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Child Psychiatrist /Adult Psychiatrist

Writer's pictureVilash Reddy, MD

Improve Mindfulness - What and How Skills (DBT)

Updated: Sep 9, 2023


Mindfulness was introduced through Buddhism, which strongly influences concepts and aspects of DBT, developed by Dr. Marsha Linehan. It is a state of awareness in which one intentionally pays attention to the present moment without judgment. One of the pillars of DBT mindfulness skills: is the WHAT and HOW skills, to help our brain more accurately process distressing events in life. We will learn to observe our emotions, thoughts, feelings as though they are on a conveyor belt, limiting being engulfed by it. It takes consistent practice and repetition.

a huperson brain lifting weights

The purpose of the WHAT skills is to help focus your attention on the present moment. By observing, describing, and participating (which we will break down). The HOW skills reflect the core qualities of that present moment attention, or how to do the WHAT skills. The WHAT skills allow us to build strength and be in control of emotions and thoughts, and the HOW skills reinforce more technique and adjustments in our WHAT skills, like a feedback loop. Quite simple, these are brain exercises to create new ways of thinking and reacting.



WHAT Skills (i.e. our strength building exercises)



OBSERVE:


Observing is about noticing what is going on both internally and externally in the present moment. Wordless watching - just notice the present moment. You can observe your external environment with your 5 senses (sight, smell, touch, taste, sound), but perhaps more challenging is learning to observe your inner experience (thoughts, emotions, bodily sensations). The key to both is to observe without trying to change what is observed, simply noticing and allowing whatever is arising moment to moment. Thoughts and feelings come as go, as long as you don't set an anchor.


- Self Observation - focusing attention on the sensations of your body inside and outside. The body is always and only in the present. The mind wanders out of the present, and although your body may react to where your mind wanders, it does so in the present moment. The body helps remind us that we are here now, in this place, in this moment. A formal practice such as body scan meditation can be helpful.


DESCRIBE: Describing builds upon the skill of observing. It is about putting words to our experience (what is observed). Label what you observe in your own words. Be sure to focus the facts versus your interpretations or opinions about what is observed. In other words, stick to the “who, what, where, and when.” For self-observation in particular, describing what we notice helps us to separate from what is observed. With mindfulness, we come to know that we are not our thoughts, not our emotions, and not our behaviors --we are the awareness of those things, the witness (observer) and the narrator (describer).

a cartoon of a brain

To practice, try using the phrasing “I am

noticing_____.” This can be especially helpful when we are stuck in negative or self-critical repetitive patterns of thinking. Noticing having a thought that “there is something wrong with me” (i.e. the fact) feels much different than “there is something wrong with me” (i.e. interpreting the thought as true).



PARTICIPATE: Participating is about engaging in the present moment. The key to participating mindfully is to enter fully into an activity without self-consciousness (no separation of self from one’s ongoing events and interactions). Throw yourself in the present moment. Don't worry about about tomorrow or focus on yesterday. Fully experience the moment without being self-conscious. Each moment is an opportunity to participate.




HOW Skills (Mental Exercise to Recondition your thought focus)


NON-JUDGEMENTALLY: Non-judgment is perhaps the most difficult quality of mindfulness to understand and apply to our attention. No good or bad, just observe the facts. Acknowledge the harmful and helpful. You cant go through life without making a judgement. The goal is to catch it and replace with a more realistic perspective. When you find yourself judging, don't judge the judge. Mindfulness asks us to try to practice a life of non-resistance, neither cling to nor push away any experience, to connect to our experience versus our thoughts about our experience. This is the practice of non-judgment.



One important point in DBT, is to recognize that suffering = pain x resistance. The more we resist the more it persists. Resistance is essentially the process of judging the pain as “bad” or “wrong.” Thus, judging increases our suffering. Our judgment can be linked back to our animal survival instinct. We are programmed to avoid pain (= bad) and to approach pleasure (= good), in order to maximize our survival as a species. The problem is, our mammalian brains never learned to decipher between physical and emotional pain nor real or imagined danger. Often in our modern lives the pain we experience is not a threat to our survival and our instinctual aversion to pain can create more suffering in the long run.



Approaching our pain and difficult emotions with non-judgment is the first step to reducing unnecessary suffering. What does this look like?

  • Feeling depressed without beating yourself up for feeling that way

  • Feeling stressed about kids not going back to school without adding guilt on top of that

  • Feeling lonely because of social distancing without interpreting it as no one cares about you

  • Noticing your white privilege and your role in individual and systemic racial injustices without getting stuck in shame (or if shame does arise, then nonjudgmentally noticing that) .


  • ONE-MINDFULLY: Stay focused: One mindfully is the quality of focusing on one thing at a time. It is the opposite of multitasking, which plagues our society at large. We are so bombard with multievents that we get anxiety, stressed out, and overwhelmed very easily.The purpose of being one-mindful, is to fully engage in the task at hand. When attention is divided, it is less effective. Let go of distractions. Literally turn off your phone, shut off your email. Your brains needs rest and can only focus on one thing at a time contrary to popular belief. This area of concentration lies in the Prefrontal Cortex, a suspected underdeveloped areas, which may be contributing to increased number of kids diagnosed with "ADHD", which is a genetic disorder. However, in the era of quick attention span many kids are suspected of having the underlying disorder. I


  • EFFECTIVELY: Do What Works: Focus on what works to achieve your goals. Don't let emotions control your behavior. Cut the cord between feeling and behavior. Play by the rules (that you have established). Act skillfully as you achieve your goes. Let go of negative feelings that resonant from the past, as the past does not dictate the present or future. It takes hard work but try to work on each aspect everyday. You will improve with practice like anything in life.


person sitting in front of tree with meditation

As mindfulness has its roots in Buddhism, I want to end with a story about how the Buddha reached enlightenment that has been helpful for me in applying mindfulness to my life. The story goes that the Buddha was meditating under the Bodhi tree all night long trying to understand the roots of suffering. The shadow god, Mara (who represents the universal evil energies) tried everything he knew to make him fail—sending him violent storms, beautiful temptresses, raging demons, etc. The Buddha met them all with a non-judgmental attention (neither reacting to nor pushing away), and as morning came, he became the Buddha, a “fully realized being.” Thich Nhat Hanh tells the story that in the years that followed, Mara continued to appear and each time the Buddha would say “I see you Mara…come, let’s have tea.” Inviting our individual “Maras” to tea is what mindfulness asks us to do. As mindfulness has its roots in Buddhism, I want to end with a story about how the Buddha reached enlightenment that has been helpful for me in applying mindfulness to my life. The story goes that the Buddha was meditating under the Bodhi tree all night long trying to understand the roots of suffering. The shadow god, Mara (who represents the universal evil energies) tried everything he knew to make him fail—sending him violent storms, beautiful temptresses, raging demons, etc. The Buddha met them all with a non-judgmental attention (neither reacting to nor pushing away), and as morning came, he became the Buddha, a “fully realized being.” Thich Nhat Hanh tells the story that in the years that followed, Mara continued to appear and each time the Buddha would say “I see you Mara…come, let’s have tea.” Inviting our individual “Maras” to tea is what mindfulness asks us to do.


Source: Dr. Marsha Linehan (DBT); Seattle Counseling and Wellness





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