Dialectical Behavior Therapy - Mindfulness Chat Conference Transcript

Michael Staub M.S.: 11/1/02

Borderline Personality Disorder Today was honored to have Michael Staub M.S. provide a chat conference about Dialectical Behavior Therapy - specifically about Mindfulness. Below are the transcripts. 

Emmespalace:

I would like to introduce Michael A. Staub, Mr. Staub is a graduate of Northwestern State University and has a Masters of Science in clinical psychology
At this time Mike will begin with a lecture on dialectical behavior therapy and mindfulness. Mike the floor is all yours.

Mike:

*clears throat*
You've all come here this evening to hear some words on the skill called mindfulness. This is the first of 4 'core skills' presented by Dr. Marsha Linehan in her therapy paradigm called Dialectical Behavior Therapy. The 4 core skills are mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance.

We begin at the beginning and mindfulness holds skills that shall be used throughout the rest of the skills training as well. These mindfulness are skills that we want to be using and practicing all the time. Some other skills are NOT that way, but we will get to them at a later date.

First, let me open up with a discussion of what mindfulness IS. What ideas do you have about mindfulness? What is it to you? Or perhaps I should say, what does it mean when you hear it? Anyone.

Emmespalace:

It is ok at this point if people want to respond to mike's questions.

Mike: 

Help me out here.

Margie:

Mindfulness is being in the here and now.

Cortex:

Balancing emotions with logic.
good, good. 

Mega:

Being aware of what's going on around yourself.

Mike:

Excellent.

Gourou:

I think it is being aware of what we feel, being able to distinguish it from other feeling, to name it...

Mike:

Anymore?

Margie:

Being aware of the 'big picture"?

ColoredBrush: 

Being focused on what you're doing at the moment instead of everything else you may be thinking or feeling.

Mike:

Good answers. Of these incorporate various aspects of mindfulness. For myself, I like to think of mindfulness as 2 words, or concepts. I keep it simple, because I'm a simple guy. I like to think of it as awareness and balance both of which were mentioned. These are the core concepts of what mindfulness is all about, to me. So lets start with some awareness.

One of the concepts I like to begin with is the idea of beliefs. Beliefs are ideas we hold dear. Things that we honestly and truly believe are reality, whether they are or not. So one way to begin to cultivate awareness is to examine our own belief systems. When I do this, we talk about 9 basic 'irrational beliefs." These are ways of thinking that are either unhealthy or in some way hold us back from reaching our potential. think of these as 'thinking errors,' if you will. the first is binocular vision. Binoculars magnify things and make them look bigger/closer than they really are.

Gourou: ?

Mike:

The question here is, do I do that with my problems? Do I focus on the problems and then make them large? Also there is a flip side. When we turn binoculars around and look through them, things become very small and distant. So the question here is, do I do that with the good things in my life or about me? Do I minimize those things or blow them off?

Everyone still with me, or are there any questions so far?

Gourou: ??? <-- Question

Mike:

Don't be shy if you want something explained or clarified. Shoot.

Gourou:

Okay :) is there somewhere in our book when we can see these 9 irrational beliefs summarized?

Mike:

No. Unfortunately, this is something I have taken from another source, but I find is an excellent intro mindfulness.

Gourou:

ok, too bad.

Mike:

It helps people to begin to see what kind of thinking errors they are using on a consistent basis and then fight against them. The second one is black and white thinking. This one is explained by Linehan a number of times. It is the idea of all or nothing, wrong or right, good or bad. notice all the 'or's. Life would be much easier if we could identify things in simple terms. She is my friend or she isn't. you are lying to me or you're not. You feel a certain way or you don't. Unfortunately, life is rarely, if ever, that simple. Life is not a series of black and white events, but rather a number of shades of gray. Getting over the idea that things are either good or bad will help to be able to withstand and eventually conquer much of the psychological turmoil you may be experiencing now.

As a therapist, I often see this expressed by clients toward myself. I am either the angel or the devil and as the angel, I will invariably make a 'mistake' at some time getting that client to see that I am simply a human being, with both good as well as BAD qualities, is very important. 

The next error is called dark glasses. Do I see the world as a fundamentally 'bad' place, as out to get me ? Do I notice all of the bad things, and sometimes even insist that NO good things happen at all? This is seeing the world through dark glasses. 

Can anyone think of a thinking error that is the opposite of dark glasses? *waits for responses* *grins*

Mega:

Rose colored glasses.

Mike:

THERE we go. Very good.

Emmespalace:

Everyone is great their best friend

Rilya_Miril-Lirin:

Thinking nothing bad could ever happen, that they are invincible.

Mike:

With rose-colored glasses, we see only the GOOD things, neglecting the bad. Exactly. This thinking error can be as bad as dark glasses, because we open ourselves up to great pain when we trust others blindly. Fortune telling is the fourth.

Mega:

Wouldn't that be a sort of black and white thinking?

Mike: 

A number of these are similar and may bleed into each other. Good question, though, Mega. You will also notice that I may be using several of these thought errors at teh same time. Fortune telling is about making predictions. Do I already know how my husband is going to respond to something before I even ask?

Margie:

self fulfilling

Mike:

If so, that is fortune telling. Yes, very much so and if I already know he is going to say 'no,' then I'm likely not even going to bother asking. If I don't bother asking, there is no chance at all I can get what I want. The chance may be small if I DO ask, but there is no chance at all if I don't. Yes, another thinking error though not on this list, is the idea of mind reading.

Do I know what someone else is thinking? As in "you don't love me." and the corollary of that - you should KNOW what I need. We will get to some of this in the next skill, interpersonal effectiveness (aka - how to get what I need)?

Gourou:

Mike stop me if I should place this comment later but... I'd answer to that forth error that I believe in statistics...

Mike:

You bring up a good point.

Gourou:

I mean if something happens often, I tend to "know" it will re-happen

Mike:

One I was going to leave out for brevity, but I like this kind of discussion.

Gourou:

And there comes the black and white :)

Mike:

The best predictor of future behavior is past behavior. This is very true BUT that is a PREDICTOR. If the way to tell what future behavior is GOING TO BE is from past behavior, and then we would all be psychics. There would be NO way to change our behavior in the future. While I am a fairly strict behaviorist, I still hold that people have the ability to script their own lives and choices and because of that, even if my husband has told me NO 137 times, there is no guarantee that he will say no the 138th. Knowing that he will is fortune telling and using the statistic is called the gamblers 'fallacy' :-)

On to #5. This is called making it personal. This one is 2 fold. 

Gourou:

It makes me think of a laboratory rat learning not to touch something because it is electrified...oops sorry

Mike:

The first question is do I usually believe that others are talking about me/looking at me/ etc? Do I personalize what is going on around me? AA has a saying for this one (that I really don't like) but I'll mention it here anyway. Why do you think YOU'RE so important?

Gourou:

lol..

Mike:

It is a good question to ask to counter that thought error, but in some ways belittle you as an individual, so I don't like it a lot for that reason.

The second part is to personalizing is this question. do I take on responsibility or actions that ARE NOT MY OWN? You do not have control over anyone else. Even children. You DO have to own your own actions, but if you own others', you are likely enabling or allowing them to do things for some reason. (Usually that's guilt, by the way).

Number 6 on the hit parade is over generalizing. Do I make conclusions based on limited exposure: This is similar to black and white, again any time you hear "all" or "none," this is often over generalizing. you never helped me around the house. Is it likely that never once, in our entire experience together, that I have not helped, even once? It COULD be true, but is much more likely to be an overgeneralization and if you're seeing these kind of statements in yourself, it is also likely you do this a fair amount of the time. These types of statements can put others on the defensive VERY quickly, and an argument ensues. 

Labeling is number 7. Do I put overly simple, derogatory labels on people or things that are much more complex than the person/thing really is? "My ex wife is just a BITCH." A simple label. I do not like my ex wife's behaviors at times, she may even ACT like a bitch or even act bitchy but labeling g\can get us into trouble because we reduce that person down to something simple and less than human. These two work great in combination. 

Let's see who can finish this sentence first. Ready? All men are ______.

Gourou:

Masculine.

Mike:

LOL Cute Anyone else?

Gourou:  ;)

Rilya_Miril-Lirin:

Pigs.

Mike:

Good one. all men are pigs. Good combination of both labeling as well as over generalizing. A more appropriate statement might be, in my experience, the men I have dealt with have not treated me well or perhaps have cheated on me.

Rilya_Miril-Lirin:

One or two have hurt me in the past so therefore all men suck?

Mike:

You are being specific with what behavior they exhibited that you didn't like, as well as acknowledging that while all the men you have dealt with have been like this, the possibility exists that some men are NOT this way. A great thinking error there Rilya.

Mega:

Too many words, when you don't talk much.

Mike:

Number 8 is similar to binocular vision. It's called, discounting the positive. do you ignore or blow off good things? Can anyone here twist a good situation until it becomes bad - i.e. talk themselves out of having a good time? Or my personal favorite. Can you accept a compliment? "Your hair look very nice tonight." " WFT? Are you saying that my hair usually looks like crap?? You bastard!!"

The last thinking error is called beating up on myself or others. 

ColoredBrush: 

I can outwardly accept the compliment because it is the polite thing to do, but in my head I do all of that that you just said.

Mike:

2 words to keep in mind (or be mindful of) here. "Should" and "must." do I insist that things have to be a certain way? This is what 'allows' us to beat up on either ourselves or on others. It justifies it. If my son didn't do the laundry the way I told him to, then he deserved the severe verbal beating I gave him. He should have listened and did it right.

The same works for us. I should have done better on the test. Because I failed, it is necessary for me to hurt myself as a punishment. I have even had some clients justify beating themselves up for recognizing that they often engage in the thinking error of beating  themselves up!

So I'm going to open the floor for a little discussion before I go no in just a sec. I have spent a long time discussing thinking errors, 

Margie: 

Is all of this "cognitive distortions:? Or do I digress?

Mike:

something that isn't even in your book under mindfulness. Have I lost my mind or does this have something to do with the topic at hand? 

Yes Margie. Some are cognitive distortions. Others are outright illogical thought patterns that we have 'learned' to make part of our reality. The bad news is, it's very difficult to break out of these because they are like bad habits.

Emmespalace:

Ok everyone that has a question for mike please type a ? and I will call on you in the order you type in your ?

Mike:

The GOOD news is that anything you can learn (and these ARE learned) can be UNlearned. 

Let's take a few questions then move on.

Gourou: ?

Emmespalace:

Gourou your question please.

Mike:

*long question* :-)

Gourou:

Thank you. I wrote all of the nine errors and I'm looking at them... unfortunately, I feel that I don't believe in some of them because of statistics... 

Mike:

Okies. Give us an example.

Gourou: hmm

ColoredBrush: ?

Mike:

Remember that this all comes back to beliefs. The reason you may not believe it si because of the thinking errors. Those beliefs are PART of us. A big part of what we BELIEVE to be reality. Often, they are not easily discarded or changed.

Should we wait for you, Gourou, or did that answer your concern?

Gourou:

Sorry Mike my ideas aren't clear, I'm thinking about it... go on and I'll catch up the next question time :)

Mike:

That's cool.

Emmespalace:

Coloredbrush your question please.

ColoredBrush: 

Can I comment on what Gourou has mentioned? I wanted to comment on it before but thought I would wait.

Mike:

Go ahead.

Mega: ?

Mike:

I think Coloredbrush has something to say, then we'll get your question, Mega.

ColoredBrush: 

Would it be safe to say, that statistics of something being "bad" and not taking action because it "always" turns out that way, is based on our behavior that causes the result, and that if we can get our behavior to be more adaptive then the statistics would no longer apply, new statistics will be made

Mike:

Well, that is certainly true but I would ALSO like to say that, even if we DON'T change, EVERY interaction is a new and therefore different one believing that they will ALL be the same is over generalizing or perhaps fortune telling or perhaps a little of both.:-)

ColoredBrush: 

Okay, so you are saying that none of it is exactly the same because even if minute, our behavior, or the circumstance has something different in it that skews the stats.

Mike: You see how these go together. Exactly. Life is not a sheet of statistics.

ColoredBrush: 

Okay, thanks.

Mike: Things cannot be boiled down that way. If it could it WOULD make things easier.

Gourou: ?

Emmespalace:

Mega your question please.

Mike:

But to my knowledge, no one has figured out how to do it

Mega:

What is the difference between these illogical thought patterns and the things that I think/do when psychotic? (Exaggeration I know).

Mike:

BIG exaggeration. That's a tough one.

Mega:

Perhaps I don't know the definition of psychotic.

Mike:

Psychosis is by its very nature impossible to tell the difference between what is real and what is fantasy. Psychotic means "break from reality." You may see visions. Things others do not or you may hear voices inside or outside your head. These things are in NO way under your control to have or not have and for most psychotics, they cannot distinguish these from everyone ELSE'S reality. the things you saw in "A BEAUTIFUL MIND, while a great concept, are not a realistic view of someone with a true thought disorder.

Mega:

No, not my idea.

Mike:

Did that help at all, Mega?

Mega:

No, but I have to think how to ask it differently.

Mike:

Illogical thought patterns are things we learn. Hallucinations are things we experience because of chemical disorder.

ColoredBrush: 

Great clarification.

Mike:

Gourou? You had a question? Thank you.

Gourou:

I think most people would agree that drinking alcohol + driving = accident ... Is this over generalizing? I mean this is what occurs most of the time so we tend to take it as a FACT. I tend to apply the same process to relationships, events in my life, etc... This is where I get lost.

Mike:

This will be the last question so we can move on to more mindfulness. Not sure what the question there is, but you bring up a grat point that we will be going over shortly. the idea that emotions, while they feel real and may be real (because you are experiencing them) are NOT necessarily reality. I have a number of friends that routinely drink alcohol and drive without getting into accidents.

Gourou:

Good point.

Mike:

I do not approve of their actions (and often voice that), but it DOES happen (aside - I used to think it was a "southern thing", till I moved back north and now my northern friends do it *shakes head*). 

Anyway, I digress back to mindfulness. does anyone here NOT have the skills training handbook?

Mega:

I do not.

Mike:

Shout out if you don't. Don't be bashful.

* dubie is now known as holds_up_hand

Mike:

LOL Funny. Okay. I will describe some of the handouts then for those of you without a book. Iit may be best if you get a sheet or two of paper and a writing utensil. Will make some of the concepts a little easier to visualize them as well as talk about them. Alright, here we go. Linehan talks about some goals of what it is we are trying to accomplish here. She specifically gets to:  what types of behaviors are going to try to learn to avoid. She looks at 4 - interpersonal chaos - is often seen as a series of intense but chaotic relationships. It is most often in the context of sexual/love relationships, but may be other types as well. Labile or quickly shifting intense moods is the second thing we are going to try to learn to regulate with mindfulness. 

The third behavior we want to use mindfulness to decrease in impulsiveness. ESPECIALLY in regards to self-destructive or self-harming behaviors.

The last is confusion about the self otherwise known as identity disturbance.

ColoredBrush: ?

Mike:

If it appears that a number of these have been pulled directly from the diagnostic criteria for borderline personality disorder in the DSM 4. That's because it was. These are the basic issues that people who have bpd experience. The behaviors we are looking to increase are the 4 core skills I spoke of earlier - mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance.