DBT Core Mindfulness Therapist Guide: The What and How Skills, Wise Mind and Adaptations
DBT · DBT · Manualised
A clinician protocol for the DBT module every other module depends on. It sets out the three What skills (Observe, Describe, Participate) and three How skills (Non-judgementally, One-mindfully, Effectively), frames Wise Mind as the practical integration of Reasonable Mind and Emotion Mind rather than a state of calm, adds five Wise Mind practices with an imagery safety note, and summarises the evidence accurately: DBT skills use as a mediator of change, the mindfulness module's effect on attention and impulsivity, and the null findings for universal school-based mindfulness.
Underlying mechanism: Dialectical Behaviour Therapy Core Mindfulness: What Skills, How Skills and Wise Mind
What it helps with
- Building the baseline capacity to observe and describe internal experience that distress tolerance, emotion regulation and interpersonal effectiveness skills all assume.
- Presenting Wise Mind as something a client practises reaching, not a trait they have or lack.
- Adapting mindfulness practice for ADHD clients (shorter, countable, movement-based) and autistic clients (sensory-checked, literal).
- Choosing safely between imagery-based and breath-based Wise Mind practices.
- Teaching the same skills to teenagers and, through caregiver-led games, to younger children.
How clinicians use it
- Read the guide in full, then teach the six skills with the adult or teen worksheet before adding Wise Mind practices.
- Keep practices short and frequent, and review the practice log each session.
- Check imagery suitability before teaching the stone on the lake or spiral staircase practices.
- For younger children, model the games with the caregiver present rather than sending a worksheet home.
Clinical Implementation Guide
- Teach core mindfulness first and return to it between other modules.
- Build skills through short, frequent practice.
- Check imagery suitability before the Wise Mind visualisations.
What the worksheet looks like
| Skill | What It Trains |
|---|---|
| Observe | Noticing a sensation, thought or feeling before putting it into words |
| Describe | Putting plain, factual words to what was noticed |
| Participate | Entering fully into an activity without a running commentary |
| Non-judgementally | Describing without labelling good, bad, fair or unfair |
| One-mindfully | Doing one thing at a time with full attention |
| Effectively | Doing what works rather than what is right |
Clinical cautions
The stone on the lake and spiral staircase practices are guided imagery. Some people cannot form mental images, and for a client with trauma or a fear of water, sinking or descending into enclosed spaces, these images can raise distress rather than settle it. Offer the breath-based practices first where imagery does not suit, allow eyes open throughout and stop any practice that brings up strong distress. This tool does not diagnose any condition and is not a substitute for individual face-to-face therapy or for emergency crisis support. Anyone in immediate distress should contact their local emergency service or crisis line.
References
- Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.
- Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., et al. (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: The MYRIAD cluster randomised controlled trial. Evidence-Based Mental Health, 25(3), 99-109.
- Linehan, M. M. (2014). DBT skills training manual (2nd ed.). Guilford Press.
- Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford Press.
- Montero-Marin, J., Allwood, M., Ball, S., Crane, C., De Wilde, K., Hinze, V., et al. (2022). School-based mindfulness training in early adolescence: What works, for whom and how in the MYRIAD trial? Evidence-Based Mental Health, 25(3), 117-124.
- Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832-839.
- Perepletchikova, F., Nathanson, D., Axelrod, S. R., Merrill, C., Walker, A., Grossman, M., et al. (2017). Randomized clinical trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder: Feasibility and outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 832-840.
- Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32(2), 146-157.
- Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. Guilford Press.
- Snel, E. (2013). Sitting still like a frog: Mindfulness exercises for kids (and their parents). Shambhala Publications.
- Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., Alvarez, E., & Pérez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150-157.
- Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness, 6(2), 290-302.
Part of
DBT Core Mindfulness
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