Mindfulness is at the core of Dialectical Behavior Therapy DBT, a CBT treatment for pervasive emotion regulation problems. Every DBT skills group begins with mindfulness meditation. Every skill depends on mindfulness. Often when trying to understand when something went wrong during your day or when something went right, mindfulness is implicated. Why mindfulness is so important in DBT however, is usually misunderstood.
What Is Mindfulness?
Mindfulness, at its essence, is simply being present. This means paying attention to what is happening right now. Without judgment. Without overthinking. Without invalidating your experience. Mindfulness is just being willing to show up to the present moment. It is acceptance of the present moment.
It sounds simple, but most people spend a very small portion of their day mindfully engaged in their lives. We usually tune out our actual experience, and get distracted by thoughts about our experience. Most of us get so conditioned to engaging with our thoughts rather than with reality, it is very easy for us to lose sight of what is actually happening to us, and consequently, how best to handle what is happening to us.
How Does Mindfulness fit into DBT and CBT?
Dialectical Behavior Therapy is a treatment that targets emotion dysregulation. Often people get emotionally dysregulated by seemingly insignificant or trivial events, not because of the events themselves, but by the judgments people have about the events. For example, you may have a job that you are reasonable happy in. Let’s say it’s working at a clothing store. You like clothes, and you like interacting with people, so it seems like a good fit. What you don’t like however, is folding clothes. You find it boring. Now, you may only have to fold clothes for about 30 minutes of a six-hour shift, which is really just a small portion of the job. You may find that as you fold clothes, your mind starts to make all kinds of negative judgments about folding clothes. “This is terrible.” “What a waste of time.” “This is stupid.” “This job is awful.” Rather than spending the time focusing on folding the clothes, your mind is busy telling all kinds of disturbing stories about this task, and will likely trigger emotions such as anger, resentment, even despair. What’s worse, these emotions have a way of coloring the rest of your day. Now instead of tolerating 30 minutes of an unpleasant chore, you spend the whole day in a foul mood, judging all aspects of your job negatively, feeling worse every minute. Because being in a bad mood for most of the day, more days than not, is very unpleasant, you start having judgments about your mood, thinking, “I can’t take this anymore.” So what started out as a relatively insignificant thing has caused a lot of suffering.
A mindful approach to this dilemma would be to approach the unpleasant task in the spirit of acceptance, willing to engage in it without engaging in a lot of judgments about it. The moment you notice a judgment, your turn your mind to folding the clothes, aware of the sensation of the fabric against your fingertips. Noticing the movement of your arms. Describing the smell of the new fabric as it reaches your nose in waves. By fully engaging in the task, repeatedly turning the mind to it, there is little room for negative attributions. You may now even find it to be a calming, soothing activity. This is one way mindfulness can help avert an emotional downward spiral.
Mindfulness can also be effective in helping us make the best decisions. People with pervasive emotion dysregulation often have histories full of others invalidating their wants, needs, thoughts, and feelings. Over time, persistent invalidation from the outside nourishes invalidation on the inside. After a while, people with emotion dysregulation learn to invalidate their own experience, having learned it was wrong, bad, or dangerous for some reason. People who get good at invalidating themselves tend to lose touch with their own experience. They no longer consider their own opinions. They no longer know where to find their own intuition. Consequently, self-invalidators live lives inconsistent with their own values and dreams. They don’t find it important when their needs are being sacrificed for those of someone else. All of this results in people who do not do what is best for themselves, which is a hard way to live life. As a result, they are unhappier, and thus more prone to becoming emotionally dysregulated.
Finally, mindfulness can help with emotional dysregulation by way of helping to relinquish the struggle with painful emotions. One of the reasons people develop emotion dysregulation is because they try to quash or control their emotional responses to things. Trying to control an emotion is kind of like trying to grab tightly onto jello. The more you try, the more of a mess it makes. With emotions, the more we try to control them, the more intense they become, and the longer they persist. Unfortunately, due to an environment plagued by invalidation from others, there is pressure from the outside to control the emotions, leading to more intense emotions, leading to more invalidation, etc. This tends to become a self-perpetuating feedback loop.
Mindfully experiencing emotions is the opposite of the control strategy. With mindfulness, you simply observe what comes up with the emotion. You notice a feeling of your face flushed. You notice a lump in your throat. You notice all of the experiences that are the emotion, and you do so not with the intention of suppressing them, but in the service of accepting each and every one of them unconditionally. There is an old expression that you can’t argue with an emotion. This is because the emotion is there for a reason, so the best one can do is tolerate it without holding on or pushing away. It is a paradoxical approach, but the end result is emotional experiences that are less disturbing and of shorter duration. The emotions naturally go just as they came. Giving them permission to be there lets emotions take their natural course as fleeting, changing, dynamic sensations.
These are some of the main reasons mindfulness is relied on so heavily in Dialectical Behavior Therapy. There are many other uses of mindfulness in the treatment. In fact, as mentioned earlier, every skill relies on a foundation of mindfulness, so there are as many uses of mindfulness as there are skills, and then some.
One of the most important points about mindfulness, is that it is very difficult. Our brains are hardwired to make judgments, time travel, and create stories. In a way, working to be mindful is working against the biology of our brains. No one is perfect at this. Luckily, there is no need to be perfect at it. We can experience the real benefit of mindfulness when we notice we are not being mindful, and choose to turn our minds back to the now. That is the power of mindfulness: recognizing when we are not mindful. If we get distracted a thousand times, we have a thousand opportunities to notice and shift our attention. It’s a bit like fly fishing. Your mind casts its line to far-flung places when you are distracted, and then you reel it back in when you reorient your mind to the present. And like fly fishing, this process occurs again and again. Numerous times in the course of one minute. And the more we practice, the easier it becomes to recognize when the mind has left the building. And with each time we practice, we gain a little more clarity and control.
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