One of the questions we get a lot is what are some of the specific Dialectical Behaviour Therapy (DBT) techniques that we teach clients? I think this is a great question and one that we can answer through some blog posts, so here’s the first one – I hope you like it!
Mindfulness is the at the core of dialectical behaviour therapy – it’s the foundation, if you will, that everything else is built upon. Mindfulness is the practice of being present in the moment, without judgement and without attachment to it. It sounds simple, but it is often very difficult for us to practice in our daily lives.
What are the goals of mindfulness, with respect to DBT, you might wonder? According to Dr. Marsha Linehan, the goals are threefold:
- Reduce suffering and increase happiness
- Increase control of your mind
- Experience reality as it is
The mindfulness skills learned through engaging in dialectical behaviour therapy help clients create their own mindfulness practice. A mindfulness practice involves incorporating different skills into a routine practice that is woven into our lives as a foundation for doing life. This can involve any or all of the skills, meditation, contemplation, and mindful movement.
There are three core mindfulness skills in dialectical behaviour therapy and I want to introduce one of my favourites because it’s one of the ones I’ve found most helpful: Wise Mind.
The Wild Mind
You won’t find this terminology in any DBT books, but it’s what I call the dance between the two extreme states of our minds: logic vs. emotion. In DBT terms, we’d call the two polar opposites Reasonable Mind and Emotion Mind.
Often, we tend toward one or the other especially when we’re under stress. Those of us who are more naturally prone to logic will rely on this part of our mind to make everything rational, logical, and pragmatic at the cost of ignoring emotional content. Others more naturally drawn to emotion will rely on this part of the mind to make everything about mood, feelings, and impulses to do or say things.
As you can probably tell, both of these approaches are likely to create problems because they focus on one area at the cost of ignoring the other. So, what’s the alternative?
The Wise Mind
The concept of Wise Mind within the framework of mindfulness involves combining the two minds, Reasonable Mind and Emotion Mind into a new framework – Wise Mind. Wise Mind balances the Reasonable Mind and Emotion Mind and allows us to follow a middle path.
Another description of Wise Mind is something we often call wisdom. In this case, it’s the wisdom within each of us that combines both our more rational, reasonable mind with the emotion-focused part to create a full picture. This focus allows us to see, and value both reason and emotion, bringing the left and right brains together as one.
I was just remarking to a client that someone once described wisdom to me this way:
“Knowledge is knowing that a tomato is a fruit. Wisdom is not putting it in a fruit salad.”
Apparently, this quote came from Miles Kingston, a journalist and musician, and what I like is that it helps explain the difference between wisdom and knowledge. In our case, knowledge is what each of our minds is telling us – our reasonable and our emotion mind. Wisdom is knowing how to combine that information and knowing what to do with it – our Wise Mind.
How Can I Get Started Using Wise Mind?
Mindfulness takes practice, as does listening to Wise Mind. Here’s an example exercise that you can try right now to see if you can listen to your inner wisdom using Wise Mind. It’s taken from the Mindfulness Handouts in the DBT Skills Training Manual from Dr. Marsha Linehan:
Asking is this Wise mind?
Breathing in, ask yourself, “Is this (action, thought, plan, etc.) Wise Mind?”
- Breathing out, listen for the answer.
- Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.
- Continue asking on each in-breath for some time. If no answer comes, try again another time.
This may not come naturally to you at first, in fact, it probably won’t. Repeat this exercise and see if you can allow yourself to enter a mindful space where you can notice what your Reasonable Mind and Emotion Mind are telling you, and then listen to your Wise Mind to see how you can trust your inner wisdom and operate out of an effective, mindful place in your decisions.
If you’d like help with this, we’re always happy to help! Please give us a call or contact us for options!
Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
Linehan, M. M. (2015). DBT® skills training handouts and worksheets (2nd ed.). New York, NY, US: Guilford Press.
My Love-Hate Relationship With Mindfulness… and why you should really, really consider practicing it
Mindfulness has been a buzzword in the health community of late. I’m hoping that after reading this, you’ll have a basic idea of what it is and why it helps.
Western culture is full of busy-ness – depression and anxiety are more common than they’ve ever been. Typically, I like to simplify depression and anxiety somewhat, down to past and future. Anxiety is the uneasiness and even fear of some future threat – generally, one that isn’t exactly easy to define. We might be really anxious about an upcoming presentation, but have a harder time nailing down where that comes from – perhaps it might come from baggage that we carry around from some intense public shame that we’ve felt in the past, and the risk of putting ourselves out there again heightens us to a degree that feels like it doesn’t even make sense (our bodies remember shame a lot more acutely than our minds do). Anxiety is often designed to warn us and protect us against the threat of more hurt like this.
Depression, often, is oriented in the reverse direction – maybe our past experiences have coloured our world in a way that joy is difficult to experience, and it’s hard to believe that we will experience anything different going forward. Depression tends to affect the innate and beautiful sense of curiosity and wonder that comes with being a human being (think of a young child you know interacting with the world around them).
Please understand that these are simplistic definitions, designed to give a basic idea of where mindfulness comes in. Often, depression and anxiety can keep our thoughts in the future or past, which is exhausting. Constant worry or feeling down can lead us to do a number of things that are very adaptive and reasonable in the moment (such as distracting ourselves from a painful experience), but they are exhausting in the long run. Mindfulness brings us to the present. It gives our brain a short break from the constant worry and just brings us into right…now. Young children (for example) are generally really good at being present in the moment.
Being mindful can help ease stress
Mindful meditation might involve focusing on our breath, the food we’re eating, the physical sensations in our bodies, or the sounds outside. It is inviting ourselves to experience the present moment for what it is – without judgment. I have a lot of tension on my shoulders, for example. I carry it with me everywhere, and I really hate having it around. But when I’m mindful, I’m not focusing on how much I wish it weren’t there. I’m just noticing it and training myself to be OK with it, just for a minute. Or, I’m noticing the sounds of the traffic outside, and I’m not thinking any thoughts at all – just experiencing the present for whatever it is. This is really hard – especially at first, and even more so when we are experiencing physical or emotional discomfort.
If you’d like to know the why behind things, I’d like to tell you about the work of two people I admire (who are just like you and me, and also happen to have a long list of impressive credentials that I won’t outline here) named Jon Kabat-Zinn and Dan Siegel. They’ve spent a lot of time researching and exploring mindfulness, and their work is very impressive.
Benefits of mindfulness
One of the main things mindfulness does is increase left forebrain function. This increased brain activity fosters that beautiful curiosity I was talking about. If we can notice and be curious when we’re stressed, we’ve already won. We start seeing ourselves from an outside perspective, with more grace and compassion (have you ever wished you could see yourself the way you see somebody you care about?). We can learn to calmly respond to things that otherwise would have sent us into a frenzy.
I could talk forever about this, but I’ll just give you a quick list of the amazing benefits you can find in mindfulness:
- Direct help with physical symptoms such as chronic inflammation and pain
- Reduced anxiety, stress, and depression
- Improved immune system function and mood
- Healthier coping – an increased ability to bounce back after one of the hard experiences that are so common in life
Sounds too good to be true, right? It is sort of. It’s not a pill – it takes the effort to be mindful. I hate it, actually. In many ways being regularly mindful is a primary component of my job, and I still suck at it. But, I’m getting slowly better – then worse – then better again. But even a little bit helps – if you can manage even 20 seconds a day, you will notice a difference.
If you want to read more about this, the works of Jon Kabat-Zinn and Dan Siegel are a great place to start. Jon Kabat-Zinn has a website and a variety of videos on YouTube that are really interesting. I’ve provided a few links below to get you started.
If you want to get started with a mindfulness practice of your own, there are quite literally endless free resources online in both video and audio format, but I recommend the Headspace app. It teaches you the basics and gives you easy, situation-specific guided meditations.
If you want more information on how to actually do the thing, here’s a Harvard blog that covers the basics pretty well:
Here’s Jon Kabat-Zinn on making what you already do in the morning into a mindful practice (this way, you don’t even need to learn to do anything new!):
Lastly, if you want to fact check my claims, I have a resource list of academic papers I’d be happy to share with you. Here’s one I really like (you may need access to an academic database to read it):
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., . . . Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570.
I hope this has been helpful for you. Sometimes we love what helps, sometimes it’s aggravating; one thing is for sure – mindfulness helps us keep calm, be present, and cope. If I, or anyone else on the team at Alongside You can be helpful in working through this with you, please contact us and give us a call.
What is chronic pain?
Most of us have felt physical pain before: we’ve pulled a muscle, had a headache or bumped our funny bone (which really isn’t very funny at all!). The pain we experience is our body telling us something is wrong and after a period of rest and healing (up to three months), we can typically go back to normal activities. Chronic pain is when our brain is in an ongoing state pain and heightened sensitivity that persists longer than 3-6 months. Despite common understandings of pain as being a purely physical reaction, pain is actually directly linked to our brain and nervous system. This video highlights the complexities of our brain and nervous system and identifies the ways in which medication, exercise, diet, medical procedures and emotional processing can help retrain the brain and improve the quality of life for those who suffer from chronic pain.
Whether persistent pain takes the form of back pain, migraines, arthritis, fibromyalgia, endometriosis, lupus, other invisible illnesses, the chronic pain experience affects the body, mind, and soul. While each person’s experience with pain is different, there is a range of common threads:
- Everyone has their own definition of a good day and a bad day. Simple tasks may be manageable one day and not the other.
- In order to “self-manage” daily symptoms, there is a constant need to balance or carefully plan periods of rest, work, exercise, social activities, diet, sleep, and spiritual connectedness.
- It is challenging to talk to family and friends about our pain. The impact on family and friends can be devastating as roles, expectations, and relationships change because of the pain.
- Pain is challenging to treat. The constant rotation of medical appointments, medications and medical procedures can be exhausting and what may work for one person, may not for another.
- Chronic pain goes hand-in-hand with mental health and evokes strong emotions as attempts are made to cope with a loss of purpose, former abilities and relationships.
How can we tackle chronic pain?
The chronic pain experience is riddled with complexities; it has both physiological and psychological components, making a holistic approach in tackling chronic pain the most effective way to approach treatment planning. This video highlights the importance of a multi-disciplinary approach. As a result, we need to find ways to reboot our nervous system, learn productive skills to manage our symptoms, help educate others on chronic pain experiences, and strive to have a better quality of life.
HOW MINDFULNESS-BASED ART ACTIVITIES CAN HELP PEOPLE WITH CHRONIC PAIN
“Art gives a face to the ambiguity of chronic pain …
it gives a visual expression to something that is often elusive.”
–Dr. Steve Feinberg, American Chronic Pain Association
What are the overall health benefits of making art?
Using art for its health benefits is widely becoming a critical component of healthcare. Art helps us explore, practice and develop our creativity as a means to promote health and well-being. Making art has several benefits in key areas:
- Mental Health: Making art reduces stress, protects against depression and anxiety, can improve self-confidence[i] and encourages positive self-care. Doing something creative in a supportive and safe environment encourages experimentation and risk-taking, two essential qualities of the art-making process.[ii]
- Social Health: Those that participate in creative activities are more likely to have wider social networks with people from different backgrounds, have a sense of belonging, and are less likely to be socially isolated and lonely.
- Brain Health: Art making is an effective preventative tool in managing symptoms of diseases such as Dementia, Alzheimer’s disease, and other chronic conditions. It also improves memory processing, problem solving, and helps to maintain neuro-spatial functions as we age.
- Emotional Health: Creative engagement can provide a healthy outlet or path to healing for those who have suffered trauma, abuse, or significant life changes. Doing something creative can act as a distraction tool and is another way to preserve self-identity and move forward.
Using Mindfulness-Based Art Therapy (MBAT) techniques to tackle chronic conditions
According to Jon Kabat-Zinn, a leading researcher on mindfulness-based programs, mindfulness is, “the ability to become fully present in this moment, in a particular way, with a non-judgmental attitude.” [iii] Combining mindfulness skills while making art can be an effective way to manage symptoms of depression and anxiety, improve pain tolerance, and elevate the quality of life of people with chronic pain [iv] [v] and illness,[vi] including those with arthritis[vii], Dementia and Alzheimer’s disease[viii], and cancer.[ix]
Why does MBAT work for chronic pain management?
Mindfulness is a frame of mind; a decision is made to intentionally pay attention to the present moment when doing an activity. It is an effective way for the brain to concentrate on surrounding senses other than the pain itself. It involves resting the physical body (doing body scans) and the psychological mind. Art therapist and facilitator Margaret Jones Callahan describes mindfulness-based art therapy (MBAT) as the “appreciative inquiry mindfully applied to the empty page or the open space. The practice of holding one’s awake attention fully in the present moment, non-judgmentally, while in the act of creating and expressing,[x] acknowledges the presence of pain and helps to get through it, moment by moment. While mindfulness is the lens in which to approach a particular moment, making art is the vehicle with which you experience it. Mindfulness-based art therapy:
- Promotes both the healing and rehabilitation process and is a way for chronic pain sufferers to “’lose themselves’ in the moment,”[xi] (also known as “being in the flow”) giving the nervous system a break.
- Provides temporary respite from physical symptoms of pain (headache, nausea)
- Is an effective method of distraction and promotes positive self-management skills to filter emotions and is a way to express suffering.
- Can build social alliances, companionship, and social affirmation, creating a wider support system with family, friends, and peers. Making art with others lends another way to talk about or communicate with others about pain experiences.
- Allows space to be self-reflective and helps monitor growth and progress in a visual manor.
- Affirms a sense of control over surroundings in the decision-making process of selecting colour, shape, and images.
At its core, MBAT, strives to create a peaceful environment where one can be completely absorbed in the moment while immersed in the process of creation. Along with healthy changes to our diet, sleep, and exercise regimes and with attentiveness on empathy, intentionally putting time aside to do something creative (read, write, paint, knit, sing, do yoga[xii], or dance) can help lower stress levels, give our nervous system a rest, and helps to promote self-care habits. By using a variety of creative processes, health difficulties can be better expressed, understood, accepted, and transformed.[xiii]
If you’d like to experience how MBAT can help you manage your chronic condition, please feel free to give me a call, or email, or come to our Open Studio Sessions where we go through many of these techniques! Give art a try!
[i] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.
[ii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 41. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.
[iii] Jon Kabat-Zinn. http://www.mindfulnesscds.com
[v] Kabat-Zinn, J., Lipworth, L. & Burney, R. J The clinical use of mindfulness meditation for the self-regulation of chronic pain. Behav Med (1985) 8: 163.
[vi] “The Art of Pain Management.” American Chronic Pain Association: https://theacpa.org/uploads/Art_and_Music_final.pdf
[vii] Reynolds, Frances and Sara Prior. Strategies of Adapting and Replacing Artistic Leisure Occupations to Maintain Participation and Identity: A Qualitative Study of Women with Arthritis. Journal of Activities and Adaption and Aging, March 2011. http://www.tandfonline.com/doi/abs/10.1080/01924788.2010.545970?journalCode=waaa20
[viii] Quintana Hernández DJ et all. The effects of a neuropsychology program based on mindfulness on Alzheimer’s disease: randomized double-blind clinical study. Revista Espanola de Geriatria y Gerontologia [2014, 49(4):165-172]
[ix] Monti, Daniel W., Caroline Peterson, et al. A Randomized, Controlled Trial of Mindfulness-based Art Therapy (MBAT) for Women with Cancer. Thomas Jefferson University, Philadelphia, PA, Psycho-Oncology 15:363–373 (2006)
[x] Callahan, Margaret Jones. Mindfulness Based Art: The Sparks Guide for Educators and Counselors. Friesen Press. 2016.
[xi] Dr. Daniel Potts. How art therapy enhances the life for Dementia Patients. 2014 http://www.alzheimers.net/2014-04-29/art-therapy-for-alzheimers/ Accessed September 15th, 2016
[xii] Ward et.al. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013 Dec;11(4):203-17. doi: 10.1002/msc.1042. Epub 2013 Jan 9. https://www.ncbi.nlm.nih.gov/pubmed/23300142 Ward L1, Stebbings S, Cherkin D, Baxter GD.
[xiii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.