Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

27. Dialectical Behavior Therapy 625participate fully in one’s actions and experiences in a nonjudgmental, onemindful,and effective manner. Observing refers to noticing experiences withoutbecoming attached, allowing thoughts or other internal experiences to flowfreely with full awareness. Describing follows observing and involves labeling orputting words on experiences. Participating is somewhat different and involvesbehaving effectively, without observing and describing internal experiences(e.g., an athlete at peak performance). Being nonjudgmental, including beingaware of judgments and letting go of their literal truth, is a central skill repeatedlypracticed by DBT clients and therapists. Being one-mindful entails asharpening of attentional focus on one thing or activity at a time. This skillinvolves staying in the present moment and not becoming distracted bythoughts about the past or future. Finally, the focus on effectiveness is a keyaspect of mindfulness. Effectiveness refers to behaving in a flexible manneracross contexts in a way that is consistent with one’s values and long-termgoals. The emphasis on effectiveness as a DBT skill illustrates how mindfulnessis a behavioral, psychological, and spiritual practice, extending beyond formalmeditation practice.Additional mindfulness skills specific to DBT-SUD include “urge surfing”and “alternative rebellion.” Urge surfing stems from Marlatt’s treatment foralcohol abuse (Marlatt & Gordon, 1985) and involves awareness of urges touse, coupled with the use of imagery of a wave as the urge is “surfed.” As isalways the case with waves, urges eventually cease. For many, use of this skillhelps considerably in preventing substance use following cravings to use. Alternativerebellion refers to identifying ways to rebel against society, parents, orothers in a skillful way that does not involve drug use. This skill is relevant forthose drug users whose identity as an addict functions as a way to be differentand unique. As a mindfulness skill, alternative rebellion is linked to being effectiveand could include dyeing one’s hair, getting a tattoo, or wearing unusualclothes.Distress ToleranceThe distress tolerance module is designed to teach clients how to tolerate aversiveemotional experiences without behaving maladaptively. A list of crisismanagement skills is taught, including strategies for effective temporary distraction,such as activities eliciting opposite emotions, and squeezing ice or a rubberball. Self-soothing skills are introduced, whereby clients learn to soothe themselvesintentionally during periods of crisis, with calming visual stimuli, sounds,smells, tastes, and objects to touch. In addition, other skills, such as imaginaland relaxation exercises, are taught to improve the current moment, in order toavert crises. Other distress tolerance skills include awareness, breathing, andhalf-smile exercises, as well as radical acceptance of reality as it is in the presentmoment. Overall, distress tolerance skills are intended to interrupt and change