DBT in Practice: Mastering The Essentials

Learn how to apply DBT principles in your everyday practice.

Earn 5.25 CE credits.

Mindfulness Skills in DBT: The 3 States of Mind

By Stephanie Vaughn, PsyD

This presentation is an excerpt from the online course “DBT in Practice: Mastering the Essentials”.

Highlights

  • The three states of mind are wise mind, emotion mind, and reasonable mind.
  • Wise mind is intuitive and is the ultimate aim in DBT.
  • The mindfulness module is repeated between every other module. A mindfulness activity is practiced at the beginning and the end of every group.
  • You cannot know someone else’s wise mind.

 

Transcript

Mindfulness and the three states of mind.
Mindfulness plays an important role in DBT. It is the foundation of learning of all of the other skills which are taught in group. It’s important to sell group members and patients on how important the practice of mindfulness is, the need to be able to understand the difference between the practice of mindfulness and guided imagery or relaxation because while mindfulness might involve those things, it doesn’t have to. And in fact, most of the time when group members are new to practicing mindfulness, they are quite far from being able to relax and thus would need to be present with whatever existed for them in the moment. Mindfulness is about being in the moment. So in order to sell group members on the benefits of mindfulness, you can present research in limited forms. And the DBT manual lists a few. You can talk about the pros and cons of practicing mindfulness. You can share your own experiences with practicing. But in the end, they’ve got to see how it’s applicable to their lives. A discussion about how they might have missed things in their lives because they weren’t paying attention can be helpful.

I find that it’s necessary to sell group members on the practice of mindfulness every time I teach it and we’re teaching the practice of mindfulness in the beginning of group before we even start anything else and we’re closing at the end of group with a mindfulness activity. We’re teaching the entire module of mindfulness between every other module. So there are four formal modules of skills in DBT, mindfulness being one of them. And we are rotating each module and interspersing the mindfulness module between each one. So for example, we would have mindfulness module, interpersonal effectiveness module, mindfulness module, emotion regulation module, mindfulness module, distress tolerance module and back to mindfulness. So it is obvious that mindfulness is extremely important.

So what is mindfulness if it is not necessarily relaxation or guided imagery? It’s simply about being attentive to the present moment. If there was only one skill to teach, mindfulness is the one to teach. One of the best recommendations I’ve heard in teaching someone who is new to mindfulness is to prompt them the first thing to notice is the desire to stop practicing. It’s not only commonplace but it’s expected that we’re going to have the desire to stop paying attention. Our attention is drawn to a variety of different things and we have a tendency to multitask. We live a lot in our thoughts as CBT attests to. And mindfulness is not about getting lost in thoughts. Mindfulness is not about getting lost in thoughts. It is about being with what is there whether that’s the five senses, whether that’s paying attention to the thoughts that are passing by but not getting entrenched in any one thing.

So within DBT, there are the core mindfulness skills. There are the what skills and the how skills and we’ll go over that in the next discussion. One of the main mindfulness skills that I want to talk about is wise mind. And wise mind involves teaching the three states of mind. It’s one of the three states of mind, the three states of mind being emotion mind, reasonable mind and wise mind, and wise mind being the ultimate aim in DBT. It’s the synthesis of emotion mind and reasonable mind and involves a backdrop of intuition. DBT, for lack of a better word, believes in intuition, the power of intuition and that the feeling of just knowing something is valid, just as valid as any empirically verifiable information as Linehan says.

So emotion mind is the state that every human being gets into when emotions take over. And that may be emotions of anger, frustration, sadness. It’s when emotion takes over and reason is pushed to the side. Every human being gets into this state at some point or another. The discussion of the pros and cons of this is important. Reasonable mind involves logic and data. We all also possess this state of mind. Reasonable mind is calculating and we may shift from being in emotion mind to reasonable mind and back and forth. We can think about media figures who personify reasonable mind being extremely logical to the point of providing comedic relief. And we can also think of people perhaps in our lives who reflect this data-driven, cerebral, emotion-less state that also has its pros and cons.
Many group members and patients will come in to treatment with either a fear or a desire of being fully in reasonable mind. Cognitive behavioral therapy emphasizes and focuses on logic and rationality. This is one of the places where DBT differentiates itself from CBT in that the ultimate aim is not reasonable mind. The ultimate aim in DBT is wise mind which again is the synthesis of emotion mind and reasonable mind. So wise mind incorporates that background also of intuition. So it’s not simply a blend of emotion mind and reasonable mind. Wise mind is a deep sense of knowing. Most of the time, you can ask group members or patients or anyone that you know to look back on their lives, to look back and ask themselves, when in your life have you made a wise mind decision? Without even explaining necessarily what wise mind is, oftentimes you will get an answer immediately.
It’s important to emphasize to group members when you’re teaching this that no one else can know their wise mind. You cannot know anyone else’s wise mind. You can only know your own. And wise mind is at times unexplainable. It’s not something that we could lay out the data for. If we are able to lay the data out for it, it’s more likely to be a state of reasonable mind. So as a therapist, it can be difficult when a patient reports that something is wise mind for them but for the therapist it doesn’t fall in line with what the therapist believes wise mind is. But it’s important to keep in mind that we have to respect as DBT clinicians the patient’s wise mind. We have to respect as clinicians the patient’s own wise mind. We can disagree with a patient’s wise mind but we cannot tell them what their wise mind says. So that wise mind is a deep sense of knowing. The idea being that every single person has wise mind and this is one of the main mindfulness skills in DBT.

The key points for audio 4, mindfulness and the three states of mind. The three states of mind are wise mind, emotion mind and reasonable mind. Wise mind is intuitive and is the ultimate aim in DBT. The mindfulness module is repeated between every other module. A mindfulness activity is practiced at the beginning and the end of every group. You cannot know someone else’s wise mind.

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