Have you tried mindfulness and “failed”? Many people struggle with mindfulness, despite it being often suggested by doctors and counsellors alike. I often share with clients that I, too, struggled with mindfulness the first time I tried as a practicum student- I was going through a personal crisis I had not told many people about, and felt incredibly anxious as if my body was vibrating intensely. I had a wise clinical supervisor who validated that some people experience this, and so although wary, I continued to try different exercises and found a couple that worked for me.
Mindfulness was touted as a miracle cure for any mental health condition when mindfulness first became popularized as a therapeutic modality. In fact, DBT’s founder Marsha Linehan claims that DBT was the first psychotherapy to include mindfulness as a part of their treatment.
The story is that she went and stayed at a Zen Buddhist monastery and tried to translate what she learned from Zen into therapy to help people struggling with intense mental health issues, specifically, Borderline personality disorder. However, she acknowledged that traditional meditation does not work for most clients with complex mental health issues and many clients cannot tolerate long meditations.
Similarly, large scale studies of mindfulness programs in school showed that for children at higher risk of mental health issues, actually worsened with mindfulness (https://www.ox.ac.uk/news/2022-07-13-how-effective-school-based-mindfulness-training). Those children were likely experiencing systemic racism, poverty and mental health symptoms and that paying attention to their distress that they were often powerless to change …did not make them feel better, but made them feel worse.
So as a therapist do I throw away with mindfulness altogether? No, actually I (like Marsha Linehan), try to adapt mindfulness exercises to work with traumatized nervous systems of those with complex PTSD. How do we do this? Shorter exercises, paying attention and listening to client feedback, making modifications as needed. Why? Because being aware of what is happening inside of you (thoughts, body sensations, emotions), and the situation you are in is key to most therapies that heal trauma and cope with the effects of trauma and mental health symptoms.
I usually start with bite-sized mindfulness and gauge how someone responds, if it does not work, we try something else, and may come back to it later.
DBT mindfulness is different than meditation. Its core principles are simply observing and describing and participating in the moment (WHAT skills). HOW to be mindful? Non-judgementally, doing one thing at a time, and being effective (doing what works).
The goal of mindfulness in DBT is not about becoming good at mindfulness or achieving a relaxed or peaceful state (though that is nice when it happens). It is to start to be aware of your own self, state of mind, actions and situation, and understand reality as it is. When you can do this you can start to act wisely and do what works for you.
And sometimes what is most effective in the moment is not doing a 10 minute mindfulness exercise, but finding support, solving a problem or even just doing what you can to get through a difficult moment (distress tolerance).