DBT is the gold-standard behavioral treatment for borderline personality disorder, and its mindfulness handouts are the most concise, varied toolkit to hand any patient in a short visit. Keep mindfulness practice apart from moments of high distress, which need their own skills, and be plain with borderline patients that medication will not fix the core problems.
What it is
DBT is the gold-standard behavioral treatment for borderline personality disorder. Opposite action is one of its core skills.
“DBT, which is gold standard behavioral treatment for borderline personality disorder, opposite action is one of the skills. It's very funny that he deduced one of the core DBT skills on his own, opposite action”
The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026 Marsha Linehan developed DBT out of a combination of behavioral therapy and the Zen tradition of mindfulness.
“Marsha Linehan, who was struggling with borderline personality disorder, went and studied some Zen Buddhism and then develop DBT out of this combination of behavioral therapy and and the Zen tradition of mindfulness”
5:35Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 The three mindfulness "what" skills are observe (just noticing body sensations), describe (putting words to your experience and labeling what you observe, usually without loaded value judgments) and participate.
“So there it really just goes through the three what skills of mindfulness which are observe, describe, participate. For observe, you're just noticing the body sensations. Describe You can put words to your experience and label what you observe, usually without loaded value-based judgments”
43:04Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
How we use it
The DBT mindfulness module is the most concise and most diverse set of mindfulness exercises available, with many different types to try.
“the simultaneously most concise and also uh diverse set of mindfulness type exercises are available within the dbt framework dialectical behavior therapy their mindfulness module has a lot of different things that you can do that are of different types”
40:08Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 Give patients the handouts, not the skills training manual, which is too detailed for non-clinicians. The mindfulness handouts are good for most patients, not only those with a personality condition or cluster B traits.
“these days to be honest with you I pretty much just give them the mindfulness handouts from the DVT manual and this is again not limited to patients who have a diagnosable personality condition or cluster B traits I just think it's a very good handout”
34:59Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Also said in 1 more episode
“not the training manual because they're not clinicians. It's going to be too detailed. The DBT skills training manual does have a set of handouts that you can give patients”
41:28Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 For the basics, read mindfulness handout 1A with the patient: what mindfulness is, what the skills are, and what the practice is.
“So in terms of just the basics of what mindfulness is, I would literally just read with the patient mindfulness handout 1A, which asks the question, what is mindfulness, what are mindfulness skills, and what is the practice”
42:29Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Introduce Wise Mind (handout 3), especially to patients on the borderline spectrum.
“I also want people to get an idea of the Wise Mind. um handout three especially if uh they actually are more borderline spectrum”
45:23Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Targeted, scheduled, regular mindfulness practice, titrated to the individual patient, is a core component of the long-term treatment of borderline personality disorder.
“targeted, Scheduled and regular specific mindfulness practice again titrated and geared towards the individual patient is definitely a core component of the long-term treatment of DSM defined borderline personality disorder”
30:14Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Mapping out your emotions, what happens when you have them and how long they last, is a useful group exercise.
“one of the lessons we were doing was kind of like mapping out your emotions, mapping out what happens when you have those emotions, mapping out how long those emotions last”
24:37Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026 Not yet confident with the material? Search "DBT mindfulness PDF" and teach from that.
“One thing that I do that I did early on in residency when I wasn't as confident with this material, I search DBT mindfulness PDF”
41:39Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
Pitfalls
Mindfulness is not for when you are totally upset. Above about 7 or 8 out of 10 distress, there are different skills for that.
“Because this is not something that you should be doing when you're totally upset, okay? If you're above like a 7 or 8 out of 10 in distress, There are different skills for that”
37:18Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Try not to associate the practice, consciously or unconsciously, with distress. If you need to teach distress tolerance, the DBT TIP skills are great.
“we are trying not to associate the practice psychologically, consciously or unconsciously with distress. Right. If you need to teach distress tolerance skills, the DBT tip skills are great and you can pick other ones”
40:51Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Used to escape panic or distress, mindfulness and grounding work pretty well the first few times, then stop working pretty quickly, like any PRN.
“Because frankly, at least the first time or the first few times, it works pretty well, grounding techniques and mindfulness, to escape panic or distress. It will stop working pretty quickly like any PRN if it's used that way”
39:40Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Describe is a little riskier for ruminators, but it is very individual, so offer a buffet of skills.
“I do feel that Describe is a little riskier when it comes to Ruminators. But again, it's very individual, which is why I just buffet it”
45:01Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Describing the moment ("it's 4 a.m., I've been sleeping for six hours") can help you calm down, even though calming is not its purpose.
“I just described like it's 4am um I've been sleeping for six hours and it actually worked really well. It helped me calm down, which is not the purpose of it, but it did work”
44:49Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026
Talking to patients
Instead of telling someone they have a personality disorder, say this is one way to think about the problem, and the good news is that calibration can change: they can engage in the process.
“Instead of telling someone, hey, you have a personality disorder, sucks to suck, you can say this is one way to think about your problem. And the good news is calibration can change. You can engage in the process”
23:48Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode With a borderline patient who declines therapy, be plain: we are not going to find the right medication that fixes the problems you are experiencing.
“I don't think we're going to find the right medication that's going to make you feel that's going to fix the problems that you're experiencing”
9:31Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024
It also comes up on
- PTSDImagery rehearsal therapy works well for nightmares, and DBT has a good nightmare protocol.
- PsychotherapyModerate to severe borderline conditions should ideally be in weekly psychotherapy, though community resources are limited. Beyond DBT, there is good evidence for transference-focused psychotherapy, mentalization-based therapy and good psychiatric management.
From these episodes
- Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026 · 2 points
- The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026 · 1 point
- Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 · 12 points
- Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 · 2 points
- Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It AllOct 2024 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.