DBT as Spiritual Practice

Yesterday, I attended a one-day training on Dialectical Behavior Therapy, which we use at the hospital to treat patients with various mental illnesses, including borderline personality disorder, depression, and anxiety. As a chaplain, I see many of these patients as they try to understand their illness in terms of their religious beliefs. I've encountered DBT in conversations with these patients (many of whom love to call it Diabolical Behavior Training).

DBT was created by Marsha Linehan, who drew methods from Zen Buddhism to treat suicidal patients. The Buddhist strands are apparent in this therapy. A significant focus of DBT is mindfulness training, learning to focus the mind and attend to one thing at a time. A koan-like 'both-and' aspect is the core of many messages given patients (this is the dialectic part): 'You are doing the best you can' and 'you can do better', or 'I can insist on my rights' and 'I am still a good person'. The Buddhist concept of 'skillful means' runs through the components on skills development and skillful execution.

DBT participants are required to keep a weekly diary card, on which they record numerous aspects of their feelings and behaviors, including use of the skills and abusive or harmful behaviors. The idea is to use the recording to identify patterns and linkages between feelings and behaviors, and then work to modify them.

What strikes me is that DBT looks like spiritual practice, and I mean that in the highest sense. There is an expectation (clearly stated) of mindful attention to the skills and practices. Modifications of lifestyle, such as healthy eating and sleep patterns, are expected of each participant. One is expected to apply an almost devotional repetition to the daily activities through the use of the diary card. These techniques have been shown to be helpful for patients in randomized trials; could they be helpful for all of us, whether healthy or ill? And if DBT can be seen as spiritual practice, does this not support the benefit of spiritual practice (in all forms) for all?

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Mind-Body Medicine

Last week, another chaplain resident and I attended a five-day training presented by the Center for Mind-Body Medicine. What a phenomenal experience. It was a sold-out event, with well over two hundred people in attendance, including over twenty from the hospital system that I am part of. We're talking doctors, nurses, psychotherapists, hospice workers, and the rare chaplain or two.

I have encountered many of the healing and self-care tools presented, including meditation, relaxation, biofeedback, movement, and guided imagery, these have been presented in the past as alternatives to science-based medicine. I loved that this training presented significant scientific evidence supporting these tools, including many controlled double-blind studies. The fact that my hospital system and the Veteran's Administration, among others, is beginning to adopt these tools is most promising. As a chaplain, I know that mind and body and spirit are deeply interconnected.

Much of our time was spent in small process groups: eight sessions of two hours each. My co-worker and I noted how these groups compared to the group we have in our Clinical Pastoral Education residency, and how difficult it was for many people, especially mental health workers, to get comfortable being a group participant. Perhaps they are used to leading groups, and not being a participant, or perhaps they just focus on one-on-one client meetings. Part of my hope is that this work may begin a renaissance of group therapy as part of the overall treatment plan for people dealing with mental health issues.