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Dialectical Behavioral Therapy (DBT): Empirical Evidence and Clinical Applications from a Christian Perspective



Dialectical behavior therapy (DBT) is a comprehensive evidence-based treatment originally developed for individuals with borderline personality disorder endorsing histories of parasuicidal behavior. Incorporating elements of mindfulness, metacognition, and acceptance into its treatment repertoire alongside more conventional cognitive and behavioral interventions, DBT can be categorized as a third wave cognitive-behavioral treatment along the likes of Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy (MBCT). This article summarizes the core concepts and the key elements of DBT’s conceptual framework, along with empirical research supporting its efficacy and effectiveness in treating not only borderline personality disorder, but a host of other conditions as well. While many of the skills in the DBT treatment model may be readily applied by Christian therapists working with Christian clients with little or no interaction or tension raised in relation to matters of faith, the authors highlight some areas of consideration that may warrant a more thoughtful engagement—offering suggestions on how to navigate these potential challenges along the way.
Journal of Psychology and Christianity
2016, Vol. 35, No.1, 68-76
Copyright 2016 Christian Association for Psychological Studies
ISSN 0733-4273
therapy (CBT) incorporating cognitive interven-
tions, and the third wave of behavioral therapies
being characterized by the integration of themes
such as metacognition, emotions, dialectics, and
the therapeutic relationship (Kahl, Winter, &
Schweiger, 2012), along with mindfulness and
acceptance. Following this taxonomy, DBT can
be categorized as a third wave treatment (Tan,
2011), along the likes of Acceptance and Com-
mitment Therapy (ACT; Hayes, Strosahl, & Wil-
son, 2012; Hayes & Strosahl, 2004), Mindfulness
Based Cognitive Therapy (MBCT; Segal,
Williams, & Teasdale, 2013), and Mindfulness
Based Stress Reduction (MBSR; Kabat-Zinn,
1982; see also Alidina 2015). It should be noted
that more recently, integrative books on ACT for
clergy and pastoral counselors (Nieuwsma,
Walser, & Hayes, 2016) and faith-based ACT
specifically for Christian clients (Knabb, 2016)
have also been published.
The standard DBT treatment program is com-
prehensive in scope, with patient care spread
across a variety of treatment modalities, including:
case management, skills training (which can be
administered within the context of group or indi-
vidual therapy), between-session skills coaching,
and a therapist consultation team (Linehan, 2015b;
see also Linehan 2015a); this standard treatment
Dialectical Behavioral Therapy (DBT):
Empirical Evidence and Clinical
Applications from a Christian Perspective
David C. Wang
Biola University
Siang-Yang Tan
Fuller Theological Seminary
Dialectical Behavioral Therapy (DBT) is an
evidence-based treatment originally developed
and evaluated for individuals with borderline
personality disorder (BPD), endorsing histories
of multiple nonfatal suicidal behaviors (Linehan,
1993). DBT incorporates a broad array of
behavioral (e.g., exposure, contingency manage-
ment) and cognitive (e.g., cognitive restructur-
ing, problem-solving skills training) techniques,
along with contextual and experiential change
strategies such as mindfulness and radical
acceptance (Hayes, Follette, & Linehan, 2004;
see also Brown, Creswell, & Ryan, 2015; Herbert
& Forman, 2011; and the recent October 2015
special issue of the American Psychologist on
“The Emergence of Mindfulness in Basic and
Clinical Psychological Science”). Hayes, Luoma,
Bond, Masuda, and Lillis’ (2006) history of
behavioral therapy delineated three generations
(or waves) in the evolution of this particular line
of psychotherapies, with the first wave of tradi-
tional behavioral therapy in the 1950s focusing
on classical conditioning and operant condition-
ing, the second wave of cognitive behavioral
Correspondence concerning this paper should be
addressed to David C. Wang, Th.M., Ph.D. at Rose-
mead School of Psychology, 13800 Biola Avenue,
La Mirada, CA 90639.
Dialectical behavior therapy (DBT) is a comprehensive evidence-based treatment originally developed for
individuals with borderline personality disorder endorsing histories of parasuicidal behavior. Incorporating
elements of mindfulness, metacognition, and acceptance into its treatment repertoire alongside more con-
ventional cognitive and behavioral interventions, DBT can be categorized as a third wave cognitive-behav-
ioral treatment along the likes of Acceptance and Commitment Therapy (ACT) and Mindfulness Based
Cognitive Therapy (MBCT). This article summarizes the core concepts and the key elements of DBT’s con-
ceptual framework, along with empirical research supporting its efficacy and effectiveness in treating not
only borderline personality disorder, but a host of other conditions as well. While many of the skills in the
DBT treatment model may be readily applied by Christian therapists working with Christian clients with lit-
tle or no interaction or tension raised in relation to matters of faith, the authors highlight some areas of con-
sideration that may warrant a more thoughtful engagementoffering suggestions on how to navigate these
potential challenges along the way.
dialectic of DBT. Which is why in practice, DBT
therapists often switch, potentially on a moment’s
notice, between supportive acceptance interven-
tions and more confrontational (at times border-
ing on irreverent) change interventions. The
term “dialectics,” as it is applied to behavior ther-
apy, refers to “the reconciliation of opposites in a
continual process of synthesis” (Linehan, 1993, p.
19), which occurs within the context of a holistic
view of reality—one that is highly contextual and
stresses the interrelatedness of its various compo-
nents (Rizvi, Steffel, & Carson-Wong, 2013).
While more traditional approaches to mental
health treatment might seek to identify, isolate,
and then treat the pathology within an individual,
the dialectical perspective of DBT affirms the
presence of health and function even within the
context of pathology and dysfunction. Part of
the task of the DBT therapist, therefore, is to rec-
ognize and validate this “kernel of truth” inherent
even in the client’s most apparently maladaptive
and destructive behavior. To illustrate, Linehan
(1993) posits that individuals with borderline per-
sonality disorder may at times engage in parasui-
cidal behavior because such behavior is often
what is required to elicit a helpful response from
their social environment. The kernels of truth
that a therapist can validate, from this example,
might be the client’s sense of genuine emotional
desperation as well as their intention to elicit
help from others to meet legitimate needs.
Linehan’s (1993) biosocial theory, the primary
tenets of which have recently received empirical
support (Reeves, James, Pizzarello, & Taylor, 2010),
forms the theoretical underpinnings of DBT’s treat-
ment approach. This theory is built on the premise
that (similar to many other mental health prob-
lems) both suicidal behavior and borderline per-
sonality disorder are, at their core, disorders of
emotion regulation (Linehan, 2015b)—which can
potentially express itself broadly over the emotion-
al, behavioral, cognitive, and interpersonal aspects
of an individual (Crowell, Beauchaine, & Linehan,
2009). For individuals with borderline personality
disorder, dysfunction of the emotional regulation
system is understood to result from the combina-
tion and interaction of certain biological predispo-
sitions (e.g., for high emotional intensity, sensitivity
to emotional stimuli, slow return to baseline fol-
lowing emotional reactions) and certain dysfunc-
tional environments (i.e., chronically emotionally
invalidating environments that do not allow indi-
viduals to learn how to label and regulate emotion-
al arousal, tolerate distress, or trust their emotional
program can also be accompanied by pharma-
cotherapy as well as acute-inpatient psychiatric
care. Due to limitations in available on-site
resources, many mental health service providers
(e.g., individual therapists operating out of a pri-
vate practice context) have elected to provide
DBT skills training as a stand-alone treatment. As
will be outlined in more detail later, although the
majority of research on the efficacy of DBT con-
sists of clinical trials involving the full standard
DBT treatment program, an emerging empirical lit-
erature is suggesting that skills training alone can
also be effective in many situations as well (Line-
han, 2015b).
Part of the original impetus for the develop-
ment of DBT came from observations made by
Linehan concerning the limitations inherent in
conventional cognitive-behavioral therapy—as
they specifically applied to the treatment of para-
suicidal individuals diagnosed with borderline
personality disorder. Of note, empirical evidence
suggests that purely content-oriented cognitive
interventions, such as the restructuring of mal-
adaptive thought patterns, does not in fact signifi-
cantly increase the effectiveness of cognitive
therapy (Longmore & Worrell, 2007). Moreover,
dismantling studies indicate that it may actually
be the behavioral components (e.g., behavioral
activation) of cognitive therapy that account for
its efficacy (Dobson et al., 2008; Dimidjian et al.,
2006). Alongside these potential limitations,
Linehan (1993) added her observation that
patients with borderline personality disorder
tended to find conventional cognitive-behavioral
therapy difficult to accept, as they often experi-
enced the course of treatment (with its prominent
emphasis on identifying and challenging beliefs
that are understood to be irrational or problemat-
ic in some way) to be inherently emotionally
invalidating. In contrast, DBT prominently
emphasizes the importance of the therapeutic
relationship as an integral ingredient for change,
with special emphasis being placed on potential
therapist-patient interpersonal dynamics that may
interfere with the therapy process.
DBT treatment emphasizes the importance of
balancing change with acceptance, moving a step
beyond standard cognitive-behavioral therapy by
retaining its change strategies while paradoxically
maintaining a concurrent emphasis on teaching
patients to accept themselves and their world as
it is in the moment. This paradox of accepting
patients just as they are within a context of help-
ing them change represents the fundamental
responses as reflections of valid interpretations of
events). The product of such a combination/inter-
action is an individual who is both emotionally vul-
nerable as well as deficient in emotion modulation
skills (Linehan, 1993). Accordingly, DBT inter-
venes by teaching clients to validate their own
emotional responses and giving them skills and
strategies to regulate their emotions in an effective
and safe manner.
DBT skills are organized into four skills mod-
ules: core mindfulness, interpersonal effective-
ness, emotion regulation, and distress tolerance.
The core mindfulness skills are titled accordingly
because these skills are considered core/integral
to the application of all other DBT skills. The
core mindfulness module speaks of three states of
mindthe reasonable mind (the state of mind
that is analytical, rational, or logical), the emotion
mind (the state of mind where emotions drive
thinking and behavior), and the wise mind (the
state of mind that integrates reasonable mind and
emotion mind, guiding one to act thoughtfully
and intuitively, with minimal internal conflict).
Mindfulness skills are divided into two categories:
“what” skills and “how” skills. “What” skills refer
to what one can do to be mindful: observe,
describe, and participate. “How” skills, on the
other hand, refer to the posture or approach one
is to follow as they practice the “what” skills: non-
judgmentally, one-mindfully, and effectively.
Interpersonal effectiveness skills help individuals
assert themselves skillfully in situations that may
require them to say “no” to others’ requests or
when they find themselves in need of asking oth-
ers for something to achieve a goal. Emotion reg-
ulation skills provide tools that help people more
accurately identify emotions (leveraging skills in
part learned from the core mindfulness module),
understand the function that emotions play, and
decrease both emotional sensitivity (i.e., the fre-
quency and likelihood of having negative emo-
tions) as well as emotional intensity (i.e., the level
and duration of emotional arousal). Last, distress
tolerance skills are pragmatic, short-term skills
designed to help individuals persevere through
crisis situations without engaging in dysfunctional
behavior (e.g., substance abuse, self-harm) that
will make their situation worse. Among the
strategies highlighted in this module are reality
acceptance skills (e.g., radical acceptance), which
guide clients towards accepting reality as it is
when they find themselves in painful situations
that cannot be changed.
Empirical Evidence for DBT
DBT is considered the most well researched
treatment for borderline personality disorder?a
condition that historically has been known to be
difficult to treat, with low rates of client retention
coupled with high rates of burnout among thera-
pists working with this clinical population (Choi-
Kain & Gunderson, 2009). DBT meets Chambless
et al.’s (1996) criteria as a well-established treat-
ment, with at least two group-design experiments
conducted in at least two independent research
settings and by two independent investigatory
teams, all finding that treatment was statistically
significantly superior to either a psychosocial
placebo or to another treatment. To date, DBT
has at least fifteen randomized controlled trials
(Neacsiu & Linehan, 2014), which have been con-
ducted by independent research teams spanning
North America (e.g., Linehan et al., 1991; McMain
et al., 2009), Europe (e.g., Verheul et al., 2003),
and Australia (Carter et al., 2010). In its initial
randomized controlled trial, Linehan et al. (1991)
investigated the effect of DBT on parasuicidal
women with BPD; a series of follow up RCT stud-
ies by this same team examined the effect of DBT
on samples of substance dependent women with
BPD (Linehan et al., 1999), opiate-addicted
women with BPD (Linehan et al., 2002), and then
BPD women with a recent history of suicidal and
self-injurious behavior (Linehan et al., 2006). Of
note, empirical evidence across multiple studies
thus far have established not only the efficacy of
DBT for borderline personality disorder, but also
its long-term effectiveness post-treatment (Kliem,
Kroger, & Kosfelder, 2010).
In addition to borderline personality disorder, a
growing literature attests to the efficacy and effec-
tiveness of DBT in treating a host of additional
conditions and disorders. For example, a recent
meta-analysis of randomized controlled studies
confirmed the efficacy of DBT in treating depres-
sion, with a large average observed effect size
(pooled Hedges’ g= -0.896; Panos, Jackson,
Hasan, & Panos, 2014). Results from RCTs have
also indicated that DBT significantly reduces anxi-
ety (Bohus et al., 2004), hopelessness (Koons et
al., 2001; Linehan et al., 1991), anger (Koons et
al., 2001; Linehan, Tutek, Heard, & Armstrong,
1994), global psychopathology (Kliendienst et al.,
2008; Bohus et al., 2004), eating disorders (Klien-
dienst et al., 2008), and impulsive behaviors (Ver-
heul et al., 2003), while enhancing or increasing
clients’ general functioning (Stoffers et al., 2012),
interpersonal functioning (Bohus et al., 2004), and
reasons for living (Linehan et al., 1991).
Since its original development, the standard
Dialectical Behavior Therapy treatment program
has also been adapted for use with additional
clinical populations and disorders, with positive
results. DBT for borderline personality disorder
with severe posttraumatic stress disorder after
childhood sexual abuse (DBT-PTSD; Steil, Dyer,
Priebe, Kleindienst, & Bohus, 2011), for example,
was developed to meet the unique needs of indi-
viduals with comorbid BPD and post-traumatic
stress disorder (PTSD) secondary to childhood
sexual abuse. Its initial pilot study reported sig-
nificant reductions in PTSD symptoms (Steil et
al., 2011), with subsequent studies replicating
these results with additional clinical samples
(Bohus et al., 2013; Kruger et al., 2014). Another
recent and promising adaptation of the standard
DBT treatment program is Dialectical Behavior
Therapy for school refusal (DBT-SR; Chu, Rizvi,
Zendegui, & Bonavitacola, 2015), a multimodal
intervention for severe emotional and behavioral
dysregulation among adolescents exhibiting
school refusal behavior.
Although DBT was originally developed as a
treatment for adults, the literature supporting its
application and adaptation for adolescent popula-
tions has grown significantly over the past few
decades (Katz et al., 2004), with Miller (1999)
among the first to propose and codify an adapted
version of DBT for adolescents (DBT-A). Of spe-
cial interest is Miller, Rathus, & Linehan’s (2007)
manual on DBT adapted for suicidal adolescents,
which incorporates a modified treatment struc-
ture that better incorporates family members into
the treatment process, modified skills handouts
and worksheets, as well as an updated theoretical
base with dialectical dilemmas that are better
suited for adolescents (e.g., excessive leniency
vs. authoritarian control, pathologizing normative
behaviors vs. normalizing pathological behav-
iors). Empirical evidence, drawn largely from
quasi-experimental studies, support the effective-
ness of DBT-A for a range of emotional dysregu-
lation problems among adolescents, including
self-harm behavior (Fleischhaker et al., 2011;
James et al., 2008), depression (Mehlum et al.,
2014; Katz et al., 2004), dissociative symptoms
(Woodberry & Popenoe, 2008), binge eating
(Safer, Lock, Couturier, 2007), and impulse disor-
ders (Shelton, 2011); these studies span multiple
treatment contexts (e.g., inpatient, community
and psychiatric outpatient settings). To date,
adaptations of DBT also exist to treat adolescents
with bipolar disorder (Goldstein et al., 2007),
oppositional defiant disorder (Nelson-Gray et al.,
2006), as well as anorexia and bulimia nervosa
(Salbach-Andrae et al., 2008).
As noted earlier, due to the comprehensive
scope of the standard DBT treatment program,
which requires a team of practitioners providing
care through multiple treatment modalities, many
mental health service providers have elected to
offer their clients DBT skills training as a stand-
alone treatment due to limitations in available on-
site resources. Although the majority of research
on the efficacy of DBT consists of clinical trials on
the standard DBT protocol, empirical evidence
that speak to the effectiveness of DBT skills train-
ing alone is also well established. Clinical RCTs
indicate that DBT skills training alone is effective
in decreasing depression (Van Dijk, Jeffrey, &
Katz, 2013), anxiety (Soler et al., 2009), binge eat-
ing (Safer & Jo, 2010), ADHD symptoms (Hirvikos-
ki et al., 2011), intimate partner violence
(Cavanaugh, Solomon, & Gelles, 2011), and
aggression and impulsivity (Shelton, Sampl,
Kesten, Zhang, & Trestman, 2009). Moreover,
additional evidence from non-RCT studies suggest
that DBT skills training can also be effective in sig-
nificantly decreasing the frequency of seizures
among patients diagnosed with conversion disor-
der (Bullock, Mirza, Forte, & Trockel, 2015), lessen
perceived burden and emotional overinvolvement
among family members of individuals who have
attempted suicide (Rajalin, Wickholm-Pethrus,
Hursti, & Jokinen, 2009), facilitate grieving among
relatives of individuals with BPD (Hoffman et al.,
2005), and increase social adjustment among
female survivors of domestic abuse (Iverson,
Shenk, & Fruzzetti, 2009).
Clinical Applications
The popularity of DBT and DBT skills training
in various mental health treatment contexts
(ranging from full-service inpatient psychiatric
facilities to individual practitioners operating out
of a private practice) is not surprising given its
substantial empirical base, the comprehensive
scope of its skills modules, the thoroughness of
the treatment manual, and the applicability and
adaptability of DBT interventions to treat a vast
and growing number of conditions beyond bor-
derline personality disorder. In addition to Line-
han’s published work, there are now several
other books available on the practice of DBT
that are particularly helpful to clinicians and
practitioners (e.g., Dimeff & Koerner, 2007;
Koerner, 2011; McKay, Wood, & Brantley, 2007;
Pederson, 2012, 2015; Van Dijk, 2013). Indeed,
even clinicians who do not primarily operate out
of a behavioral or cognitive-behavioral theoreti-
cal orientation may still readily find occasion to
integrate DBT skills training into their clinical
work because many clients, despite their level of
motivation and/or insight, may not actually pos-
sess all the requisite skills necessary for change.
For instance, some clients may continue to strug-
gle with saying no to other people not because
they remain unconvinced of their need to do so
or because they haven’t come to terms with the
many consequences resulting from not doing so
in the past?but simply because they’ve rarely
practiced or seen this behavior modeled by oth-
ers and as a result, never had an opportunity to
learn how to do it in real life. In such cases,
the contents of the DBT training manual and
corresponding DBT skills training handouts and
worksheets booklet would be an excellent
resource for clinicians to draw upon in providing
the necessary scaffolding for their clients to build
competence and remediate skills deficits. While
many of the skills in the DBT repertoire may be
readily applied by Christian therapists onto
Christian clients with little or no interaction or
tension raised in relation to matters of faith (in
fact, Sandage et al. (2015) recently manualized a
group forgiveness module within DBT, with
promising empirical results), some aspects of the
treatment model may warrant more thoughtful
engagement (see Tan, 2011; see also Symington
& Symington, 2012; cf. Hathaway & Tan, 2009).
Below, we will highlight a few key areas of con-
sideration, offering suggestions—whenever
applicable—on how to possibly navigate poten-
tial challenges along the way.
First, it is noteworthy to point out that the Chris-
tian doctrines of justification and sanctification
convey a certain paradoxical posture in the man-
ner God relates to His people that is not unlike
the fundamental dialectic of DBT—that is, of God
loving, accepting, and redeeming
individuals—declaring them as righteous just as
they are, even while they were still sinners (cf.
Romans 5:8) all the while inviting them into a life-
long journey of becoming increasingly set apart
for His work (cf. Ephesians 2:10) and confirmed
into His likeness (cf. Romans 8:29). Indeed, DBT’s
emphasis on accepting individuals as they are
within a context of helping them change should
not at all be unfamiliar to Christians because this
theme is central not only to the mission of the
Church but also the testimony of Christ Himself.
Bonhoeffer (1937/1995) explained, “the Word of
God had become flesh, it had come to take sin-
ners to itself, to forgive and to sanctify. It is this
same Word which now makes its entry into the
Church” (p. 250). Furthermore, this dialectic of
acceptance and change is also a fundamental char-
acteristic of lived Christian spirituality, which
according to former archbishop of Canterbury
Rowan Williams (1990), is in part grounded in the
paradox of the incarnation: “God in flesh, ‘raising
up in power with himself the whole man,’ leaves
us with a ‘restless spirituality,’ always liable
to…change” (p. 67).
The DBT concept of wise mind (i.e., the state of
mind that integrates or synthesizes reasonable
mind and emotion mind, guiding one to act
thoughtfully and intuitively) can similarly be under-
stood and conveyed from a Christian perspective.
Indeed, Scripture affirms the rightful place of both
rationality (cf. 1 Corinthians 13:11, Isaiah 1:18-20)
and emotion (cf. Ecclesiastes 3:4-6, Proverbs 17:22,
Mark 14:32-34) in the human constitution, both of
which are grounded in our being created in the
image of God (e.g., Augustine, 1991; Aquinas,
2006). Richard Rohr’s (2013) distinction between
the Christian’s true self and false self may be a par-
ticularly helpful analogy to employ here as well.
According to him, the embodiment of one’s true
self (i.e., who we are objectively in God) is under-
stood to be foundational to the spiritual journey; it
also implies a freedom from forms of internal con-
flict (between the mind and heart, rationality and
emotion) that often arise out of our tendency to
build, protect, or maintain fragile and idealized
self-images—many of which may turn out to be
religiously-themed (e.g., seeing oneself as a good
Christian, a spiritual leader, or as spiritually-
mature). In step with this line of thought, David
Benner (2011) conceptualized the process of
authentic spiritual growth and maturity as “a jour-
ney from fragmentation to integration, from alien-
ation to alignment, from part to whole…a journey
towards being at one—at one within our self and
at one with all that is” (p. 170). In contrast, Chris-
tian spiritualities that fall short of this journey may
exhibit a tendency to equate faith with thoughts
and beliefs, reducing it to mere mental processes;
alternatively, they may be overly concerned with
superficial behavioral change, cutting people off
from their deep longings and desires because such
longings may potentially seek an unacceptable out-
let of expression and are often difficult to keep
under control. Such false Christian spiritualities
bear little resemblance to the restless soul of St.
Augustine in Confessions, who modeled a robust
Christian spirituality that was formed by both deep
emotion and intellectual rigor.
The principle and practice of non-judgment is
another foundational component of the DBT
treatment model—for example, it comprises one
of the “How” skills in the core mindfulness mod-
ule and is foundational to the practice of the
many reality acceptance skills presented in the
distress tolerance module. Practicing non-judg-
ment requires people to observe, describe, and
participate in life without labeling or evaluating
things as “good” or “bad,” positively or negatively,
or through the lens of “should” and “shouldn’t.”
It is common for facilitators of DBT skills groups
to lead group members in rephrasing statements
of judgment (e.g., “Chocolate is good,” “That driv-
er was a horrible person”) into statements that are
merely descriptive (e.g., “I like chocolate,” “I was
cut off and almost had an accident”). In doing so,
clients learn to more thoughtfully and accurately
distinguish the objective facts of their circum-
stances from the judgments that they impose on
their experiences, which in turn can support more
adaptive problem-focused coping behavior—to
illustrate, thinking “I’m a terrible person” after
putting one’s family at risk due to substance
abuse can trigger guilt and shame responses
which in turn make it even more difficult for that
individual to think about what’s actually needed
to change the situation.
Practicing non-judgment may turn out to be an
especially difficult endeavor for some Christian
clients, who (perhaps unknowingly) have been
socialized at an early age in their religious
upbringing to automatically apply moral judg-
ments to their own behavior as well as the
behavior of others. Although Scripture gives
clear warning about judging others (cf. Matthew
7:1-2), clarifying that it is God who is the ulti-
mate judge (cf. James 4:12), elsewhere, Chris-
tians are instructed to not only judge sinful
believers (cf. 1 Corinthians 5:12-13) but to do so
with mercy (cf. James 2:12-13). Indeed, Chris-
tians cannot indefinitely suspend all forms of
judgment, because doing so would be antitheti-
cal to their faith—for example, it would deny the
reality of sin, the depravity of human nature, and
the need for redemption in Christ Jesus. Never-
theless, we believe that Christians can still bene-
fit from practicing non-judgment, with perhaps a
few caveats in place. First, it may be helpful to
speak of the importance and benefits of sus-
pending judgmentfor a time, rather than remov-
ing all judgment (or alternatively, despairing
over or denying the possibility or tenability of
making any kind of judgment at all). Because
judgments suspend meaning making and the
emotional processing of experiences, the pur-
pose of suspending judgment would be create
space to more clearly see and give proper con-
text to the behavior or situation being judged.
Anecdotally, we have found that when Christian
clients practice non-judgment, especially in rela-
tion to observations or descriptions of their own
suffering, the temporary suspension of guilt
(e.g., “It was my fault”) or shame-based judg-
ments (e.g., “I should be doing better than I
am”) can in fact lead them to a breakthrough
where they, perhaps for the first time, bear wit-
ness to the compassion that God has for them
even as He sees their suffering.
Finally, the mindfulness component of DBT
from a Christian perspective needs to be contex-
tualized “within a Christian contemplative tradi-
tion of learning to be mindful of the sacrament
or sacredness of the present moment, and sur-
rendering to God and His will…. Clients can be
encouraged to let their thoughts come and go,
especially to Jesus so that every thought is
brought captive to His control (cf. 2 Cor. 10:5)….
This also means that the content of one’s
thoughts is important because biblical truth is
crucial in right thinking that still affects one’s
feelings and actions (cf. John 8:32; Romans 12:2;
Phil. 4:8). Such truth includes having hope for
the future because of eternal life in Christ” (Tan,
2011, p. 246). Therefore, while a Christian per-
spective on life will include focusing on the now
or present moment (e.g., see Boyd, 2010), it will
also anticipate the future with eschatological
hope in Christ (Tan, 2011).
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David C. Wang, Th.M. (Regent College), Ph.D. (Univer-
sity of Houston) is Assistant Professor of Psychology at the
Rosemead School of Psychology, Biola University in La
Mirada, CA, and Associate Editor of the Journal of Psy-
chology and Theology. His research focuses on trau-
ma/traumatic stress, spiritual theology and spiritual
development, mindfulness, and various topics related to
multicultural psychology and social justice.
Siang-Yang Tan, Ph.D. (McGill University) is Professor
of Psychology at the Graduate School of Psychology, Fuller
Theological Seminary in Pasadena, CA, and Senior Pas-
tor of First Evangelical Church Glendale in Glendale, CA.
He has published numerous articles and thirteen books,
the latest of which is Counseling and Psychotherapy: A
Christian Perspective (Baker Academic, 2011).
... In their explanation of mindfulness, Wang and Tan (2016) described three states of the mind: reasonable mind, emotional mind, and wise mind. The reasonable mind is where the logical, analytical aspect of a person exists (Wang & Tan, 2016). The emotional mind is where emotions govern the thought process and result in action (Wang & Tan, 2016). ...
... The reasonable mind is where the logical, analytical aspect of a person exists (Wang & Tan, 2016). The emotional mind is where emotions govern the thought process and result in action (Wang & Tan, 2016). ...
... The wise mind integrates both the reasonable and emotional mind to bring balance to the individual's internal processes, supporting wise decisions (Wang & Tan, 2016). ...
Full-text available
The purpose of this qualitative descriptive study was to describe how Christians in Arizona, ages 30-50, coped with their experiences of impostor phenomenon during spiritual identity formation. The conceptual framework for this study included social influence theory, subject-object constructive-development theory, and approach/avoidance coping model of stress. Three research questions guided this study: How do Christians in Arizona, ages 30-50, experience impostor phenomenon during spiritual identity formation, How does the church support Christians in Arizona, ages 30-50, in their experience of impostor phenomenon during spiritual identity formation, and How do Christians in Arizona, ages 30-50, cope with their experiences of impostor phenomenon. The study used semistructured individual interviews with 10 participants and a semistructured focus group interview with four participants, which were a subset of the sample. The researcher utilized an inductive, thematic data analysis strategy. The data from this study resulted in four themes: We experience an ongoing identity crisis in our spiritual identity; Resources connected to overcoming impostor phenomenon during spiritual identity formation are scarce; We need help becoming more holistically authentic people; and We cope with impostor phenomenon by becoming more holistically authentic people. The data collected and analyzed in this study suggested a cyclical and symbiotic relationship between spiritual identity development and holistic identity development triggered by the stressful experience of impostor phenomenon.
... Of particular interest for the present article is the current increase in attention third wave behavior therapy is receiving from Christians. In addition to a Christian perspective on DBT (Wang & Tan, 2016) and ACT (Rosales & Tan, 2016; see also Sisemore, 2014), mindfulness-based CBT (Tan, 2011; see also Symington & Symington, 2012) has previously received some attention. ...
... Given widespread interest in MBIs, it is unsurprising that attempts have been made to adapt MBIs to faith based contexts. However, unlike DBT (see Wang & Tan, 2016) and especially ACT (see Rosales & Tan, 2016), MBCT has received relatively little adaptation for Christian clients (see Tan, 2011). Instead, Christian counselors have often chosen to address and adapt MBIs in general (e.g. ...
... Symington & Symington, 2012). Notwithstanding the importance of comparisons with Buddhism, there is a growing consensus in the Christian literature that mindfulness can be appropriately used with Christian clients (see Rosales & Tan, 2016;Symington & Symington, 2012;Tan, 2011;Wang & Tan, 2016). Of course, adaptations and qualifications are necessary and may prove helpful. ...
... The phenomenon of Jewish Mindfulness is but one aspect of a broader phenomenon of the appropriation of Mindfulness within Western religious contexts. One can observe, for example, similar trends in the phenomenon of "Christian Mindfulness" (Tan 2011;Symington and Symington 2012;Frederick and White 2015;Trammel 2015;Ford and Garzon 2017) and "Muslim Mindfulness" (Ghorbani 2009;Mirdal 2012;Thomas et al. 2016;Helminski 2017;Salyers 2017). ...
... (accessed on 27 April 2019). 34 Mindfulness has also been imported in the field of Christianity (Tan 2011) and Islam (Thomas et al. 2016). 35 Kornfield, Goldstein, Salzberg, Schwartz, Kabat-Zinn, and many more of their colleagues and students in the American Buddhist field are all Jewish, as has been noted by observers (Kamenetz 1994;Nisker 2003, p. 116;Lew 2001, p. 60) and by scholars (Prebish and Tanaka 1998, p. 3;Coleman 1999, pp. ...
Full-text available
Since the late 1990s, the expression “Jewish Mindfulness” has become ubiquitous in Jewish community centers (JCCs) and synagogues in America, in Israel, and in the Western diaspora. “Mindfulness”, a secular meditation technique originating from Buddhism which has been popularized in Western culture through its recontextualization within the Western therapeutic culture, has been increasingly used in Jewish Religious settings, including Modern Orthodox. How do Modern Orthodox rabbis describe their use of “Mindfulness” in their religious teachings? Why do they refer to Mindfulness Meditation rather than to Jewish Meditation? In this article, I comparatively analyze the discourses spoken—online, and in print—of American rabbis from various Modern Orthodox trends as a case to study strategies of adaptation in the current context of globalization. By identifying three types of use of Mindfulness—through, and or as Judaism—I seek to highlight the various ways in which today’s Orthodox educators use “Mindfulness”, both as a meditation technique and as a spiritual mindset, and how this is reshaping the way they teach Jewish religion. Observing contemporary Orthodox discourses on Mindfulness within Jewish religious pedagogy can help us better understand the processes of cultural appropriation and translation as well as religious change in the making, as part of a boundary maintenance work within today’s cosmopolitan cultures.
... A recognition of the compatibility between mindfulness and Christianity should provide a platform for Christian clinicians to remain true to their faith while offering their clients modern, evidence-based care. The particulars of how specific third-wave therapies can be viewed from a Christian perspective are beyond the scope of this article, but have been thoughtfully examined by Tan and colleagues (Hathaway & Tan, 2009;Rosales & Tan, 2016, 2017Tan, 2011). Of note, while Tan (2011) mentions that minor accommodations to mindfulness-based therapies may be necessary for Christian clients, his work shows no irreconcilability between mindful psychotherapeutic approaches and Christianity, but rather a broad base of agreement between the two. ...
... The particulars of how specific third-wave therapies can be viewed from a Christian perspective are beyond the scope of this article, but have been thoughtfully examined by Tan and colleagues (Hathaway & Tan, 2009;Rosales & Tan, 2016, 2017Tan, 2011). Of note, while Tan (2011) mentions that minor accommodations to mindfulness-based therapies may be necessary for Christian clients, his work shows no irreconcilability between mindful psychotherapeutic approaches and Christianity, but rather a broad base of agreement between the two. ...
In the past few decades, the social sciences have generated a great deal of research on the topic of mindfulness, both as a state and as a practice. The mental and physical health benefits of mindfulness practices are profound, and the excitement generated by these findings has created a bonanza of interest within and without the psychological research community. The popular psychology, self-improvement, and corporate development pipelines now brim with mindfulness content. As this focus continues to take center stage in the forums that deal with contemporary wellness strategies, traditional Christians may struggle to accept this healthy modality. One of the primary reasons for this is mindfulness’ rooting in Buddhism and other Middle Eastern mystical religious traditions. The other reason has to do with more secularized versions of mindfulness in which the non-judgmental component of mindfulness practice may appear to stand in ideological opposition to the idea of moral standards or absolute truth. As a result, Christians may feel the practice of mindfulness might require them to deviate from or dishonor deeply held mainline Christian convictions. Within this paper, the construct of mindfulness is briefly reviewed along with its health benefits. Thereafter, the seeming disparity between mindfulness and Christianity is discussed, and a potential way to resolve the apparent dissonance is presented.
... This secularization of contemplative practices happens for several reasons, but a major one seems to stem from concerns about 'scaring off' non-Buddhists, especially those who adhere to a different religious faith. Some scholars suggest that mindfulness may be particularly problematic for Christians (Blanton 2011;Hathaway and Tan 2009;Knabb 2012;Tan 2011) while others argue that Buddhism and Christianity "have much to share" (Mong 2015, 113;Bowen et al. 2015). ...
Full-text available
Contemporary mindfulness is a contentious topic in scholarship. Buddhist traditionalists argue that right mindfulness entails ethical considerations that are absent from contemporary versions of practice. Others believe mindfulness can be secularized without issue. The media presents mindfulness as a scientific cure-all for mental and physical ailments, but mindfulness studies are plagued with problematic methods and inconclusive results. Some therapists also worry that embracing the Buddhist origins of mindfulness techniques might repulse non-Buddhist clients who stand to benefit from the practice. The present study employs a qualitative survey distributed on social media to better understand contemporary mindfulness from the self-identified practitioner's perspective. Using a thematic approach, this research analyzes 127 personal explanations of individual mindfulness usage and practice. These accounts suggest that contemporary mindfulness is not missing an ethical component, that contemporary mindfulness is a tool for spiritual hygiene, and that contemporary mindfulness is generally compatible with non-Buddhist religious traditions.
... ACT has shown compatibility with Christian faith and practice (Symington & Symington, 2012;Tan, 2011). Several community settings have received GKT (Capp et al., 2001;Hayes, Shaw, Lever-Green, Parker, & Gask, 2008;Matthieu et al., 2008;Tompkins & Witt, 2009;Wyman et al., 2008). ...
Objective: This study is a feasibility evaluation of The HOLLY Program, a suicide prevention gatekeeper training (GKT) program that uses the core processes of Acceptance and Commitment Therapy (ACT) and is tailored to Christian faith-based organisations (FBOs). Method: Thirteen participants received the program, and nine participants provided post-intervention data. Results: Paired samples t-tests corrected for familywise error did not find any significant outcomes. However, there were marginally significant trends for improvements in self-efficacy, prevention behaviors, stigma, and engagement with values, which were supported by the qualitative and descriptive data. Across the sample, high levels of satisfaction with the program’s helpfulness, relevance, and practical content were reported. Qualitative data investigating perceptions of suicide motivation and suicide prevention found that participants recognised the psychological nature of suicide and provided sound, scientific suggestions for prevention. Conclusions: While large-scale validation is required, proximate outcomes as presented in this study suggest that The HOLLY Program is viable and promising, and that members of Christian FBOs are willing and suitable recipients of GKT for suicide prevention.
... Whether presented with explicitly Buddhist or explicitly secular, e.g., mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based interventions, non-Buddhist, such as Christian clients may view mindfulness practices as contradictory to their values and/or beliefs. This would seem to contradict the prevalence of contemplative practices within Western faith traditions (Tan 2011), yet remains a salient concern for many practitioners. ...
Full-text available
A special issue of Learning: Research and Practice dedicated to mindfulness is summarized with the assertion that the contributions illustrate a perspective for successful mindfulness scholarship. Specifically, definitional components of mindfulness practice are just as essential for mindfulness scholarship. After a review of the special issue, this perspective for mindfulness scholarship is presented, and the article closes with two examples of mindfulness scholarship aligned with the 3-component framework of intention, awareness, and non-judgment.
... Mindfulness, with its working definition as both a practice and a state of mind, can draw from Christian contemplative and mystical practices such as Centering Prayer and Lectio Divina (Trammel, 2017). In addition, Christian-based adaptations to third-wave behavioral therapies such as dialectical behavioral therapy (DBT) and mindfulness based cognitive therapy (MBCT) have been discussed clarifying areas of confluence in the work Wang and Tan (2016), and Rosales (2016), respectively. ...
Mindfulness is the practice of present-moment awareness with nonjudgment. Mindfulness-based therapies draw from secular or Buddhist frameworks. Including other religious traditions that also incorporate mindfulness assists in skill attainment. This descriptive phenomenological study explores the lived experience of nine Christian mental health practitioners. Three themes resulted: a divine presence in session guides and affirms practitioners’ work; practitioners’ increased attunement to clients in clinical work; and integration of the sacred and the secular in treatment. Practitioners using mindfulness with clients strengthened their ability to be aware of spiritual aspects of themselves suggesting implications for training mental health practitioners to enhance therapeutic praxis.
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Mindfulness is defined as nonjudgmental awareness which includes softness, acceptance of experience as it is, non-evaluation, kindness, openness, and curiosity. Although mindfulness originates in the Buddhist doctrine of faith, practices from Jewish and Christian scripture, as well as patristic fathers and mothers, support the same principles. Recent studies of mindful awareness practices reveal that it can result in profound improvements in a range of mental, physical, interpersonal, and spiritual domains. Understanding basic brain-based phenomena of meditation of different traditions can enhance religious engagement. Although prayer is a common means to spiritual growth, mindfulness meditation offers original method of cultivating spirituality irrespective of religious affiliation, or non-affiliation. A growing body of research suggests that neuro-psycho-biological mindfulness concept (interdisciplinary model of meditation) may play crucial role for understanding phenomena of spirituality and contemporary interfaith dialogue. Recent studies show that mindfulness may be useful to improve theological considerations about spirituality, meditation and mysticism.
The purpose of this study was to investigate the impact of religiously accommodative mindfulness compared with traditional mindfulness on stress, anxiety, and depression in an evangelical Christian college sample using a randomized trial design. Volunteer participants (n = 78) were randomly assigned to 1 of 2 treatment conditions. The Christian mindfulness training (CMT) group protocol was explicitly adapted to the evangelical Christian faith, while the conventional mindfulness training (MT) group protocol utilized typical mindfulness meditations. Participants completed 3 weeks of treatment that included psychoeducational group sessions and prescribed daily applications of the mindfulness techniques. Posttreatment differences between the 2 groups were then compared on the measures. Measures used included the Perceived Stress Scale (PSS, Lee, 2012) and the Depression Anxiety and Stress Scale (DASS, Lovibond & Lovibond, 1995). Results indicated significant differences within and between groups, with the CMT group reporting lower levels of stress and depression compared to the MT group, as well as lower overall negative symptoms based on total DASS scores. CMT group participants also reported significantly greater treatment compliance in comparison with MT group participants. Findings provide preliminary support for potential differences in treatment outcomes when religious accommodations are made to mindfulness. Limitations and recommendations are considered.
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We have investigated the effects of sulfated chitin derivatives and heparin on the invasion of B16-BL6 melanoma cells through reconstituted basement membrane Matrigel which contains laminin, type IV collagen, heparan sulfate proteoglycan, and entactin. 6-O-sulfated chitin (S-chitin) and 6-O-sulfated and carboxymethyl chitin (SCM-chitin) significantly inhibited the penetration of tumor cells through Matrigel in parallel with the increased degree of sulfation. However, 6-O-and N-sulfated but partially N-deacetylated chitin derivative (SCM-chitosan) and CM-chitin had no effect. SCM-chitin with a high degree of sulfation (SCM-chitin III), which exhibited fairly low levels of anticoagulant activity, was more effective than intact heparin. SCM-chitin III and heparin were also shown to block the attachment and migration of tumor cells to laminin-coated substrates, which are considered to be involved in tumor invasion. The inhibition of cell attachment and migration by SCM-chitin III and heparin is likely to depend upon their specific binding to laminin molecules (possibly the heparin-binding domain). Degradation of heparan sulfate by heparanase was inhibited by SCM-chitin III and heparin in a dose-dependent manner. Surprisingly, SCM-chitin III could inhibit type IV collagenolytic activity of tumor cells more potently than heparin. Thus, nontoxic SCM-chitin III of low anticoagulant properties may provide a promising basis for the prevention of cancer metastasis. © 1990, American Association for Cancer Research. All rights reserved.
"Cheap grace is the mortal enemy of our church. Our struggle today is for costly grace." And with that sharp warning to his own church, which was engaged in bitter conflict with the official nazified state church, Dietrich Bonhoeffer began his book Discipleship (formerly entitled The Cost of Discipleship). Originally published in 1937, it soon became a classic exposition of what it means to follow Christ in a modern world beset by a dangerous and criminal government. At its center stands an interpretation of the Sermon on the Mount: what Jesus demanded of his followers-and how the life of discipleship is to be continued in all ages of the post- resurrection church. "Every call of Jesus is a call to death," Bonhoeffer wrote. His own life ended in martyrdom on April 9, 1945. Freshly translated from the German critical edition, Discipleship provides a more accurate rendering of the text and extensive aids and commentary to clarify the meaning, context, and reception of this work and its attempt to resist the Nazi ideology then infecting German Christian churches.
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout. New to This Edition *Reflects tremendous advances in ACT clinical applications, theory building, and research. *Psychological flexibility is now the central organizing focus. *Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation. *Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
The Book is the Italian Edition of M-M: Linehan DBT skills training manual pp.900
Because ACT is a contextual treatment, your attempts to conceptualize a presenting problem might be different from traditional case conceptualization models. The most important principle in contextual analysis is that you are not just assessing a particular symptom with a particular topography; you are also attempting to understand the functional impact of the presenting complaint. The same clinical complaint can function in dramatically different ways for clients. Thus, your case conceptualization and associated treatment plan may differ for clients with seemingly similar problems. For example, many patients are diagnosed with major depression, single episode (a categorical formulation) based on the number and severity of symptoms described by the patient (a topographical assessment). In clinical practice however, it is fair to say that no two depressed patients are alike. Each is unique in how their life space is organized, how depression affects their functioning (and vice versa) and how depressive beliefs and behaviors define the individual’s sense of self and external world.