What and How
Mindfulness as practiced, not preached. Three verbs and three adverbs.
8 to 10 minAbout today
What and How are the core mindfulness skills in DBT. Every other skill in the curriculum is one of three moves performed in one of three manners. Crisis distress tolerance, emotion regulation, interpersonal effectiveness. Each is a What done in a How, applied to a specific job.
The What skills name what the mind is doing. Observe. Describe. Participate. The How skills name how the mind is doing it. Non-judgmentally. One-mindfully. Effectively.
The eating disorder has its own version of each of the six. The work today is to learn the difference between the skill and its counterfeit by the way each one lives in the body.
What's shared here stays here. Names, stories, details, all of it is protected. The only exception is safety.
You can pass at any point. No explanation needed. If something doesn't fit right now, say "pass" and we move on.
10 to 12 minBridge questions
Share your name, then take these one at a time. The first word out is the honest one.
10 to 12 minWhy two categories
In the Skills Training Manual (2nd ed., 2014), Linehan splits mindfulness into two axes because each axis can be done badly without the other catching it. A patient can observe with great precision and still observe for the wrong reason. A patient can describe in non-judgmental phrasing and still describe one-mindlessly, with attention split between the description and a rule the description is being held against.
The What names the move. The How names the manner. A skill is both axes at once.
This is a clinical decision, not a philosophical one. When a patient is failing a mindfulness practice, the diagnostic question is which axis broke. The verb, the adverb, or both.
What and How are the foundation of the Mindful Awareness column in the eight-module DBT curriculum. They sit at Module 4 because by then the group has practiced one or two crisis skills and has the gap to slow down. They do not work earlier; an active crisis cannot do the slow attention these skills require.
Every later skill borrows from these six. Wise Mind is observation plus description plus non-judgment. Radical Acceptance is participation plus non-judgment plus effectiveness. Validation, taught in the interpersonal column, is non-judgmental observation of another person's experience. If a later skill breaks, the failure usually traces back to one of the six.
Each of the six skills has a counterfeit that the eating disorder is already running. The counterfeits look like the skill from the outside and feel familiar from the inside, which is why they are dangerous. The body knows the difference; the mind has to be taught it.
- Observe collapses into surveillance.
- Describe collapses into judgment.
- Participate collapses into compulsion.
- Non-judgmentally collapses into anesthesia.
- One-mindfully collapses into rule-following.
- Effectively collapses into perfectionism.
Linehan calls these practices, not concepts. They are verbs the body does. The mind learns them by doing them. A patient who can define non-judgmental observation in clinical language and cannot perform it for sixty seconds has not learned the skill. A patient who can perform it for sixty seconds and cannot define it has.
This matters for how the session runs. The reading is short. The practice is long. The discussion afterward names what the body just did.
What and How are foundation skills, not crisis skills. They do not stop an urge. They build the attention that everything else uses. If a patient is in active crisis, route to STOP or TIP first and return here when the wave drops.
15 to 18 minThree verbs
Tap any skill to open. The header is the one-line teach. The body holds the skill, the counterfeit, and a body test for telling them apart.
Linehan's definition. Attending to events, emotions, and other behavioral responses without trying to terminate them when painful or prolong them when pleasant. Watching the breath. Watching a thought arrive and leave. Watching the urge build and crest and drop.
The ED counterfeit: surveillance. Counting calories on a label. Scanning the room for who is eating what. Cataloging the body's surface every time you pass a window. Surveillance looks like observation because both involve attention. The difference is the agenda. Observation has no agenda. Surveillance has a verdict already written.
Linehan's definition. Applying verbal labels to events and behavioral responses; describing what is, not what one fears, imagines, or believes. I notice tightness in my chest rather than I am anxious. I notice the thought "I have eaten too much" rather than I have eaten too much.
The ED counterfeit: judgment. My stomach feels disgusting is not a description. It is a verdict. The fact is the sensation. The verdict is the interpretation laid over the sensation. The skill is to keep them separate.
The split matters because the body can tolerate the sensation alone. The body cannot tolerate the sensation plus the verdict. Most of what looks like emotional intolerance is verdict-intolerance.
Linehan's definition. Entering wholly into an activity. Becoming one with what is in front of you, acting from wise mind, without the self-conscious "I am doing this" layer. Eating the meal. Saying the thing. Walking from the chair to the door.
The ED counterfeit: compulsion. Compulsion looks like full engagement because both involve total commitment. The difference is whether you chose. Participating is chosen and reversible. Compulsion is automatic and resists interruption.
In recovery, participating is the hardest of the three. It requires you to do the thing without simultaneously watching yourself do it.
15 to 18 minThree adverbs
The How skills modify the What skills. Same format. Skill, counterfeit, body test.
Linehan's definition. Removing the layer of evaluation laid over the fact, so the fact can be addressed without the suffering it has accrued. The fact is the meal contains 450 calories. The judgment is that is too many.
The ED counterfeit: anesthesia. Many patients hear non-judgmentally and try to stop feeling anything at all. That is not non-judgment. That is anesthesia. Non-judgment keeps the feeling and drops only the verdict.
The skill is harder than it sounds because judgments are pre-installed. They run before the conscious mind notices. The work is to catch them after they fire and choose whether to keep them.
Linehan's definition. Focusing the mind on the present moment activity. When other thoughts arrive, returning to the activity without scolding the mind for wandering. Eating one bite. Then the next bite. The fork down between them.
The ED counterfeit: rule-following. The eating-disordered mind can hold ferocious one-mindfulness around food rules. Exact gram counts. Exact intervals. Exact movements. The mind treats that as mindfulness. It is not. One-mindfulness is full entry into the activity that is happening. Rule-following is escape from the activity that is happening.
Body test. One-mindfulness produces presence. Rule-following produces relief from anxiety. They feel different.
Linehan's definition. Focusing on what works to meet your goals, given the situation as it actually is, not as it should be. Choosing the action that produces the outcome you want, even when the action violates a personal rule.
The ED counterfeit: perfectionism. Perfectionism does the thing that follows the rule. Effectiveness does the thing that produces the result. When the rule and the result diverge, perfectionism keeps the rule and abandons the result. Effectiveness keeps the result.
In recovery, the rule is often do not need anyone. Effectiveness is asking for help when help is what works.
12 to 15 minThree exercises, stacked
The exercises build. The first practices one What with no How specified. The second adds description. The third stacks all six. Each one is shorter than it sounds.
Three minutes. Eyes open or closed. Notice five things in the room without naming them. Then notice five sensations in the body without naming them. If the mind reaches for a name, let it arrive and pass. Do not work to suppress it.
What this rehearses. Observation without description. The mind will try to label everything. The instruction is to let the label arrive and not hold onto it.
What goes wrong. The most common failure is collapsing into surveillance, especially around body sensations. Patients who track sensations as evidence of fullness or thinness are surveilling. The instruction is to notice the sensation and release it, not to file it.
What to listen for in the debrief. "I noticed I was rating myself on how well I was observing." That is surveillance about the practice. Name it. Run it again.
Three minutes. Same room. Same body. This time name what you noticed in factual language only. Lamp in the corner. Tightness behind the sternum. Heater running. If a judgment arrives, say so out loud. Judgment arrived. Then return to description.
What this rehearses. The split between description and judgment. Naming the judgment when it fires, without arguing with it, without suppressing it, without acting on it.
What goes wrong. Some patients say nothing for the full three minutes. That is description-paralysis, not skill mastery. The instruction is to keep producing words, even imperfect ones, and to flag judgments as they arrive.
What to listen for. The first too. Too cold, too quiet, too long. When you hear it, ask the patient to say the same observation without the word.
Four minutes. One activity. Pass a small object from hand to hand around the circle. Each person holds it for ten seconds. The instruction is to fully receive the object, hold it, and pass it. No commentary. If you drop the object, pick it up and continue. If you laugh, laugh, then continue.
What this rehearses. Participation, non-judgmentally, one-mindfully, effectively. Observation and description are inside the act, not separate from it. The activity is too small to be impressive and too specific to be abstract.
What goes wrong. The most common failure is performing the practice instead of doing it. Patients watching themselves participate, narrating internally, calibrating whether they are doing it right. That is not the skill; that is the rehearsal of the skill. Name the difference.
What to listen for. Patients who say "I forgot to watch myself for a second" are reporting the skill. Patients who report a clean technical execution and no internal experience are reporting the counterfeit.
The exercises are short on purpose. The teaching happens in the debrief, not in the practice itself. Build in two to three minutes after each one to let members name what they noticed before moving to the next.
10 to 12 minGroup process
Pick one or two. No one has to answer in order.
5 to 8 minPick one
Choose one What and one How to practice between now and next session. Pick the combination that is hardest, not the one that sounds most achievable.
Track one data point each time. Before the practice, name the counterfeit your mind would have run instead. After the practice, name whether the counterfeit showed up anyway. That is all.
One word
Around the circle. The word names what you noticed today. Not what you learned. What you noticed.
If a member offers a learned-sounding word ("integration," "presence"), accept it and ask what specifically they noticed that the word is naming. The specifics are the data; the abstractions are the report on the data.