Mindfulness
Mindfulness skills are central to DBT (hence the label “core” mindfulness skills for the first group of skills described below). The core skills are the first skills taught, and they underpin and support all of the other DBT skills. They are reviewed at the beginning of each of the other three skill modules and are the only skills highlighted throughout the entire treatment. DBT mindfulness skills are psychological and behavioral translations of meditation practices from Eastern spiritual training. Mindfulness skills are as essential for therapists and skills trainers to practice as they are for participants. Indeed, clinicians’ practice of mindfulness has been found to be associated with a better therapeutic course and better outcomes (Grepmair, et al. 2007). Thus mindfulness practice is ordinarily the first agenda item in DBT treatment team meetings.
Mindfulness has to do with the quality of awareness or the quality of presence that a person brings to everyday living. It’s a way of living awake, with eyes wide open. As a set of skills, mindfulness practice is the intentional process of observing, describing, and participating in reality nonjudgmentally, in the moment, and with effectiveness (i.e., using skillful means). In formulating these skills, they are drawn most heavily from the practice of Zen. But the skills are compatible with Western contemplative and other Eastern meditation practices, as well as with emerging scientific knowledge about the benefits of “allowing” experiences rather than suppressing, avoiding, or trying to change them. Both Eastern and Western psychologies, as well as spiritual practices, are converging on the same insights.
Mindfulness practice per se was and is central to contemplative spiritual practices across denominations and beliefs, and the mindfulness practices included here may be incorporated into any individual’s spiritual practices and beliefs. DBT, however, is specifically designed to be nondenominational (i.e., compatible with an array of beliefs and traditions), and thus practices are purposely provided in a secular format. No spiritual or religious convictions are expected or necessary for practicing and mastering these skills.
The mindfulness skills can also be thought of as the components that together make up the foundation for meditation practices taught in many psychological and stress reduction treatment packages:
- Mindfulness Based Cognitive Therapy (Segal, Williams, & Teasdale, 2013)
- Mindfulness Based Relapse Prevention (Bowen, Chawla, & Marlatt, 2011)
- Mindfulness Based Stress Reduction (Kabat-Zinn, 1990)
- Internal Family Systems Therapy (Schwartz, 2001)
- Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 2011)
In some ways, the mindfulness skills in DBT can be thought of as skills for beginners in mindfulness—that is, skills for individuals who cannot yet regulate themselves well enough to practice formal mindfulness meditation. They can also be thought of as skills for persons advanced in mindfulness—the skills such persons need to practice in everyday life. In this sense, these skills are the application of mindfulness meditation to everyday life.
What is Mindfulness?
“Mindfulness” is the act of consciously focusing the mind in the present moment without judgment and without attachment to the moment. When mindful, we are aware in and of the present moment. We can contrast mindfulness with automatic, habitual, or rote behavior and activity. When mindful, we are alert and awake, like a sentry guarding a gate. We can contrast mindfulness with rigidly clinging to the present moment, as if we could keep a present moment from changing if we cling hard enough. When mindful, we are open to the fluidity of each moment as it arises and falls away. In “beginner’s mind,” each moment is a new beginning, a new and unique moment in time. We can contrast mindfulness with rejecting, suppressing, blocking, or avoiding the present moment, as if “out of mind” really did mean “out of existence” and “out of influence” upon us. When mindful, we enter into each moment.
“Mindfulness practice” is the repeated effort of bringing the mind back to awareness of the present moment, without judgment and without attachment; it includes, therefore, the repeated effort of letting go of judgments and letting go of attachment to current thoughts, emotions, sensations, activities, events, or life situations. In sum, mindfulness is a practice of entering into the current moment without reserve or grudge, entering into the cosmic process of existence with awareness that life is a process of constant change. Mindfulness practice teaches us to move into the moment and become aware of everything in it, functioning from there.
“Mindfulness everyday” is a way of living. It’s a way of living with our eyes wide open. It is very difficult to accept reality with our eyes closed. If we want to accept what’s happening to us, we have to know what’s happening to us. We have to open up our eyes and look. Now a lot of people say, “I keep my eyes open all the time.” But if we look at them, we’ll see that they are not looking at the moment. They’re looking to their past. They’re looking to their future. They’re looking to their worries. They’re looking to their thoughts. They’re looking to everybody else. They’re looking absolutely everywhere else, except at the moment. Mindfulness as a practice is the practice of directing our attention to only one thing. And that one thing is the moment we are alive. The very moment we are in.
The beauty of mindfulness is that if we look at the moment, just this moment, we will discover that we are looking at the universe. And if we can become one with the moment—just this moment—the moment cracks open, and we are shocked that joy is in the moment. Strength to bear the suffering of our lives is also in the moment. It’s just about practice. It’s not a type of practice where listening to it just once and going through it just once gets us there. Mindfulness is not a place we get to. Mindfulness is a place we are. It is the going from and coming back to mindfulness that is the practice. It’s just this breath, just this step, just this struggle. Mindfulness is just where we are now, with our eyes wide open, aware, awake, attentive. It can be extremely difficult. Things may come up that are difficult to bear. If that happens, we can step back, notice, let go. This moment will pass. Difficulty may come up again. It may be difficult again. We can look at it, let it go, let it pass. If it becomes too difficult at some moment, we can just gently stop. We can come another day, wait, and listen again.
“Meditation” is the practice of mindfulness while sitting or standing quietly for a period of time. Meditation is sometimes mistakenly thought to be the core of mindfulness. However, it is important not to confuse meditation and mindfulness. Although meditation implies mindfulness, the reverse is not necessarily so: Mindfulness does not require meditation. This distinction is very important. Although everyone can practice mindfulness, not everyone can practice meditation. Some cannot sit or stand still. Some are too terrified to look at their breath or watch their mind. Some cannot practice meditation now, but will be able to at a later point.
“Mindful meditation” is the activity of attending to, gazing, watching, or contemplating something. In Zen, for example, one is often given the instruction “Watch your mind.” In other spiritual practices, one may be given words, texts, or objects to focus the mind on. In an art gallery, one stands or sits and gazes at artistic works. We attend to the chirp of the birds or the car engine sounding different than before. We watch the sun set and gaze at children frolicking in the park. Each of these is mindful activity. Although the term “meditation” is sometimes used to refer to thinking about something as in connection to the universe or the miracle of life, the more common understanding in secular circles is that of mindfulness. Just as common is the understanding that when one meditates, one is (usually) sitting quietly and is focusing on one’s breath, one’s bodily sensation, a word, or some other focus dictated by one’s individual practice or tradition.
Meditation as a contemplative or mindfulness practice is both a secular practice, as in meditating on or contemplating art, and a religious or spiritual practice, as in contemplative prayer. Indeed, in all the major religions of the world, there is a tradition—however broad or narrow—of contemplative practice. This tradition within religions, often referred to as the “mystical” tradition, recommends mindfulness practices of various sorts and emphasizes spiritual experiences that may result from these practices. Whether mindful meditation and practice are secular or spiritual depends completely on the orientation and beliefs of the individual. For the spiritual person, mindfulness can be both a secular and a spiritual or religious practice.
In meditation and in mindfulness, there are two types of practices: “opening the mind” and “focusing the mind.” Opening the mind is the practice of observing or watching whatever comes into awareness. In sitting meditation, it is simply noticing thoughts, emotions, and sensations that enter awareness without holding onto or pursuing them. It is like sitting and watching a conveyor belt going by—noticing what is going by on the conveyor belt, but not shutting off the belt to examine objects more closely. It is like sitting on a hill watching a harbor and noticing the boats entering and leaving without jumping onto one of the boats. For beginners or for persons with attention difficulties, opening the mind can be very difficult, because it is so easy to get caught up in a passing thought, emotion, or sensation and to lose the focus on awareness. For these individuals, focusing the mind is usually recommended.
When focusing the mind, one focuses attention on specific internal or external events. For example, when focusing on internal events, one might focus attention on a specific sensation succession (a series of sensations), emotions arising, thoughts going through the mind, or repeated words or phrases that have been decided before. For example, some schools of meditation give out mantras, or specific words to say with each breath. One instance of this is the “wise mind” practice (described below) of saying the word “wise” while breathing in and the word “mind” while breathing out. Another example is counting breaths (up to 10 and then starting over), which is a typical instruction in Zen. Guided mindfulness exercises given by clinicians or via meditation recordings give instructions of where and how to focus the mind. When focusing the mind externally one might focus on a leaf, a painting, a candle, another person or persons, or scenery, as in a walk in nature, a sunrise or sunset, and so forth.
There are also two stances one can take in practicing: either getting distance by pulling back and watching, or moving forward and becoming “what is” (by moving into what is being watched). Contrasts of these stances, stated in metaphorical language, are standing on a high mountain and picturing one’s emotions as boulders far down below versus entering fully into the experience of one’s emotions; sitting on the edge and watching the emptiness within oneself versus entering into and becoming the emptiness; noticing self-consciousness at a party versus throwing oneself completely into a party; and watching one’s own sexual responses versus entering entirely into one’s own sexual response.
Core Mindfulness Skills
States of Mind and the Mindfulness “Wise Mind” Skill
In DBT, three primary states of mind are presented: “reasonable mind,” “emotion mind,” and “wise mind.” A person is experiencing and using reasonable mind when he or she is approaching knowledge intellectually; is thinking rationally and logically; attends only to empirical facts; and ignores emotion, empathy, love, or hate in favor of being planful, practical, and “cool” in approaching problems. Decisions and actions are controlled by logic.
A person is experiencing and using emotion mind when thinking and behavior are controlled primarily by current emotional states. In emotion mind, cognitions are “hot”; reasonable, logical thinking is difficult; facts are amplified or distorted to be congruent with current affect; their reality of what is actually happening is misinterpreted and perceived as a danger or threat; and the energy of behavior is also congruent with the current emotional state.
Wise mind is the synthesis of emotion mind and reasonable mind; it also goes beyond them: Wise mind adds intuitive knowing to emotional experiencing and logical analysis. In Mindfulness-Based Cognitive Therapy, two other states of mind are also discussed: “doing mind” or “doing mode” and “being mind” or “being mode.” (Williams, 2008) Doing mind focuses on getting things done. It is multitasking, task-oriented, and driven. In contrast, being mind is “nothing-to-do” mind, where the focus is on experiencing rather than doing. These two states of mind are relevant to DBT mindfulness skills, because wise mind can also be considered as a synthesis of doing mind and being mind.
Mindfulness skills are the vehicles for balancing emotion mind and reasonable mind, being mind and doing mind, and other extreme sets of mind and action to achieve wise mind and wise action. There are three “what” skills (observing, describing, and participating). There are also three “how” skills (taking a nonjudgmental stance, focusing on one thing in the moment, and being effective).
Mindfulness “What” Skills
The mindfulness “what” skills are about what to do: “observe,” “describe,” and “participate.” The ultimate goal of mindfulness skills practice is to develop a lifestyle of participating with awareness. Participation without awareness is a characteristic of impulsive and mood-dependent behaviors. Generally, paying special attention to observing and describing one’s own behavioral responses is only necessary when one is learning new behaviors, when there is some sort of problem, or when a change is necessary or desirable. Learning to drive a stick-shift car, to dance, and to type are familiar examples of this principle. Consider beginning piano players, who pay close attention to the locations of their hands and fingers, and may either count beats out loud or name the keys and chords they are playing. As skill improves, however, such observing and describing cease. But if a habitual mistake is made after a piece is learned, a player may have to revert to observing and describing until a new pattern has been learned. This same deliberate reprogramming is necessary for changing impulsive or mood-dependent behavior patterns. Observing ourselves with curiosity and openness to what we will find can also, in time, lead to greater understanding and clarity about who we are. We find our “true selves” only by observing ourselves.
Observing
The first “what” skill is observing—that is, attending to events, emotions, and other behavioral responses, without necessarily trying to terminate them when they are painful or prolong them when they are pleasant. What you will learn from practicing this skill is to allow yourself to experience with awareness, in the moment, whatever is happening—rather than leaving a situation or trying to terminate an emotion. Generally, the ability to attend to events requires a corresponding ability to step back from the event. Observing walking and walking are two different activities; observing thinking and thinking are two different activities; and observing one’s own heartbeat and the heart’s beating are two different activities. This focus on “experiencing the moment” is based on Eastern psychological approaches, as well as on Western notions of nonreinforced exposure as a method of extinguishing automatic avoidance and fear responses.
Describing
A second mindfulness “what” skill is that of describing events and personal responses in words. The ability to apply verbal labels to behavioral and environmental events is essential for both communication and self-control. Learning to describe requires that a person learn not to take emotions and thoughts as accurate and exact reflections of environmental events. For example, feeling afraid does not necessarily mean that a situation is threatening to life or welfare. Many people confuse emotional responses with precipitating events. Physical components of fear (“I feel my stomach muscles tightening, my throat constricting”) may be confused in the context of a particular event (“I am starting an exam in school”) to produce a dysfunctional thought (“I am going to fail the exam”), which is then responded to as a fact. Thoughts (“I feel unloved” or “I don’t believe anyone loves me”) are often confused with facts (“I am unloved”).
Participating
The third mindfulness “what” skill is the ability to participate without self-consciousness. A person who is participating is entering completely into the activities of the current moment, without separating him- or herself from ongoing events and interactions. The quality of action is spontaneous; the interaction between the individual and the environment is smooth and based in some part on habit. Participating can, of course, be mindless. We have all had the experience of driving a complicated route home as we concentrated on something else, and arriving home without any awareness of how we got there. But it can also be mindful. A good example of mindful participating is that of the skillful athlete who responds flexibly but smoothly to the demands of the task with alertness and awareness, but not with self-consciousness. Mindlessness is participating without attention to the task; mindfulness is participating with attention.
Mindfulness “How” Skills
The other three mindfulness skills are about how one observes, describes, and participates; they include taking a nonjudgmental stance (“nonjudgmentally”), focusing on one thing in the moment (“one-mindfully”), and doing what works (“effectively”).
Nonjudgmentally
Taking a nonjudgmental stance means just that—taking a nonevaluative approach, not judging something as good or bad. It does not mean going from a negative judgment to a positive judgment. Although individuals often judge both themselves and others in either excessively positive terms (idealization) or excessively negative terms (devaluation), the position here is not that they should be more balanced in their judgments, but rather that judging should in most instances be dropped altogether. This is a very subtle point, but a very important one. The problem with judging is that, for instance, a person who can be “worthwhile” can always become “worthless.” Instead of judging, DBT stresses the consequences of behavior and events.
For example, a person’s behavior may lead to painful consequences for self or others, or the outcome of events may be destructive. A nonjudgmental approach observes these consequences, and may suggest changing the behaviors or events, but would not necessarily add a label of “bad” to them. DBT also stresses accurate discrimination of one thing from another and description of what is observed. In discriminating, one determines whether a behavior meets a required definition or not. For example, a lawyer or judge can discriminate whether a certain behavior breaks the law or not. A diving judge can discriminate whether a diver’s form matches the required form for the dive or not. Behavior may not be good or bad, but it can meet criteria for being against the law or for fitting the ideal model for a particular dive.
One-Mindfully
Mindfulness in its totality has to do with the quality of awareness that a person brings to activities. The second “how” skill (Section VIII) is to focus the mind and awareness in the current moment’s activity, rather than splitting attention among several activities or between a current activity and thinking about something else. Achieving such a focus requires control of attention—a capability that many individuals lack.
Often participants are distracted by thoughts and images of the past, worries about the future, ruminative thoughts about troubles, or current negative moods. They are sometimes unable to put their troubles away and focus attention on the task at hand. When they do become involved in a task, their attention is often divided. This problem is readily observable in their difficulties in attending to skills training sessions. The participants need to learn how to focus their attention on one task or activity at a time, engaging in it with alertness, awareness, and wakefulness.
Effectively
The third “how” skill, being effective, is directed at reducing the participants’ tendency to be more concerned with being “right” than with what is actually needed or called for in a particular situation. Effectiveness is the opposite of “cutting off your nose to spite your face.” As our participants often say, it is “playing the game” or “doing what works.” From an Eastern meditation perspective, focusing on effectiveness is “using skillful means.” The inability to let go of “being right” in favor of achieving goals is often related to experiences with invalidating environments.
A central issue for people who have been frequently invalidated is whether they can indeed trust their own perceptions, judgments, and decisions—that is, whether they can expect their own actions to be correct or “right.” However, taken to an extreme, an emphasis on principle over outcome can often result in these individuals’ being disappointed or alienating others. In the end, everyone has to “give in” some of the time. People often find it much easier to give up being right for being effective when it is viewed as a skillful response rather than as a “giving in.”
Other Perspectives on Mindfulness
Three sets of supplementary mindfulness skills are included: mindfulness practice from a spiritual perspective; skillful means: integrating doing mind and being mind; and wise mind: walking the middle path. These skills add to and expand the core mindfulness skills described above, and each can be aligned with a spiritual perspective to a greater or lesser degree. They can be integrated into learning the core skills, can be learned in an advanced skills course, or can be used in individual psychotherapy settings as needed and as appropriate.
Mindfulness Practice: A Spiritual Perspective
The focus on mindfulness from a spiritual perspective is included for a number of reasons. The practice of mindfulness itself has its origins in age-old spiritual practices. For many individuals, spirituality and religious practices are very important in their lives. Such practices can be important sources of strength and can also provide coping resources in difficult moments. Religious affiliation, in addition, can provide a community that often furnishes important spiritual and interpersonal support. Leaving out a recognition—and, indeed, a recruiting—of spirituality as a source of strength and sustenance when we discuss mindfulness practices, particularly mindful meditation, runs the risk of ignoring the spiritual diversity of the populations we treat. Including handouts on mindfulness from a spiritual perspective provides an avenue for helping clients strengthen their own spirituality and integrate it into their practices of mindfulness.
In contrast to the psychological goals of mindfulness, the goals of mindfulness from a spiritual perspective include experiencing ultimate reality as it is (something that is defined differently across cultures and religious practices), cultivating wisdom, letting go of attachments and radically accepting reality as it is, and increasing love and compassion toward self and others. For many, the practice of mindfulness also includes reflectiveness and the cultivation of ethical qualities. It is important here to keep in mind that spirituality and religion are two different things.
Although there are many definitions of spirituality, a working definition from Miller, W. R., & Martin, J. E. (1988) is that it can be viewed as the “acknowledgment of a transcendent being, power, or reality greater than ourselves.” (p 14) In particular, from this perspective, spirituality is a quality of the individual that has to do with regard for the spiritual, transcendent, or nonmaterial. As a practice, spirituality focuses on beliefs that in the universe “there is more than meets the eye”; that is, reality is not limited to what we can know via the material and sensory world. A spiritual perspective on mindfulness is designed to include every person. It is important here to recognize that spirituality can cover a vast terrain—from the community as a higher power (as is often said in 12-step groups), to humanistic views, mystical experience, religious practices, and (in DBT) wise mind.
Whereas spirituality is a quality of the individual, a religion is an organized community of individuals. Religions focus on beliefs, rituals, and practices oriented to bringing individuals within the community into closer relationship with the transcendent. Both spirituality and religion emphasize values and moral actions, and both can provide meaning, purpose, and hope to life. In particular, both can create meaning for those living lives of intense suffering. Purpose and hope can be extremely important in finding a way to build a life experienced as worth living.
Wise Mind from a Spiritual Perspective; Loving Kindness
Wise mind from a spiritual perspective outlines different types of spiritual practices, as well as providing a list (see Mindfulness Handout 7a) of some of the many names and terms used with reference to the transcendent. It also provides a description of the experience of wise mind from this perspective. Many spiritual and religious practices share elements with mindfulness practices, including silence, quieting the mind, attentiveness, inwardness, and receptivity. These are characteristics of deep spiritual experiences. Many individuals have such experiences without any realization of their importance or validity. This handout helps both clients and clinicians understand such experiences. The emphasis across spiritual paths on love and compassion for even enemies is captured here in the mindfulness practice of loving kindness. Although written as a practice of wishing self and others well, it can also be practiced as brief prayers for the welfare of self and others.
How I Will Discuss Spirituality with You
- I won’t hesitate to ask you whether you are spiritual. If I need to define what I mean, it simply is the belief that “there is more to reality than what we can know through our senses.” If you are spiritual, I will also be curious, do you believe in God, a higher power, or the like.
- I will respect your religion, spirituality, or its absence, but it is also important that I set the tone in such a way that you will always expect me to act in a respectful manner.
- I will do no harm. I will not impose my own spirituality, which happens to be learning Buddhism and practicing Scientific Skepticism.
- I endeavor to find a path to understanding and a language for spirituality that can be translated in multiple ways. Throughout this website and the many course lessons, there are multiple ways to talk about various topics related to spirituality. We can also try to pick up on the language used by each other.
Skillful Means: Balancing Doing Mind and Being Mind
Among the growing number of treatments combining mindfulness meditation and yoga practice with behavioral interventions are Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction, (Kabat-Zinn, Lipworth, & Burney, 1985) as well as Mindfulness-Based Cognitive Therapy (Segal, Williams, & Teasdale, 2013) and Mindfulness- Based Relapse Prevention. (Bowen, Chawla, & Marlatt, 2011) The latter two are also based on the work of Kabat-Zinn (1990). These treatments stress the differences between “doing mode” and “being mode.” To bring these ideas into the fold of DBT, the skill of skillful means has been added, and a handout focusing on the synthesis of these two concepts and titled Skillful Means: Balancing Doing Mind and Being Mind (Mindfulness Handout 9).
Doing mind focuses on achieving goals; being mind focuses on present experiencing. Put another way, doing mind is “something to-do” mind, and being mind is “nothing to-do” mind. From a spiritual point of view, the difference between Martha and Mary in the Biblical story is that Martha was distracted by preparing what was needed for Jesus when he was visiting them, and Mary chose the “better part” by sitting at his feet and listening. (Luke 10:38–42) Being mind is the contemplative life path, and doing mind is the active life path. (For more on this topic, put the term “contemplative vs. active life” into your search engine.) The polarity between them is similar to that between reasonable and emotion mind. Wise mind brings the two into a synthesis. Without aspects of both being mind and doing mind, it is difficult if not impossible to lead a balanced life.
Wise Mind: Walking the Middle Path
“Walking the middle path” is living life between the extremes, or finding the synthesis between the extremes. This skill is, to a degree, a summary of previous skills with a few additions. The idea here is that mindfulness brings together opposites, finding the truth in alternate and opposite sides. As discussed previously, mindfulness skills focus on the synthesis of reasonable mind and emotion mind, as well as between doing mind and being mind. From a spiritual perspective, mindfulness skills bring together the material and the mystical—form and emptiness as one. (For a discussion of mysticism, see Mysticism: Its History and Challenge by Bruno Borchert (1994) The two new oppositions have to do with finding the synthesis between acceptance on the one side and change on the other. In the first dichotomy, the main focus is on recognizing that one can give up attachments, as in radical acceptance of the moment, without at the same time suppressing the desire for change. The paradoxical point is that the very effort to reduce desire is itself a failure to radically accept desire.
The supplementary skills include walking the middle path in the context of interpersonal relationships, with a particular emphasis on parent–teen relations. From a spiritual perspective, the middle path brings together the material and the mystical, form and emptiness, wise mind and the cloud of unknowing. (Johnston, 2005); (Stapp, 2007); (Miller, 1958) It is represented in the skills of replacing self-denial and asceticism with moderation, and replacing self-indulgence and hedonism with just enough satisfaction of the senses.
References:
Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76(6), 332–338.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press.
Bowen, S., Chawla, N., & Marlatt, G. A. (2011). Mindfulness-based relapse prevention for addictive behaviors: A clinician’s guide. New York: Guilford Press.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte.
Schwartz, R. C. (2001). Introduction to the internal family systems model. Trailheads publications.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.
Williams, J. M. G. (2008). Mindfulness, depression and modes of mind. Cognitive Therapy and Research, 32(6), 721–733.
Miller, W. R., & Martin, J. E. (1988). Spirituality and behavioral psychology: Toward integration. In W. R. Miller & J. E. Martin (Eds.), Behavior therapy and religion (pp. 13–24). Newbury Park, CA: Sage.
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.
Luke 10:38–42. (Any version of the Bible; see, e.g., www.devotions.net/bible/00bible.htm)
Borchert, B. (1994). Mysticism: Its history and challenge. York Beach, ME: Samuel Weiser.
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the
self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.
Luke 10:38–42. (Any version of the Bible; see, e.g., www.devotions.net/bible/00bible.htm)
Borchert, B. (1994). Mysticism: Its history and challenge. York Beach, ME: Samuel Weiser.
Johnston, W. (2005). The cloud of unknowing and The book of privy counseling. New York: Doubleday.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., et al. (2007). A randomized controlled
trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of
mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21.
Broderick, P. C. (2005). Mindfulness and coping with dysphoric mood: Contrasts with rumination and distraction. Cognitive Therapy and Research, 29(5), 501–510.
Davidson, R. J. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564–570.
Gross, C. R., Kreitzer, M. J., Reilly-Spong, M., Winbush, N. Y., Schomaker, E. K., & Thomas, W. (2009). Mindfulness meditation training to reduce symptom distress in transplant patients: Rationale, design, and experience with a recycled waitlist. Clinical Trials, 6(1), 76–89.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943.
Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62(5), 613–622.
Chiesa, A., & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: A systematic review of the evidence. Journal of Alternative and Complementary Medicine, 17(1), 83–93.
Pradhan, E. K., Baumgarten, M., Langenberg, P., Handwerger, B., Gilpin, A. K., Magyari, T., et al. (2007). Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis and Rheumatism, 57(7), 1134–1142.
Sephton, S. E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., et al. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis and Rheumatism, 57(1), 77–85.
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley, T. G., et al. (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60(5), 625–632.
Creswell, J. D., Myers, H. F., Cole, S. W., & Irwin, M. R. (2009). Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: A small randomized controlled trial. Brain, Behavior, and Immunity, 23(2), 184–188.
Tang, Y. Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., et al. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences USA, 104, 17152–17156.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York: Guilford Press.
Hayes, S. C., & Melancon, S. M. (1989). Comprehensive distancing, paradox, and the treatment of emotional avoidance. In L. M. Ascher (Ed.), Therapeutic paradox (pp. 184–218). New York: Guilford Press.
Fischer, N. (2008). Mindfulness. Lecture presented at the Benedicktushof, Holzkirchen, Germany.
Giuliano, R. J., & Wicha, N. Y. Y. (2010). Why the white bear is still there: Electrophysiological evidence for ironic semantic activation during thought suppression. Brain Research, 1316, 62–74.
Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53(1), 5–13.
Stapp, H. P. (2007). Mindful universe: Quantum mechanics and the participating observer. New York: Springer.
Walsh, J. (Ed.). (1981). The cloud of unknowing. New York: Paulist Press.
Jager, W. (1994). Contemplation: A Christian path. Ligori, MO: Triumph Books.
Keating, T. (n.d.). The method of centering prayer. Available from www.cpt.org/files/WS-Centering Prayer.pdf
Deikman, A. J. (1982). The observing self: Mysticism and psychotherapy. Boston: Beacon Press.
Polanyi, M. (1958). Personal knowledge. Chicago: University of Chicago Press.
May, G. G. (1982). Will and spirit: A contemplative psychology. San Francisco: Harper & Row.
Senay, I., Albarracin, D., & Noguchi, K. (2010). Motivating goal-directed behavior through introspective self-talk: The role of the interrogative form of simple future tense. Psychological Science, 21(4), 499–504.
Butryn, M. L., Phelan, S., Hill, J. O., & Wing, R. R. (2007). Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity, 15(12), 3091–3096.
Nelson, R. O., & Hayes, S. C. (1981). Theoretical explanations for reactivity in self-monitoring. Behavior Modification, 5(1), 3–14.
Krishnamurti, J. (1991). The collected works of J. Krishnamurti: Vol. 5. 1948–1949, Choiceless awareness. Dubuque, IA: Kendall/Hunt.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.
Wegner, D. M., & Erber, R. (1992). The hyperaccessibility of suppressed thoughts. Journal of Personality and Social Psychology, 63(6), 903–912.
Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35(4), 747–766.
Roemer, L., & Borkovec, T. D. (1994). Effects of suppressing thoughts about emotional material. Journal of Abnormal Psychology, 103(3), 467–474.
Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25–39.
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.
Cioffi, D. (1993). Sensate body, directive mind: Physical sensations and mental control. In D. Wegner & J. W. Pennebaker (Eds.), Handbook of mental control (pp. 410–442). Englewood Cliffs, NJ: Prentice-Hall.
Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428.
Csikszentmihalyi, M. (1997). Finding flow: The psychology of engagement with everyday life. New York: Basic Books.
Beatrice Grimm taught me these dances at Benedicktushof in Germany.
Besser, B. (n.d.). Shepherd’s dance. On More beginner’s dances [CD]. (Available from Barbara Besser, Nienberger Kirchplatz 1, D-4861 Munster, Germany)
Based on Bays, J. C. (2011). How to train a wild elephant and other adventures in mindfulness. Boston: Shambhala.
Schneider, P. (2005). The patience of ordinary things. In Another river: New and selected poems. Amherst, MA: Amherst Writers and Artists Press.
Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy, 28(2), 153–158.
Rubinstein, J. S., Meyer, D. E., & Evans, J. E. (2001). Executive control of cognitive processes in task switching. Journal of Experimental Psychology: Human Perception and Performance, 27(4), 763–797.
Jackson, M. (2004). Pressured to multitask, workers juggle a fragmented existence. Health, 10, 26.
Healy, M. (2004). We’re all multitasking, but what’s the cost? Los Angeles Times. Retrieved from www.umich.edu/~bcalab/articles/LATimesMultitasking2004.pdf
Henig, R. M. (2005). Driving? Maybe you shouldn’t be reading this. The New York Times. Retrieved from www.umich.edu/~bcalab/articles/NYTimes-Multitasking2004.pdf
Rubinstein, J., Meyer, D., & Evans, J. E. (2001). Is multitasking more efficient?: Shifting mental gears costs time, especially when shifting to less familiar tasks. Retrieved from www.apa.org/news/press/releases/2001/08/multitasking.aspx
Cable News Network. (2001, August 5). CNN Tonight: Multitasking has problems, study finds. Retrieved from www.umich.edu/~bcalab/articles/CNNTranscript2001.html
Anderson, P. (2001, December 6). Study: Multitasking is counterproductive. Retrieved from www.umich.edu/~bcalab/articles/CNNArticle2001.pdf
McClure, E. B., Treland, J. E., Snow, J., Schmajuk, M., Dickstein, D. P., Towbin, K. E., et al. (2005). Deficits in social cognition and response flexibility in pediatric bipolar disorder. American Journal of Psychiatry, 162(9), 1644–1651.
Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible. Psychological Science, 15(7), 482–487.
Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299.
Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243–1254.
Lester, N., Smart, L., & Baum, A. (1994). Measuring coping flexibility. Psychology and Health, 9(6), 409–424.
Cheng, C. (2001). Assessing coping flexibility in real-life and laboratory settings: A multimethod approach. Journal of Personality and Social Psychology, 80(5), 814–833.
Byron, G. G. (1979). Childe Harold’s pilgrimage. In M. H. Abrams (General Ed.), The Norton anthology of English literature (4th ed., Vol. 2, pp. 518–541). New York: Norton. (Original work published 1812–1818)
Miller, H. (1958). The smile at the foot of the ladder. New York: New Directions.
Spretnak, C. (n.d.). Retrieved from www.famousquotes.com/author/spretnak
Butcher, C. A. (Trans.). (2009). The cloud of unknowing with the book of privy counsel: A new translation. Boston: Shambhala.
Teasdale, W. (1999). The mystic heart: Discovering a universal spirituality in the world’s religions. Novato, CA: New World Library.
St. John of the Cross. (1990). Dark night of the soul (E. A. Peers, Ed. & Trans.). New York: Image Books.
Williams, J. E., Paton, C. C., Siegler, I. C., Eigenbrodt, M. L., Nieto, F. J., & Tyroler, H. A. (2000). Anger proneness predicts coronary heart disease risk: Prospective analysis from the Atherosclerosis Risk In Communities (ARIC) Study. Journal of the American Heart Association, 101(17), 2034–2039.
Markowitz, J. H., Matthews, K. A., Wing, R. R., Kuller, L. H., & Meilahn, E. N. (1991). Psychological, biological and health behavior predictors of blood pressure changes in middle-aged women. Journal of Hypertension, 9, 399–406.
Shapiro, D., Goldstein, I. B., & Jamner, L. D. (1996). Effects of cynical hostility, anger out, anxiety, and defensiveness on ambulatory blood pressure in black and white college students. Psychosomatic Medicine, 58(4), 354–364.
Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5), 1045–1062.
Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8(5), 720–724.
Hofmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review, 31(7), 1126–1132.
Carson, J. W., Keefe, F. J., Lynch, T. R., Carson, K. M., Goli, V., Fras, A. M., et al. (2005). Loving-kindness meditation for chronic low back pain: Results from a pilot trial. Journal of Holistic Nursing, 23, 287–304.
Barnhofer, T., Chittka, T., Nightengale, H., Fisser, C., & Crane, C. (2010). State effects of two forms of meditation on prefrontal EEG asymmetry in previously depressed individuals. Mindfulness, 1, 21–27.
Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of mindful breathing, progressive muscle relaxation, and loving kindness meditation on decentering and negative reactions to repetitive thoughts. Behaviour Research and Therapy, 48(10), 1002–1011.
Williams, J. M. G., Teasdale, J. D., Kabat-Zinn, J., & Segal, Z. V. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press.
Geary, J. (2007). Geary’s guide to the world’s great aphorists. New York: Bloomsbury USA.
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In order to view the material in this section of the course, you must be a current or previous client of James Fitzgerald, MS. The content on this page has been adapted from DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to use the information is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills Training Manual, Second Edition, for personal use and use with individual clients only.
