The best explanation I have heard for DBT Mindfulness Practice is from DBT trainer, Randy Wolbert, who said “mindfulness is simply the state of being completely awake right now.” Mindfulness has attracted significant attention in the media in the past few years. It has emphasized the benefits of mindfulness meditation. From mental health to medical benefits, to performance enhancement, mindfulness is getting a lot of attention. I find this exciting. I also find this a little frustrating. There is rarely an explanation of how to begin practicing mindfulness in your daily life. This post will provide a simple introduction to the practice of mindfulness and the importance of this practice in DBT. In the following blog, I will provide some simple mindfulness practices that any person can do, whether it be at home in a rare quiet moment, to maintain calm during a potential crisis, or even between meetings during a busy day at the office.
Mindfulness practice is a meditation that involves being fully awake in the present moment. It does not involve an inward focus, one that tunes out the world. It actually involves the state of being open and observing the individual’s environment, internal thoughts, feelings, sensations, and external senses. Observing is not responding. Thoughts about thoughts, feelings, etc, takes away from the experience of being; it most likely involves judgments as well as leads to distraction. This is normal. Before beginning a mindfulness exercise, accept that judgments and distractions will happen. They happen to everyone. Plan to respond to these without judging your mindfulness practice. Plan to respond by observing with a simple narration of the behavior, “I’m thinking about lunch,” “my stomach is making noise,” and re-center your attention on your breath. Doing this without frustration or self-criticism, which would further lead to more judgments and distractions.
Mindfulness practice stresses the act of focusing on one thing at a time. How can we do this? Aren’t we supposed to be able to juggle several tasks at once? Isn’t that a requirement in many job descriptions? We live in a society that places in high priority the ability to multi-task, a skill that actually does not exist. The more an individual splits their attention between activities, the less effective they become, even in the things we excel at. Focusing on doing one thing at a time highly improves our performance.
The reason why mindfulness practice is stressed so much in DBT is sometimes unclear to individuals entering treatment. High reactivity is the most common experience in this population. Individuals experience very intense feelings and overwhelming thoughts and urge. Very seldom do they feel they are in control of these things and very often they feel driven by them. Over time, mindfulness practice provides individuals with the skills to develop an awareness of feelings and thoughts and urges. The client develops the ability to observe these without judgment, without the impulsivity that has the potential to make things worse. DBT mindfulness practice allows for a balance in experiencing life and reacting to stressors effectively.
Individuals beginning the DBT program are oriented to mindfulness practice as it is the core of DBT and is interwoven throughout all of the DBT skills. So many individuals are concerned that they are doing the mindfulness incorrectly. This concern interferes with the effectiveness of their practice. Individuals continue to develop their mindfulness practice skills for many years. The importance of the practice is the focus on the breath.
During my first DBT session with a client, I guide individuals through a five-minute practice in several steps to orient them to focus on their breath. Many individuals coming into DBT experience severe anxiety. The effect of anxiety is shallow breathing. Getting clients familiar with the rhythm of their breath is the first step. Find a comfortable spot in a quiet space in which you can practice mindfulness exercises. This will not matter so much in the future. Spend a minute or two simply observing your breath. Change nothing at this time. Simply follow your natural rhythm of inhaling and exhale. When you have a sense of your breath’s rhythm, count the seconds on the inhale and then the exhale. Many individuals remark that they can only count to 3 or 4 for each. This is typical of individuals with anxiety. Unfortunately, this rhythm has natural negative feedback in which your body interprets possible threats, keeping you anxious.
By making small adjustments with the breath we can change the messages we are giving our body. Up until now, the person has only observed the natural rhythm of their breath. Orient yourself to how you are sitting, slouched postures may interfere with mindfulness practice. Try to sit back in a comfortable position. Uncross your legs, or cross them at the ankles. Hold your arms at the sides with the hands facing palm side up on your lap. Alternatively, place your forearms on the arms of the chair, or on the table. I find it helpful to open the chest by slightly drawing the elbows to the back of the chair. This will not feel natural, especially if your usual posture is slightly curved forward. It does quickly get easier with consistent practice.
Now observe the breath again. Note both the intakes and outtakes of breath. There may be subtle changes in how many seconds you are able to count on each inhale and exhale. Gently follow the breath. Without judgment, notice the way your sensations change in your body. If your attention goes elsewhere (to the next appointment, to what you plan to cook tonight, to a problem you are wrestling with), know that this is normal. Simply observe that your mind wandered and bring your focus gently back to following your breath. Continue until you have completed five minutes of mindfulness practice.
Many individuals become concerned that their minds continue to wander throughout the five minutes of mindfulness practice. This difficulty of focus is normal and expected. Consider how alien this practice seems after going through the rest of your experience juggling topics through your attention.
DBT mindfulness practice is ideally completed daily for 20-30 minutes. In the beginning, new clients will practice mindfulness for 5 minute periods. Building up to 20-30 minutes will take time. The first-week individuals are encouraged to practice for 5 minute periods, increasing at the beginning of the second week by a minute every day, until they are at their goal of either 20 or thirty minutes. This will take longer if the practice is inconsistent. Track progress in a notebook that will be used specifically for the purpose of mindfulness. Note issues such as distraction, consistency, thoughts, and feelings experienced during mindfulness. Do this in order to review and discuss with your therapist in an individual session or skills class.