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?

Picture by Untitled blue