The first skill is where we observe or attend to thoughts, feelings, events, and behaviors without trying to change them- we just collect data. We want to know how we respond to certain events in our lives. After we become aware through observation, we want to describe our experience. Describing is the second “what” skill of core mindfulness. The more accurately and richly we describe our experience, the more empathy and self control we can access. It is important to separate the experience from reality and understand that feeling and thoughts are not facts. For example, if I feel unloved, it does not mean I am unloved. The final “what” skill of core mindfulness is to participate without self consciousness. To participate, we are fully present in the moment. We try to become more present and alive in each moment of our lives.
The final aspect of core mindfulness are the “how” skills: non-judgmentally, one-mindfully, and effectively. Non-judgmentally means taking “a non-evaluative approach, judging something as neither good not bad”. Instead of judging events, DBT teaches looking at consequences of behaviors and events. One-mindfully is a way to help focus on the task at hand. We practice controlling our attention and focusing on one thing in he moment. We do not let worry thoughts or negative mood influence our task. One-mindfully is the opposite of multi-tasking. Effectively, or doing what works, is the final “how” skill of core mindfulness. Effectively is understanding and acting according to a goal rather than acting according to what we deem as “right or fair”. It empowers us to act from our goals and objectives versus judgments. It is a tool for enabling action on a single goal versus endless contemplation.
Overall, the core mindfulness “what” and “how” skills help to form a foundation for DBT skills training. The main objective is to develop awareness and insight in order to behave in ways that attain our goals. DBT helps to develop awareness, understanding, communication and focus to navigate life and challenging situations.
To learn more about DBT individually or as a group, you can call Dr Tara Arnold at 404-964-6629.
Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. Guilford: New York.
- By Tara Arnold, Ph.D., LCSW