Dialectical Behavior Therapy for Binge Eating and Bulimia (25 page)

Wise Mind

Wise Mind is the state of mind in which clients synthesize all ways of knowing.
Aspects of both Reasonable Mind, such as analyzing, and Emotion Mind, such
as feelings, are included, but Wise Mind is more than the sum of its parts. For
example, Wise Mind includes knowing through intuition, knowing from a place
that comes from deep within. It’s a state of mind that really taps into one’s inner
recognition and experiencing of truth. It means knowing something in a very cen—
tered way.

Wise Mind has a certain peace; it’s not a surface experience. If clients think of
Emotion Mind as the waves and ripples on the surface of a pool after a stone has
been thrown in, Wise Mind would be the waters underneath. It is that deep, cen-

DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA

tered place where a person knows something very clearly. Wise Mind is receptive
and open. It accepts rather than judges. It is patient rather than impatient. Other
terms for Wise Mind are true self, spirit, consciousness, or heart of hearts.

In Wise Mind, the client’s best self takes over. Action is effective when its basis
is wise knowing. In fact, a wise response may be to not act at all
but to just main—
tain awareness of the urge to act—for example, being aware of urges to binge but
not acting on these urges. Wise Mind is aware of emotions and reason as they come
and go but is not controlled by them. The therapist’s self-disclosure about his or
her use of Wise Mind in everyday life can be especially effective in illustrating the
concept. As an example, one of our therapists disclosed the following:
“I have worked a great deal to fgure out what it is that I’m really feeling inside.
I’ve had to have a strong intention to separate myself and what I think from
absorbing what someone else around me thinks. For example, I have a signif—
cant other who is the kind of driver who always believes there’s suffcient time
to make a turn against an oncoming driver. I am a more cautious driver. One
day we were driving and as usual my partner was pressing me to just go ahead
and take the turn. In a gut way I knew that this was not the time to press my
luck because it was a busy intersection at rush hour, and, in fact, just then a
car rushed by. This was the right decision for me and involved trusting my
own sense and not doing something to please my partner. That’s an example
of Wise Mind in my everyday life. I know I’ve been able to tune into it when it
feels like a gut response from deep within. I don’t want to make it sound like
Wise Mind is necessarily calm. Imagine making a decision about separating
conjoint twins. You would use all the current science to make a Wise Mind
decision. Though you might fnd a level of peace with the decision, it wouldn’t
be calm. It would be agonizing. The point is that you would know you had made
a Wise Mind decision even when it might be the most diffcult and wrenching
decision you’ve ever had to make.”

DISCUSSION
P
OINT: “Take a minute to think of a time in your life when
your behavior was
infuenced by your access to your Wise
Mind.”

It is useful to point out that everyone
has a Wise Mind—whether or not it has
ever been experienced: Having a Wise Mind is like having a heart. It is part of the
defnition of being a human being and everybody has one. However, some hearts
are stronger than others, and this can be infuenced by the amount of exercise one
does, the amount of attention one pays to strengthening this muscle. Binge eating
(and purging), mindless eating, and other problematic eating behaviors interfere
with being in touch with Wise Mind—with one’s best self, with one’s clarity of
being, with that clear inner sense of what’s important. Especially initially, clients
may not have ready access to their Wise Minds or may not have experienced this
connection lately.

Therapists may wish to use the next exercise to offer clients a chance to prac—
tice accessing Wise Mind and to be helped to avoid acting on urges to use food. It
is important to make clear that no one client’s experience of Wise Mind will be the

Mindfulness Core Skills

same as anyone else’s. Furthermore, there is no formula or set of tricks to accessing Wise Mind. Clients will have to determine which ways work best for them; the
following exercise is just one option. Clarify that although one cannot force access,
this does not mean that one cannot do anything to better position oneself for such
access. Practicing the Mindfulness skills, for example, paves the way or sets up the
conditions for accessing Wise Mind. It brings one “into the vicinity.” The following
script can be modifed as needed.

ExPERIENTIAL
Ex
ERCISE:
FINDING
Y
OUR
W
ISE
M
IND

“Let’s start off fnding a place for your eyes to gently focus so that you’re not dis—
tracted. Let the chair fully support you as you sit comfortably, your legs on the foor
and your hands on your knees or lap. Imagine a string is running through your
head up to the ceiling, keeping you upright. If you fnd your mind wandering, notice
this and bring it gently back to the exercise. We’ll begin by following your breath.
This is often a helpful way to facilitate mindfulness, as it anchors you into the present moment. You don’t have to do any type of special breathing, just be aware of
your breathing. It may help to initially note the sensation of air moving in and out
of your nostrils. And as you breathe, see if you can go into yourself and fnd a place
of calmness, of peace. Some people fnd it helpful to imagine themselves as a stone
or pebble slowly sinking into a warm lake. The surface of the lake has ripples, but
as you sink down into the water, it becomes more still. Imagine yourself foating
down ... gently ... slowly. Allow yourself to sink and settle calmly into the sandy
bottom of the lake. You are at rest. The sandy bottom is fully supporting you. From
this quiet, peaceful place, you have distance from the choppy surface, and you can
get in touch with your core values. Operating from your Wise Mind, you can see
and respond to what is, to reality. You are your true self, your spirit, your con—
sciousness. You become open to experience itself. Let your deep inner wisdom give
you direction in guiding your actions so that they’re consistent with your values.
Now, take three deep, slow, fowing breaths as you leave this image.”

DISCUSSION
P
OINT:

“What was that experience like for you?”

Therapists emphasize that the most important thing about learning to use the
skill of accessing Wise Mind is to practice, practice, practice! Because clients are
most vulnerable to binge eating (and purging) when in Emotion Mind, they might
fnd it helpful to try to notice when emotions are beginning to become very intense.
The goal is for clients to reach the point at which they wake up to the fact that
their actions are being controlled by their Emotion Mind. This awareness in and
of itself helps to break the automatic link between emotional dysregulation and
problematic eating behaviors. By then focusing on their breathing and anchoring
in the present, clients should gradually fnd themselves more and more skillful at
shifting from Emotion Mind to their inner wisdom.

DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
TROUBLESHOOTING
D
IFFICULTIES
IN
T
EACHING
THE
T
HREE
S
TATES
OF
M
IND

••
Example: “Does binge eating always take place in Emotion Mind, when you’re
triggered by emotions? It seems as much a habit as anything else.”

••
Potential therapist reply
: “It’s important to be clear about how one defnes
‘habit.’ Some people use the word to imply that something just happens—that it
takes place without a cue and cannot necessarily be understood. To my way of
thinking, binge eating is a learned behavior. What I defnitely believe, however, is
that over time it can become so ‘overlearned’ that it starts to feel automatic. That’s
why it’s so helpful to use the chain analysis. When I think of a ‘habit,’ I think of a
lack of awareness. That lack of awareness is not Wise Mind. Without the awareness, one couldn’t be in touch with which emotions one was experiencing. Binge eating is also not effective behavior and so would probably not be Wise Mind behavior.
By gaining access to a wise, peaceful state of mind, your experience of what now
feels like a ‘habit’ may broaden.”

SUGGESTED
HOMEWORK
P
RACTICE

1.
Therapists instruct clients to complete the Wise Mind Homework Sheet
(Appendix 4.2). Clients should write about an experience in which they use their
Wise Mind over the following week. Clients should pay attention to a time when
they noticed that their thoughts and behaviors were driven by their Emotion Mind
and felt an urge to engage in problem eating behavior. At that time they should
practice accessing their Wise Mind by asking “What would my Wise Mind say
here?” or “How would I respond wisely?”

2.
Therapists instruct clients to fll out the Emotion Mind and Reasonable Mind
Homework Sheets (Appendices 4.3 and 4.4), writing about at least one instance of
being in each state of mind during the following week. In particular, clients should
notice what gets them into Emotion Mind and how this state of mind differs from
Wise Mind and Reasonable Mind. Therapists should point out that by using these
writing exercises, clients will increase their awareness of what state of mind they
are in.

3.
Therapists suggest that clients make it a point to practice getting in touch
with their Wise Minds every day. Purposely setting aside time to practice will be
most helpful, so as not to become distracted by trying to do something else simulta—
neously. Therapists encourage clients by reminding them that it may take a while
to fnd their Wise Minds and that a helpful way to practice is to begin by using
diaphragmatic breathing, bringing their attention to their breath. Once clients
have found their Wise Minds, they will often fnd it a good time to renew their
commitment to refrain from binge eating (and purging) and other problem eating
behaviors.

Mindfulness Core Skills

ORIENTATION TO MINDFULNESS “WHAT” SKILLS

The core Mindfulness skills include two sets of skills to help strengthen the client’s
ability to open her or his Wise Mind. The frst set of these includes the “What”
skills. They answer the question “What
do individuals do to try to facilitate getting
in touch with their Wise Minds?” These skills are Observe, Describe, and Partici—
pate.

Observe

The skill Observe involves sensing or experiencing without labeling or putting
words to the experience. In other words, clients are placing attention on some—
thing and noticing the experience without getting caught up in it, judging it, or
reacting to it. Like a guard watching over a castle gate, clients will use Observe
to control where they place attention but not what they see. Point out that clients
can use Observe for things that are outside themselves, or they can step inside
and Observe their internal experiences—such as their thoughts and/or emotions.
Remind clients that it is much harder to engage in binge eating (and purging) or
other problem behaviors when they are focused on observing urges to binge or the
sensations of eating. As therapists make clear, it is necessary to be able to step
back and Observe in order to have a wise and nonreactive awareness of events.
Therapists may wish to use the following sample script, modifying as needed, to
experientially introduce the skill.