Dialectical Behavior Therapy for Binge Eating and Bulimia (29 page)

Mindfulness Core Skills

DISCUSSION
P
OINT: “What comes to mind regarding how you might satisfy and honor

the wish to rebel without destroying your overall goal of stopping binge eating and/or
purging?”

SUGGESTED
HOMEWORK
P
RACTICE

Therapists instruct clients to fll out the Alternate Rebellion Homework Sheet
(Appendix 4.8) describing their practice of this skill over the following week or
until the next session.

APPENDIx
4.1

List of Mindfulness Core Skills

《
Wise Mind
《
Observe
《
Describe
《
Participate
《
Mindful Eating
《
Nonjudgmentally
《
One-Mindfully
《
Effectively
《
Urge Surfing
《
Alternate Rebellion

Mindfulness “What” Skills

Mindfulness “How” Skills

From Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice
Y. Chen. Copyright 2009 by The Guilford Press. Permission to photocopy this appendix is granted to purchasers
of this book for personal use only (see copyright page for details).

APPENDIX 4.2

Wise Mind Homework Sheet

Wise Mind is intuitive, calm, peaceful, and sure. Wise Mind is an integration of all ways of
knowing: by observing, feeling, analyzing, intuition, and so forth. In Wise Mind, there is a sense
of knowing, of understanding, of experiencing truth. It involves knowing something in a very
centered way. Wise Mind is an experience that comes from deep within, not from your current
emotional state. Wise Mind means that your best self, your wise self, guides you. In Wise Mind
your true self and values, your own internal wisdom, guide you.

Instructions:
In the following space and on the back of this sheet, write about your experiences of
(1) fnding your Wise Mind, (2) experiencing your Wise Mind, and (3) asking yourself, “What does
my Wise Mind say?” Describe what you did to fnd your Wise Mind. Describe your experience of
your Wise Mind. Practice asking yourself, “What would my Wise Mind say?” and “What is wise
responding?” when an Emotion Mind behavior threatens and urges to binge, purge, and/or eat
mindlessly arise. Describe on this practice sheet what your Wise Mind says.

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.3

Emotion Mind Homework Sheet

Emotion Mind means that your emotions are in control—that your thinking and actions are
controlled by your current emotional state. Thinking is hot rather than cool and rational. Behavior
is reactive and lightning fast, rather than measured and with consequences logically considered.

Instructions:
Describe in the following space times during the week when your Emotion Mind was
in control. Describe the circumstances that evoked your Emotion Mind, as well as your Emotion
Mind thinking, actions, and sensations. Describe your experience of Emotion Mind, as well as the
consequences or outcome of your Emotion Mind taking control. What would have been different
had your Wise Mind been in control?

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.4

Reasonable Mind Homework Sheet

Reasonable Mind means that rational thinking and logic are in control of what you do. In
Reasonable Mind, thinking and emotions are cool, and situations are approached in a measured
and nonreactive manner.

Instructions:
Describe times during the week when your Reasonable Mind was in control.
Describe the circumstances that evoked your Reasonable Mind, as well as your Reasonable Mind
thinking, actions, emotions, and sensations. What was your experience of your Reasonable Mind?
In addition, describe the consequences or outcome of your Reasonable Mind taking control.
Write about what would have been different had your Emotion Mind been in control.

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behav—
ior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.5

Mindfulness “What” Skills Homework Sheet

Instructions:
In the following spaces, describe your practice of each of these skills. For example,
describe in detail your experience of Observe, Describe, and Participate. Practice Mindful Eating
(i.e., practice using your Observe, Describe, and Participate skills while eating). Write about your
Mindful Eating practice. Date each of your entries.

Observe

Describe

Participate

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behav—
ior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.6

Mindfulness “How” Skills Homework Sheet

Instructions:
In the following spaces, describe your practice of each of these skills. For example,
describe observing Nonjudgmentally, and write about behaving One-Mindfully and Effectively.
Use the “how” skills to practice Mindful Eating. Write about your Mindful Eating practice, including
a date for each entry.

Nonjudgmentally

One-Mindfully

Effectively

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behav—
ior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.7

Urge Surfng Homework Sheet
Urge Surfng involves mindful observing of urges to binge eat or to eat mindlessly. Urge
Surfng involves stepping back from your experience and using Mindfulness skills, including
nonjudgmental observing and describing of urges, cravings, and food preoccupation. Urge
Surfng involves awareness without mindlessly giving in to the urge. Urge Surfng just notices
without judging the urge, without pushing it away or holding onto it. One simply notices and
describes, moment to moment, the ebb and fow of the urge without reacting to it.

Instructions:
In the following space, describe your practice of Urge Surfng. Be very detailed.
Describe your moment-to-moment observations. Describe the ebb and fow of your thoughts,
feelings, sensations, urges.

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behav—
ior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

APPENDIX 4.8

Alternate Rebellion Homework Sheet

Alternate Rebellion is the opposite of cutting off your nose to spite your face. Alternate Rebellion
involves the nonjudgmental observation of the desire or wish to rebel or retaliate. If your Wise
Mind decision is to act on this desire, then Alternate Rebellion means doing it effectively without
destroying your commitment to stop binge eating. Rebelling Effectively means not shooting
yourself in the foot. You fnd an alternate means of rebellion that is effective and nondestructive.
For example, you may decide to carry out your rebellion imaginally. Be creative in your rebellion.
Act in a manner that maintains your self-respect.

Instructions: In the following space, write about your use of the Alternate Rebellion skill. Describe
the circumstances surrounding the wish to rebel. Describe your thoughts, feelings, sensations,
and behaviors. Describe in detail what you did to Effectively rebel. Describe how this was different
from past rebellions in which you ended up harming yourself.

Adapted from Telch (1997a). Copyright 1997 by Christy F. Telch. Adapted with permission in Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

CHAPTER
5

Emotion Regulation Skills

A
t the heart of DBT for BED and BN is the underlying assumption that indi—
viduals who binge eat (and purge) frequently experience emotional states that they
are ill equipped to skillfully manage. The aim of the Emotion Regulation skills
taught in this module is to help clients acquire, develop, and implement adaptive
skills that will enable them to more effectively manage negative emotional states,
as well as cultivate a greater capacity for positive emotional experiences. Specif—
cally, the Emotion Regulation skills (Appendix 5.1) and homework sheets outlined
in this chapter are designed to enable the client to:
••
••
••
••
••
••

Identify and label emotions.

Understand the function of emotions.

Reduce vulnerability to intense emotions.

Increase the number of positive experiences.

Increase mindfulness to emotions.

Learn to change emotions when doing so would be effective.

It is important to emphasize that the goal of the Emotion Regulation skills is
not
to eliminate negative and unpleasant emotions. Distressing and diffcult feel—
ings are a part of life; they cannot be entirely avoided. However, clients often bring
about or increase their distress and suffering through unskillful means. And this
can
be changed. The goal of the Emotion Regulation skills module is for clients
to learn skillful emotion regulation strategies to reduce the suffering they create
in their lives by, for example, turning to binge eating and other self-destructive
behaviors. An equally important goal is to acquire and practice skills that build
positive experiences and sense of self.

A second important point to underscore at the outset is the issue of judging
emotions or binge-eating behaviors as either “good” or “bad.” Judging in and of
itself is not good or bad, right or wrong. One needs to use judgment in order to
discern whether or not a particular behavior, action, or thought pattern will assist
in achieving one’s goals. Therefore, it is appropriate to question whether a particu-

Emotion Regulation Skills

lar action is skillful or unskillful for the purposes one has in mind. If one desires
long-term happiness and well-being, being able to discern whether binge eating
leads to this goal is useful. Additionally, if harsh or critical judging of one’s emotions increases distress and decreases well-being, a goal would be to drop this type
of judging. Ultimately, the question regarding judging is whether or not it is used
skillfully in the service of one’s goals.