One of the major changes described by participants was an enhanced capacity for self-awareness and an increased personal appreciation of the value of learning and practising mindfulness and radical acceptance. Linehan (1993a, p. 20-21) acknowledges that the emphasis on these practices as core components of DBT arises from her personal experiences of ‘studying meditation and Eastern spirituality’. ‘The DBT tenets of observing, mindfulness, and avoidance of judgment are all derived from the study and practice of Zen meditation.’ Linehan (1993a, p. 144) notes, however, that these skills ‘are compatible with most Western contemplative and Eastern meditation practices.’
The inclusion of mindfulness based interventions within psychotherapy is gaining increasing attention within therapeutic circles. Kostanski et al. (2006) state that the
…demonstrated utility of mindfulness meditation within a wide range of physical and mental health contexts has resulted recently in it being an area of significant growth in psychological research (p. 16).
Brown and Ryan (2003), for example, conducted a number of studies exploring mindfulness and its role in psychological well-being and concluded that ‘mindfulness is a reliably and validly measured characteristic that has a significant role to play in a variety of aspects of mental health’ (p. 844).
For some participants this was their first exposure to such concepts. Several described the impact as pervasive.
…it’s like I don’t take things so personally anymore…it just gives me…the capacity to engage my wise mind regularly…it’s just with me all the time (R1:p.3).
…it’s quite an energizing place to be in…a sense of involvement in life which is…a deeper level in some way…of being deeply satisfied about what’s happening…(R5: p.19)
…I just feel like my heart opens up a little bit and there’s just this…lightness and a complete sense of being alive (R6: p.8).
…mindfulness and that’s something that I’m just continually aware of in my life…it helped me to actually have more of a sense of being alive by using mindfulness um to actually notice kind of each moment…ooh, radical acceptance … I think is also crucial (R6:p.9).
The radical acceptance ideas have been really big. That this just is how it is. It’s a big thing. Um, and once you can stop focusing energy on battling that because many of us do, it’s amazing how much energy you’ve got to do other things (R3:p.17).
…and it’s a very forgiving kind of way of thinking about yourself…You can drop the criticism and just think about how it is that you’re going to try and handle yourself more gently and with a bit more loving kindness…You know, the whole love and kindness, in terms of how you treat yourself, and if you can treat yourself that way, then there’s a better chance that you can treat other people that way (R4:p.10).
One participant gave a touching example of teaching his children mindfulness and radical acceptance and later observing his older child teaching and coaching the younger child in the use of these skills at times of distress. He also described the value of mindfulness and acceptance for himself thus:
I think that practice of mindfulness and that acceptance, has just made it easier to work what at times is a really difficult job, um, but not let that have an impact in other parts of my life. But most probably easier on myself and others outside of work (R7:p.10).
Another participant appeared to have come somewhat reluctantly to mindfulness practice initially.
…you’re almost forced to become more mindful and go through some of the process itself… (R8:p.4).
He then provided an example of how mindfulness markedly assisted him in dealing effectively and calmly with his children at home after a busy day at work, going on to state,
I think the biggest one for me is…the whole idea of mindfulness and how useful it can be in everyday life (R8:p.4).
Some participants had already developed a mindfulness practice or had a well-established meditation practice prior to their involvement in DBT. One of these noted that his experience of learning and practising DBT had served to deepen his existing
mindfulness practice and that he was frequently reminded to ask, ‘am I utilizing the moment?’ (R5:p.18).
The benefits these participants experienced in their clinical practice from this reported enhanced capacity for self-awareness and practice of mindfulness and acceptance are consistent with those described by Robins (2002, p. 57). He emphasizes the importance of clinicians having their own mindfulness practice if they are to teach mindfulness skills. The capacity to step back from the intensity of emotion often experienced in interactions with persons with BPD and to regulate one’s own emotions is seen as enabling clinicians to respond in a more thoughtful manner.
One benefit of mindfulness is an increased ability to observe and describe the patient’s behavior in session in a nonjudgmental manner, which can be particularly difficult when one feels criticized or is afraid that the patient may attempt suicide (Robins, 2002, p. 57).
Confirming the widely acknowledged benefits of mindfulness practice, several participants in this study spoke at length of benefits extending beyond their professional self and noted positive changes in their personal self and interpersonal relationships. ‘Along with benefiting the life of the therapist in general, regular mindfulness practice can also help the therapist maintain direction throughout the challenging course of treatment that BPD patients present’ (Robins, 2002, p. 57).