Mindfulness  is a technique in which a person becomes intentionally aware of their thoughts and actions in the present moment, non-judgmentally. It plays a central role in Buddhism,  being the seventh element of the Noble Eightfold Path, the sadhana of which is held in the tradition to engender insight and wisdom.

"The attempt to be continuously mindful can easily lead to the entrance into the dark night, a singular state of consciousness in which the individual experiences a sudden and deep suffering^[1] . While this is a normal stage of the process of learning to be mindful, sometimes it might be difficult to realize that this state is caused by mindfulness itself. This realization, together with a lot of acceptance and a renewed attempt to be mindful will lead to the exit of the dark night and to the entrance into the equanimity states. The dark night is a very delicate moment in which the guidance of a qualified master is specially useful. Stopping meditation at this point can lead the meditator to be stuck in the dark night for a quite long period."

Biosocial theory

"DBT is based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation. The disorder is characterized by heightened sensitivity to emotion, increased emotional intensity and a slow return to emotional baseline. Characteristic behaviors and emotional experiences associated with BPD theoretically result from the expression of this biological dysfunction in a social environment experienced as invalidating by the borderline patient." ^[2]

Cognitive behavioural therapy

"One of DBT's several elements is cognitive" behavioural therapy (CBT). DBT espouses the scientific ethos. It makes use of self-monitoring, there is an emphasis on the here and now and much of the therapeutic technique is borrowed from CBT, including the style of open and explicit collaboration between patient and therapist. Furthermore, the treatment has a manual. The ‘bible’ of DBT is Linehan's Cognitive Behavior Treatment of Borderline Personality Disorder (1993a). (She says that her publisher insisted on ‘cognitive behavior treatment’ because they felt that a title including the word dialectical was less likely to sell well, particularly in the USA.) "^[3]

 Zen

"DBT utilizes Zen concepts as a basis to encourage patients to be mindful in the current moment, see reality without delusion, and accept reality and themselves without judgment. This skill, which has its roots in Western contemplative and Eastern meditative practices, is called mindfulness." ^[4]

 The Dialectic

"As a world view... dialectics anchors the treatment within other perspectives that emphasize: 1. the holistic, systemic and interrelated nature of human functioning and reality as a whole (asking always "what is being left out of our understanding here?"); 2. searching for synthesis and balance, (to replace the rigid, often extreme, and dichotomous responses characteristic of severely dysfunctional individuals); 3. enhancing comfort with ambiguity and change which are viewed as inevitable aspects of life." ^[5]

The four modules

The purpose of the DBT skills in all four skill sets is to help the client get into a state of mind referred to in DBT as wise mind. Wise mind is the middle ground in the dialectic between rational mind and emotional mind. To be too far on the side of rational mind would mean focusing only things such as facts and figures; ignoring and suppressing emotion. To be too far on the side of emotional mind would mean being so blinded by strong emotions that one would not be able to consider the facts.

Mindfulness

The essential part of all skills taught in skills group are the core mindfulness skills.

• Observe, describe, and participate are the core mindfulness what skills. They answer the question, "What do I do to practice core mindfulness skills?"
• Non-judgmentally, one-mindfully, and effectively are the how skills and answer the question, "How do I practice core mindfulness skills?"

Mindfulness comes from the Buddhist tradition and can be read about in more detail in the book The Miracle of Mindfulness by Thich Nhat Hanh (among others).

Interpersonal effectiveness

Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Individuals with borderline personality disorder frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his/her own situation.

This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

Distress tolerance

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavioral therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.

Emotion regulation

Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile. They can be angry, intensely frustrated, depressed, or anxious. This suggests that these clients might benefit from help in learning to regulate their emotions. Dialectical behavioral therapy skills for emotion regulation include:

• Identifying and labeling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to emotion mind
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques