Mindfulness and Trauma Treatment: Dialectical Behavioral Therapy
I think I first encountered the term Mindfulness in 2000 at a workshop presented by Marsha Linehan, Ph.D. on Dialectical Behavioral Therapy (DBT). DBT was primarily developed to work with those diagnosed with borderline personality disorder (BPD), a form of complex PTSD as I conceptualize such things. Mindfulness is the core skill of DBT and can be applied to help trauma survivors learn non-reactivity to thoughts and emotions. As such, it is highly applicable to trauma treatment.
In DBT, mindfulness practice is designed to help you learn how to experience a state Linehan calls “Wise Mind”. This is the same state others may call being centered, true self or authentic self. Wise mind refers to the state in which your emotions and your thoughts work together so that informed choices are possible, even when your life and/or circumstances are difficult. You’re in wise mind when you can meet each moment of life as it is, not as you would have it be, and respond to it effectively. Everyone has the capacity to experience this but trauma may have gotten in your way.
In Linehan’s Skills Training Manual for Treating Borderline Personality Disorder (1993), there is a clear explanation of mindfulness, as well suggestions for practice. This is a great practical resource for clinicians working with complex trauma survivors, not just those formally diagnosed with BPD. Linehan breaks mindfulness into six specific skills. I will elaborate on these and their application to treating trauma in upcoming posts.
Given the context of an ineffective family environment that often goes hand in hand with complex trauma, many trauma survivors need to learn skills and develop basic capacities that have been missing or lacking since childhood. These are the things the trauma therapist will focus on in phase one of trauma treatment. The lack of capacities like emotional regulation and frustration tolerance understandably make daily life more difficult. Grounding and mindfulness are emotion management tools that can come in handy here.
I feel like the following passage from the Mindfulness and Psychotherapy blog captures what I see as one of the hallmark goals of this stabilization phase of trauma therapy: to increase the individual’s ability to tolerating sitting with the range and extent of their feelings. Elisha Goldstein, Ph.D. writes:
Daniel Siegel, M.D., author of many books the most recent being Mindsight, describes that we all have “a window of tolerance.” The heart of working with trauma is to get to a point where the emotional reaction from the trauma memory is no longer overwhelming. We can learn to ride the edge of this window and allow ourselves to look onto the emotional and physical distress associated with the memory with “nonjudgmental awareness.” While it seems counterintuitive, we want to very carefully bring the trauma into awareness so we can eventually change our relationship to it. This is challenging and takes practice and skilled support.
This is what you, with the support of a trained trauma therapist, can accomplish in the beginning of trauma treatment.
Dr. Kathleen Young: Treating Trauma in Tucson 