DBT Mindfulness What & How Skills: PDF Worksheet, Tools and Exercises

In DBT practice, explaining mindfulness to patients often collapses into a vague instruction to "just notice." The WHAT/HOW distinction, the backbone of Linehan's mindfulness module, resists oral delivery because its two axes operate simultaneously yet must be introduced sequentially. This PDF worksheet gives the framework a concrete visual structure the patient can follow in session and reference between appointments, rather than reconstructing it from memory.

Why the WHAT/HOW Structure Collapses Without a Visual

The three WHAT skills (observe, describe, participate) are mutually exclusive in use: you pick one at a time. The three HOW skills (nonjudgmentally, one-mindfully, effectively) run concurrently as attitudinal layers over whichever WHAT skill is active. Holding both axes in working memory while tracking one's own emotional state is demanding for a regulated patient; for someone mid-crisis or high in experiential avoidance, the distinction evaporates within minutes of leaving your office.

Two confusions recur with particular regularity. First, patients conflate mindfulness with relaxation, arriving at the next session convinced they "did it wrong" because they felt tense while observing. Second, they mistake participating for a kind of distracted doing, rather than the full-immersion stance the model specifies. Neither confusion survives a well-walked visual, because the "Is / Is not" structure printed on the page makes the misapplication explicit before the patient encounters it. The same precision that challenging automatic thoughts exercises requires, distinguishing inference from observation, is exactly what the Describe skill demands, and the fiche makes that line visible rather than relying on the clinician to re-explain it verbally each session.

What the Fiche Contains: Six Panels, One Printable Page

The fiche is structured into six numbered panels. Panel 1 lays out the three WHAT skills with a rule stated plainly up front: "You can only do one at a time." Each skill receives an "Is / Is not / Practise" breakdown that immediately names the most common misapplication, Observe is not "chewing over the past," Describe is not "guessing minds." This format does what an oral walkthrough rarely achieves: it pre-empts errors rather than correcting them after the fact.

Panel 2 is a worked example anchored in one scenario, a couple's argument, showing how each WHAT skill applies to the same lived moment. Panel 3 is the visual centrepiece: a schematic joining WHAT on one side and HOW on the other, with an arrow pointing to "a present moment fully inhabited." Clinicians can use this diagram as a whiteboard anchor mid-session, pointing to each axis as they talk. Panel 4 mirrors the structure for the HOW skills, including the highest-yield reframe: "I'm pathetic for crying" becoming "I notice tears and I notice the thought that I shouldn't be crying", the descriptive labelling move that feeds directly into non-judgmental stance work and prepares the ground for emotion regulation skills.

Panel 5 returns to the same conflict scenario through the HOW lens. Panel 6 clears two persistent confusions, mindfulness is not relaxation, the mind is not supposed to empty, and closes with a "To discuss in session" checklist flagging three specific patient presentations, including the clinically important case where internal observation worsens anxiety and an external anchor is more appropriate.

> Key takeaway: This fiche is a visual support that facilitates in-session explanation; the clinician walks the patient through the WHAT/HOW structure using the printed page as a shared reference point. It is not a self-guided questionnaire the patient completes alone.

When and How to Introduce It in Session

The fiche fits naturally into the first or second session dedicated to mindfulness in a DBT skills program, after you have established a basic rationale for present-moment awareness. It is equally useful mid-treatment when a patient in longer-term work keeps collapsing into judgment or multitasking, and where re-anchoring to the HOW axis has more clinical traction than another verbal explanation.

For introduction, you might say: "I have a one-page summary of the framework we are building toward. Let's go through it together, I'll flag the parts that tend to trip people up." Walk the six panels in sequence, directing attention to the "Is / Is not" distinctions and using the worked examples as discussion prompts. Do not assign it as independent reading before you have covered it together; the value is in the shared narration, not the text itself.

Debrief by asking which WHAT skill the patient already uses naturally, and which HOW attitude feels furthest from their current repertoire. That asymmetry points directly to the clinical priority ahead, whether toward distress tolerance skills, defusion from ruminative loops, or sensory grounding exercises for patients whose internal observation reliably increases arousal rather than settling it.

For clinicians working across third-wave frameworks, the fiche pairs naturally with the ACT Hexaflex, present-moment contact maps directly onto the ACT flexibility model, and with psychological flexibility exercises where that contact is a named treatment target. Within a DBT program, it establishes the mindful ground from which ACCEPTS distress tolerance skills, DEAR MAN assertiveness work, and cognitive defusion techniques all operate. The fiche does not replace the skills group or the therapeutic frame; it makes the explanation land faster and leaves the patient with a concrete reference when the session ends.