Trauma Recovery and Mindfulness: Techniques for Everyday Life 

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text-revision (DSM-5-tr): 

“Psychological distress following exposure to a traumatic or stressful event is quite variable. In some cases, symptoms can be well understood within an anxiety- or fear-based context. It is clear, however, that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety- or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms” (pg. 448). 

In layman’s terms, experiences of trauma produce diverse reactions or symptoms in individuals that are commonly associated with symptoms of anxiety (excessive worry, heart palpitations, hypervigilance, etc) and fear (nightmares, crying, paranoia, etc). However, the most common reactions/symptoms of trauma are those that we may label as depression (inability to feel pleasure, worthlessness, unhappiness/discontent), anger (irritability, yelling, and/or physical altercations), and out-of-body experiences (feeling disconnected from your body, memories, emotions, or thoughts). In short, many experiences of trauma result in behaviors consistent with intense emotional distress. 

DBT and Trauma 

Marsha Linehan created Dialectical Behavioral Therapy (DBT) to help treat individuals with more intense forms of psychopathology, and while DBT has been shown to be effective for multiple

disorders¹, it is most commonly associated with the treatment of borderline personality disorder (BPD). Studies have shown that trauma is a common experience for individuals with BPD. (Bozzatello et al., 2021; Harned, 2022). Therefore, it makes sense that DBT has been found effective in treating trauma (Bohus et al., 2020; Tanvir et al., 2023; Prililinger et al., 2024). One of the core components of DBT is mindfulness. 

Mindfulness 

Mindfulness is described as intentionally living in the moment, without rejecting or judging the moment, and without attachment to the moment. While you can practice mindfulness through various formats (meditation, prayer, mindful moments (e.g., walking, yoga, exercise, etc)) three techniques make up the core mindfulness skills in DBT: (1) WISE Mind, (2) “WHAT” skills, and (3) “HOW” skills. 

WISE Mind: States of Mind 

DBT has a concept of three states of mind; reasonable mind, emotional mind, and WISE mind. Reasonable mind is the state of mind where logic, facts, and rationalization are prioritized over values and feelings. While it may be effective to operate in this state in the short term, emotions are often ignored or suppressed while in a reasonable mind which can lead to the exasperation of symptoms common as a result of trauma such as depression and dissociation. Emotion mind refers to the state of mind where mood, feelings, and urges are prioritized over logic and reason. Similar to reason mind, emotion mind can be effective in the short term, however, being in a state where your decisions and behaviors are controlled by emotions can also exasperate trauma responses such as anger, irritability, and impulsivity. WISE Mind is the middle ground between a reason mind and emotion 

¹ Ecacy of DBT: Linehan and Wilks (2015) state that DBT is an eective treatment for multiple disorders such as “eating disorders (Safer & Jo, 2010; Safer & Joyce, 2011), depression in older adults (Lynch et al., 2007; Lynch Morse, Mendelson, & Robins, 2003), and a cluster B personality disorders (Feigenbaum et al., 2011) (p.11). The authors also note that “DBT skills component alone (without the individual therapy) to be efficacious for a variety of populations including incarcerated 

women with histories of trauma (Bradley & Follingstad, 2003), ADHD (Hirvikoski et al., 2011), and for intimate partner violence (Iverson, Shenk, & Fruzzetti, 2009) among others” (Linehan & Wilks, 2015, p.11). Furthermore, in a recent systematic review of 18 random controlled treatment studies, Hernandez-Bustamante et al., (2024) found DBT to be an effective treatment in the reduction of suicidality, hospitalizations, mood instability, impulsivity, depressive symptoms, and compliance in those diagnosed with borderline personality disorder.

mind. In WISE mind, emotion and reason are equally valued and thus decisions are more effective as they are informed by logic without discounting feelings. Practicing WISE mind can be effective for treating trauma as it can help you manage addressing triggers and responding to your environment effectively. You can practice engaging in WISE mind through the WISE mind breathing technique (inhaling while thinking “wise” and exhaling to the thought of “mind” until you nd yourself in that state) or talking to your WISE mind (acknowledging the mind state you are in “am I in emotion mind? Reasonable mind? Or wise mind?” and asking WISE mind for guidance on what to do) (Linehan, 2015, pg. 46-51). 

“WHAT” Skills: Observe, Describe, and Participate 

The “WHAT” skills help you take control of your mind by practicing observing, describing, and participating. The “observe” component of the skill asks you to focus your attention on the present moment and what is happening both inside and outside of yourself, without attaching judgment or putting too much weight on the observation. For example, noticing your ve senses and feelings in the moment. The “describe” component of the skill asks you to expand on this by labeling your observations using facts. For example, describe your observations through the 4 W’s (who, what, when, and where). The “participate” component of the skill asks you to engage with the present moment (e.g., engage in conversations happening around you rather than remaining silent) (Linehan, 2015, pg. 53). The “WHAT” skills can be particularly helpful for addressing dissociative (out-of-body experiences and feeling disconnected) symptoms of trauma. 

“HOW” Skills: Non-judgementally, One-Mindfully, and Effectively 

The “HOW” skills help you take hold of your mind by practicing non-judgementalness, one-mindfullness, and effectiveness techniques. The “non-judgementally” component of the skill asks you to consider things with an open mind, without attaching opinions, critiques, or praise to it. However, this does not entail ignoring your emotions, values, or desires; practicing operating non-judgementally, and acknowledging these things without judgement. One way to practice this skill effectively, would be to interpret things through facts. The “one-mindfully” component of the “HOW” skill asks you to concentrate on being present in the moment without engaging in

distractions. For example, completing one chore at a time rather than multi-tasking. The “effectively” component of the skill asks you to be mindful of your desired outcomes in the situation and determine how to achieve that outcome in the most practical/successful way (Linehan, 2015, pg. 60). Leaning into WISE mind or problem-solving can be a good way to engage in this skill. Similar to WISE mind, the “HOW” skills can help you manage triggers and navigate interactions with your environment. 

Through mindfulness, individuals who experienced trauma can learn how to be more in tune with the present, rather than reliving the past or being worried about the future, acknowledge their thoughts and emotions without judgment, and build tolerance for managing and navigating difficult situations/experiences without becoming triggers or having intense adverse responses.

References 

1. Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA psychiatry, 77(12), 1235–1245. https://doi.org/10.1001/jamapsychiatry.2020.2148 

2. Bozzatello, P., Rocca, P., Baldassarri, L., Bosia, M., & Bellino, S. (2021). The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Frontiers in psychiatry, 12, 721361. https://doi.org/10.3389/fpsyt.2021.721361 

3. Harned, M. S. (2022). Treating trauma in dialectical behavior therapy: The DBT prolonged exposure protocol (DBT PE). Guilford Publications. 

4. Hernandez-Bustamante M, Cjuno J, Hernández RM, Ponce-Meza JC. Ecacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials. Iran J Psychiatry. 2024 Jan;19(1):119-129. doi: 10.18502/ijps.v19i1.14347. PMID: 38420274; PMCID: PMC10896753. 

5. Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press. 

6. Linehan, M. M, & Wilks, C. R., (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97-110. 

doi:https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97 

7. Prillinger, K., Goreis, A., Macura, S., Hajek Gross, C., Lozar, A., Fanninger, S., Mayer, A., Oppenauer, C., Plener, P. L., & Kothgassner, O. D. (2024). A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. European journal of psychotraumatology, 15(1), 2406662. https://doi.org/10.1080/20008066.2024.2406662 

8. Tanvir, Z., Bokhari, M. Z., Kareem, R., & Butt, M. G. (2023). The effectiveness of DBT compared to other psychological therapies in patients with a dual diagnosis of PTSD and BPD: A systematic review. Journal of Population Therapeutics and Clinical Pharmacology, 30(18), 1121–1133. https://doi.org/10.53555/jptcp.v30i18.3245