Mindfullness and Mental Illness

Mindfulness and Mental Illness
~Debra Meehl,DD,MSW and Lucinda Venn Johnstone,MS,LPC

In 2003 when my (Debra’s) husband Mark was diagnosed with bipolar disorder, I was determined to find a therapy that worked. I knew that if I could find something that we could use together, Mark would have a better chance for recovery, and I would have a better chance of keeping my marriage to the most wonderful -- and exasperating -- man I knew. Anyone living with and loving someone with a mood disorder knows, only too well, the hair-pulling frustration of finding the right medication and therapy. Mark and I had both dabbled with meditation. Both of us had a clear understanding that it was different than the praying that we had been taught as children, but neither of us had a true practice. A big part of the problem was Mark’s bipolar disorder. He said that, at times, his thoughts were racing at the speed of light – like the Starship Enterprise taking off into warp speed, with the lights of the stars zooming past. He could clearly understand how mindfulness and meditation could be beneficial; he just could not figure out how to get there. When we found DBT, we knew it was the answer for us.

Bipolar clients “receiving intensive psychotherapy were 1.58 times more likely to be clinically well in a given month.” -- NAMI Advocate (“Latest NIMH Study,” 2007)

DBT is More Effective than Therapy as Usual: According to a study reported in Cognitive-Behavioral Therapy of Borderline Personality Disorder, Dialectical Behavior Therapy (DBT) was found to be far more effective than standard psychotherapy in reducing treatment dropout, reducing admissions to psychiatric units, attaining improved social adjustments, modulating emotions, and improving problem-solving. DBT was found to have a 60-87% success rate in the treatment of clients diagnosed with borderline personality disorder (BPD), which some psychiatrists believe is on the same spectrum as bipolar disorder. Without training and skills, these clients live from crisis to crisis, unable to manage their emotions, finances and relationships. They seem always to be in a state of chaos and rarely in a state of peace. DBT has since been further developed and successfully implemented in the treatment of bipolar disorder, binge eating, chronic substance abuse, self-mutilation, depression and anxiety.

How is DBT different? Marsha Linehan, Ph.D., developed DBT, a bio-social theory. Bio-social refers to every person’s biology -- the brain chemistry inclination for extreme moods and how they are affected by the society (including the family) with which the client interacts. DBT takes the best of cognitive and behavioral therapies to formulate an intensive treatment. The ultimate goal of DBT is “to create a life worth living.” Without appropriate skills, people with mood and personality disorders tend to swing wildly from logical mind to emotional mind. With DBT skills, the same people learn to move gently into wise mind, finding the peace that passes understanding, the calm that lights the darkest storm. There are four components to Skills Training: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Relationships. The skills trainer “pushes” the skills and the therapist “pulls” those skills out of clients, helping them apply the skills to their real life situations.
Mindfulness is the core. Mindfulness is broken into “what skills” and “how skills”. “What skills” require (1) learning the difference between observing and describing our thoughts and feelings. (2) fully participating in life, (3) being alert to every thought and feeling, (4) recognizing self-sabotaging thinking that prevents changing harmful situations or reactions, and (4) being aware that our thoughts plus our emotions equals behavior. “How skills” require (1) taking control of our minds by being non-judgmental, (2) doing things mindfully, and (3) choosing to do what works. When we focus on the facts rather than our interpretations, we become “effective” in life and relationships. Being effective is always about doing what works; it is never about should or should not, right or wrong, or fair or unfair. Removing judgment also removes the need to defend oneself. Being effective is about doing what works rather than determining who is right. It creates a win/win situation, which is one of the reasons that DBT has such a high success rate with teens and people who have mood disorders.
Emotional Regulation is learning how to normalize the intensity of behavior. The first lesson is to understand the functions of emotions: (1) to validate our own perceptions and interpretations of events, and (2) to influence or control the behaviors of others. Understanding these functions is the first step in learning to identify the obstacles to changing behavior. Increasing mindfulness without judging or controlling emotion is the key here. Trying to cut off or shut down emotion leads to ruminating about the painful situation. Learning to go through an emotion -- not around it -- is the key. When you have a knowing deep within that you can tolerate a painful or distressing emotion without producing a destructive action, then you are on the road to emotional regulation.
Distress Tolerance is radical acceptance. Surviving a crisis situation is about doing what is effective, but some people are more interested in “woundology,” receiving sympathy for their story, rather than practicing radical acceptance and willingness. We had a really hard time understanding the concept of radical acceptance even after reading the explanations of many gurus. DBT broke radical acceptance into small skills that we could understand. We came to realize that radical acceptance was not fighting reality. Radical acceptance does not judge reality as good or bad, right or wrong, fair or unfair. Radical acceptance requires accepting an unpleasant situation while at the same time believing the situation can change and working for that change. It seemed that these ideas contradicted one another but, in fact, radical acceptance promotes and motivates change. One must cultivate willingness for this to happen, and willingness is focusing on what is effective and purposefully turning the mind toward reality again and again. Like most people, we were opinionated about and had a stake in the outcome of situations. With this attitude there was little room for the God of our understanding to be the source of our supply. Relinquishing control where there was none allowed the God of our understanding to be the source of our wisdom.
In the DBT program, clients contract to a minimum of 26 weeks of DBT Therapy (one hour a week) and DBT Skills Training (two hours a week). Some DBT programs, such as that of the Meehl Foundation, also offer Multifamily Skills Training Groups that teach family members the same skills and language as clients are learning. This training enables family members to become the real conduit for the recovery of their loved ones as they model skills and coach their loved ones. This participation allows families to become excited and motivated instead of exhausted and blaming.
Life after DBT. In 2004, Mark and I (Debra) would start the Meehl Foundation, and I would become a pastoral counselor and a DBT Skills Trainer. In the Spring of 2008 , we will open the Meehl House, a residential group home for people with bipolar disorder and BPD. We know that if we can reach families struggling with this mental illness we can show them that there is a life after diagnosis. Lucinda Johnstone will be our full time DBT therapist. Clients relate to her because she also has a bipolar diagnosis and has made DBT and meditation a disciplined part of her life. We tell our clients and their family members that we have no magic wand and no fairy dust but we do offer a therapy that is proven to work, that this is a way of life, this is recovery.

For more information on the Meehl Foundation’s outpatient DBT family, adolescent and adult client programs or information about transitional group homes, please contact us at www.meehlfoundation.org or 979.798.5182

Campbell, D.R. (1977). How to really love your child. Wheaton, Illinois: Victor Books.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guildford Press.
Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: The Guildford Press.