Schizoaffective Disorder, DBT, and Mindfulness

The day I sat there in my psychiatrist’s office the words that I had been diagnosed with schizoaffective disorder was both one of the scariest and best days of my life. Hearing schizo anything is frightening, it is one of those mental illnesses you are brought up to fear by our society. Schizophrenia is bad enough, but knowing I had those symptoms (hallucinations and delusions) as well as a mood disorder (major depression) seemed like the end of my life yet a relief at the same time. I finally had an answer to what those voices were that had plagued my head and living nightmare for years. Thus I began on my long journey to discovering the right cocktail of medications, the most effective form of therapy, and the support structure I needed. It was a long struggle which ended up leading me to a cocktail of three medications, additionally a combination of meditation, mindfulness, and DBT (Dialectical Behavioral Therapy) before I found true beginnings of progress. Before this occurred I would spend two six weeks sessions of partial hospitalization an all day outpatient therapy at a local mental hospital in a little over a year.

On a trip to Boston I was spending the afternoon at Harvard Square waiting to meet up with a friend. I was eating, having coffee, and visiting various bookstores all while admiring Harvard. A man mistaking me for a friend wrapped his arms around me from behind. I lost it. I don’t know any easier way to put it. The next thing I would know I was in a crowded Starbucks, a latte in front of me, and a gap of over an hour missing from my life. A blackout. To this day I have no idea how I got there, what I did for that hour, what had transpired. Piecing that hour back together is not what would truly frighten me though, that was my racing mind jumping from one delusion to the next each one a little more fantastic. In a matter of moments I went from being convinced that my friend had been in accident, then murdered, then all the patrons of the coffeehouse could read my mind, to implanting their thoughts and desires in my head. I had a conversation with someone who wasn’t there. A new kind of therapy was needed. I couldn’t go on living this way. That’s when I told my therapist I wanted to up my meds and try DBT.

First question first, what is mindfulness?

Mindfulness is no longer just for practitioners of Zen and Buddhism but has moved into the mainstream Mental Health counseling. It has become one of the primary techniques employed among many therapists and coupled with meditation has shown tremendous amounts of improvements in otherwise non-responsive patients. As science furthers more and more we are seeing them recognize the benefits of Zen in daily practice. As NAMI (National Alliance on Mental Illness) describes it, “While the combination of therapy and medication is crucial to recovery, the addition of self-awareness tools and skills can also be beneficial. Whether you are just beginning your recovery or are further along on your journey, the holistic practices can be an excellent complement to therapy and medication.”

While many treatment programs employ the use of mindfulness, I will focus on DBT (Dialectical Behavioral Therapy) in my analysis. So what is DBT? “Dialectical Behavior Therapy (DBT), is a comprehensive cognitive-behavioral treatment that was originally developed to treat chronically suicidal individuals suffering from borderline personality disorder (BPD). DBT has been found especially effective for those with suicidal and other multiply occurring severely dysfunctional behaviors. Research has shown DBT to be effective in reducing suicidal behavior, psychiatric hospitalization, treatment dropout, substance abuse, anger, and interpersonal difficulties,” ( So what exactly does all that mean? It is a non-judgmental way of the patient accepting that they have a problem with how they think, and rather than judge it, they can make changes to make their thinking more balanced using mindfulness as one of the primary techniques.

What is mindfulness within this context? The best and simplest definition I have come across is, “doing one thing at a time, in the present moment, with your full attention, and with acceptance,” (DBT Made Simple). This can be further broken down into two parts for the patient. First, awareness and focusing on the present moment. The second part is acceptance, and this is the part that seems to be overlooked. This requires not judging what you are doing mindfully. A large percentage of patients respond well to this primarily, in my opinion, because they are taking control of their mind. Most patients, as is the case with most people in general spend far too much time in the past reliving negative things and mindfulness is a way to put a stop sign up to this harmful cycle.

How is mindfulness employed? There are a multitude of ways this is employed in your everyday life, but I will briefly cover seven of them:

1. Counting breaths. Count your breaths up to ten. One on the inhale and two on the exhale and so on. When you find your mind has wandered, simply return to counting your breath without judgment.
2. Observing sounds. Sitting silently focus your mind on any sounds which you hear: the sound of your breath, the traffic outside, the air-conditioner, etc. When you catch your mind wandering, take note of it without judgment and return to observing sounds.
3. Observing an object. Pick an object, any object. Examine the object with all of your five senses. Touch it. Smell it. Take note of any sound it makes when you move it. When you mind wanders, simply bring your attention back to the object.
4. Observing your thoughts in a cloud. Also could be called labeling your thoughts. You imagine yourself lying in a field of grass looking up at the sky. In each cloud is a thought and as it floats by you label what kind of thought it is without judging yourself for having that thought. For instance if you think this is a stupid exercise, that would be an anger thought. If you think how will I pay my house payment next month, that would be a worry thought.
5. Focusing on a thought. Pick a meaningful thought or short sentence and focus on the thought as you breathe. For instance if you think wise as you breathe in and think mind as you breathe out. When your mind wanders return to your thought without judging yourself.
6. Being the gatekeeper to your mind. This is more simply observing your thoughts. As a gatekeeper would watch people coming through a gate, you will simply experience and observe each thought as it passes over you without judging it. Experience thoughts and emotions as they come to you, do not try to block them. When your mind wanders or you feel yourself trying to stop thoughts simply return to the practice of observing them without judging the thoughts or yourself.
7. Being in your body. Quietly sitting, focus on the different sensations you experience in your body. For example, the feel of your bottom on the chair or your arms against the armrests. Take notice of any emotions you might be feeling, such as worry over a presentation you have at work next week. When your mind wanders simply return your thoughts to your body without judgment.

I went through a litany of excuses each week with my therapist as to why I wasn’t applying what we went over in our sessions. Throughout this period my symptoms were getting worse, I was in partial hospitalization programs due to my poor coping techniques including among other things self harm – slamming my head against the wall and routinely cutting myself with a razor blade, suicidal thoughts, ideation, and plans. Eventually though due to my therapist’s dedication and persistence things began to slowly improve. It’s now been over two years since I employed any of those negative coping methods and I owe a great deal of that to finding a therapist I trust, have a connection with and was dedicated enough to believe in me. The practice of mindfulness takes patience and dedication and the litany of excuses not to practice are endless, but I will attempt to debunk a few of the more common ones.

“It makes me more anxious”

Some people, especially people with anxiety issues, find practicing mindfulness increases their anxiety. This is an understandable reaction, but not enough to give up on the practice. It is often found that the exercises focusing on breathing cause the most anxiety. Simply focus on the non-breathing focused exercises to begin and once you become comfortable with mindfulness practice come back to the breathing exercises.

“I just can’t do it”

What exactly does the person mean by this? Is it just too hard? Are they having difficulties concentrating? Do they believe to be successful thoughts and feeling never intrude? Many people say they can’t do it when they just mean it is really hard. Truth is practicing mindfulness is a hard skill and the only way to get better is to keep pursuing it.

“I don’t have time”

This is one of the simplest problems to fix. You can practice mindfulness anytime, doing anything. If what you mean is you don’t have time for formal practice, let me remind you some of the exercises only take a few to ten minutes. It is better to spend 10 minutes fully dedicated than an hour half-heartedly. Try setting aside 10 minutes in the morning to practice mindfulness.

“I can’t stay focused”

Mindfulness is simply about staying in the present moment with acceptance. Please throw any other expectations out the window. The object of practicing mindfulness for many is to feel better. It is with this in mind that we reach a paradox. To feel better you must practice mindfulness, but if you focus on feeling better you have trouble staying focused on mindfulness. So throw away the goal while practicing mindfulness and you will achieve that goal.

“I fall asleep”

Some people find they drift off when they practice mindfulness. If the person has trouble sleeping this can be a good thing, simply practice mindfulness of part of your preparing for bed routine. There are several factors to consider if this is a common issue:

~ Do you need more sleep? If you are sleep deprived your body will want to take advantage of this quiet time.
~ Is there a better time of day to practice? If at the end of the day you are always exhausted, simply begin practicing in the morning.
~ Did you eat a big meal shortly before practicing? Watch out for a food coma!
Is there a different position you can try? If you practice mindfulness lying down, simply try it is a sitting position.
~ Are you closing your eyes? Keep your eyes open while practicing.

“You have to plan for the future”

Some people believe that practicing mindfulness means you never consider the past or the future. This simply is not the case, but you may be able to do those things mindfully whereas you do not currently. Often planning for the future isn’t planning at all, but instead it is worrying. Mindfulness actually helps you in planning for the future by keeping you grounded in reality of the present moment.

It’s been a long journey for me over just a few years since I came to the conclusion that self-care was my full time job. I no longer look to find blame for this condition, but accept this is my reality. I now meditate for a minimum of two hours a day, and if I miss a session I notice it the next day. I came to the acceptance that I need a maximum dose of an antidepressant, a high dose of an antipsychotic, and anxiety medication. I periodically meet with my therapist, but not nearly as often as I used to. She saved my life and I am grateful. I keep a gratitude journal and pull it out when depression is rearing its head. I attend support groups as much as I feel I need them to keep grounded and help others who are where I was a few years ago. I now have a core group of friends who understand my condition and I lean on them when I need to. Am I cured? Absolutely not, but I am no longer ignoring my condition or looking for the answer in the bottom of a bottle of whiskey. Daily I remind myself how far I’ve come and damn it I’m proud of the hard work I’ve put in. The other day the friend I’ve leaned on the hardest, the one that was there through my partial hospitalizations, he’s seen me at my worst and he sent me a short note, “You knew what, the guy you are today is way different than the guy we all met. Congratulations, you overcame so much. I’m so glad you’re enjoying life.” He’s absolutely right for I am enjoying life. Finally after all those years I’m living, as opposed to merely existing.

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