168 • ii: MindFulnESS in EduCATing FOR SElF-REgulATiOn And EngAgEMEnT
dialectic Behavioral Therapy
DBT was developed by Marsha Linehan for patients with borderline personality disorder
(BPD; Linehan, 1993; Obrien et al., 2008). The term “dialectic” refers to the central tenet of
the therapy—an emphasis on balance and integration of opposing ideas such as acceptance
and change (Baer & Krietemeyer, 2006; Cook-Cottone, 2015; Obrien et al., 2008). Specifically,
DBT provides psychosocial skills training in four modules: core mindfulness skills, interper-
sonal effectiveness skills, emotional regulations skills, and distress tolerance skills (Linehan,
1993). The core mindfulness skills module includes didactic information that provides a
rationale for practicing mindfulness and controlling attention (Baer & Krietemeyer, 2006;
Cook-Cottone, 2015). Linehan (1993) refers to the integration of the cognitive (i.e., reason-
able) mind and the emotional mind as wise mind. The specific skills include teaching patients
what to do when being mindful (i.e., observe, describe, and participate [attend to activity
in the present moment]; Linehan, 1993). Patients are all taught how to be mindful (i.e., non-
judgmentally, one-mindfully, and effectively; Linehan, 1993). The emotional regulation and
distress tolerance modules of DBT also integrate mindfulness skills (Baer & Krietemeyer,
2006). Within the distress tolerance module, patients are taught to notice the rising and
passing away of distressful or uncomfortable feelings or urges (Linehan, 1993). Patients are
taught other skills such as distraction and breath work to assist in tolerating distress (Obrien
et al., 2008). There are many adapted manuals for DBT. See Fleischhaker et al. (2011) for a
description of a DBT adaption for adolescents (DBT-A). For a detailed description of DBT
see Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993) and for
more on DBT training, and resources, go to the Linehan Institute at behavioraltech.org/
index.cfm.
Acceptance and Commitment Therapy
ACT is viewed as a general approach to psychotherapy designed to increase psychologi-
cal flexibility in terms of an individual’s current context (Baer & Krietemeyer, 2006; Felver
et al., 2013; Obrien et al., 2008; Wilson, Schnetzer, Flynn, & Kurz, 2012). Psychological
flexibility has been defined as “the willingness to accept all aspects of one’s experience
without engaging in unnecessary avoidance behaviors, when doing so serves the devel-
opment of patterns of values-congruent activity” (Wilson et al., 2012, p. 27). Specifically,
ACT addresses mindfulness and acceptance skills and behavioral changes needed to help
patients engage in a life that is vital and meaningful (Baer & Krietemeyer, 2006; Obrien
et al., 2008).
Central to ACT is the negotiation of experiential avoidance of feelings, sensations,
cognitions, or urges (Baer & Krietemeyer, 2006; Cook-Cottone, 2015; Felver et al., 2013).
Present moment awareness is encouraged and experiential avoidance is seen as a root
cause of many forms of psychopathology (Baer & Krietemeyer, 2006; Cook-Cottone,
2015; Obrien et al., 2008). Present moment awareness in ACT is consistent with present
moment awareness activities described throughout this text. Specifically, ACT involves a
series of mindfulness activities that encourage observation of present moment experience,
accompanying internal and external sensations, labeling experiences without judgment or
evaluation, and acceptance (Baer & Krietemeyer, 2006; Cook-Cottone, 2015). Values and
committed action is a feature unique to ACT (Baer & Krietemeyer, 2006). The ACT protocol