MINDFULNESS WORKSHEET 4A

(Mindfulness Handouts 4–4c ) 95–35 . pp ;

Observing, Describing, Participating Checklist

Due Date: Name: Week Starting:
Check off mindfulness skills that you use when you use them. You can check each skill up to four
times. If you practice a skill more than four times, extend your checks toward the edge of the page,
or use the back of the page if needed.
Practice observing: Check off an exercise each time you do one.
‰‰‰‰‰‰1. What you see: Watch without following what you see.
‰‰‰‰‰‰2. Sounds: Sounds around you, pitch and sound of someone’s
voice, music.
‰‰‰‰‰‰3. Smells around you: Aroma of food, soap, air as you walk.
‰‰‰‰‰‰4. The taste of what you eat and the act of eating.
‰‰‰‰‰‰5. Urges to do something: Urge-surf, notice urge to avoid,
notice where in body urge is.
‰‰‰‰‰‰6. Body sensations: Body scan, sensation of walking, body touching
something.
‰‰‰‰‰‰7. Thoughts coming in and out of your mind: Imagine your mind as a river,
as a conveyor belt.
‰‰‰‰‰‰8. Your breath: Movement of stomach, sensations of air in and out nose.
‰‰‰‰‰‰9. By expanding awareness: To your entire body, to space around you,
to hugging a tree.
‰‰‰‰‰‰ 10. By opening the mind: To each sensation arising, not attaching, letting go of each.
‰‰‰‰‰‰ 11. Other (describe):
Practice describing: Check off an exercise each time you do one.
‰‰‰‰‰‰ 12. What you see outside of your body.
‰‰‰‰‰‰ 13. Thoughts, feelings, and body sensations inside yourself.
‰‰‰‰‰‰ 14. Your breathing.
‰‰‰‰‰‰ 15. Other (describe):
Practice participating: Check off an exercise each time you do one.
‰‰‰‰‰‰ 16. Dance to music.
‰‰‰‰‰‰ 17. Sing along with music you are listening to.
‰‰‰‰‰‰ 18. Sing in the shower.
‰‰‰‰‰‰ 19. Sing and dance while watching TV.
‰‰‰‰‰‰ 20. Jump out of bed and dance or sing before getting dressed.
‰‰‰‰‰‰ 21. Go to a church that sings and join in the singing.
‰‰‰‰‰‰ 22. Play karaoke with friends or at a karaoke club or bar.
‰‰‰‰‰‰ 23. Throw yourself into what another person is saying.
‰‰‰‰‰‰ 24. Go running, riding, skating, walking; become one with the activity.
‰‰‰‰‰‰ 25. Play a sport and throw yourself into playing.
‰‰‰‰‰‰ 26. Become the count of your breath, becoming only “one” when you count 1, becoming
only “two” when you count 2, and so on.
‰‰‰‰‰‰ 27. Become a word as you slowly say the word over and over and over.
‰‰‰‰‰‰ 28. Throw caution to the wind, and throw yourself into a social or work activity.
‰‰‰‰‰‰ 29. Other (describe):
List any and all wise things you did this week:
From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis-
sion to photocopy this worksheet is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills
Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)
 MINDFULNESS WORKSHEET 5A
(Mindfulness Handouts 5–5c ) 36–06 . pp ;

Nonjudgmentalness, One-Mindfulness,
Effectiveness Checklist
Due Date: Name: Week Starting:

Practice nonjudgmentalness: Check off an exercise each time you do one.

‰‰‰‰‰‰1. Say in your mind, “A judgmental thought arose in my mind.”
‰‰‰‰‰‰2. Count judgmental thoughts.
‰‰‰‰‰‰3. Replace judgmental thoughts and statements with nonjudgmental thoughts and
statements.
‰‰‰‰‰‰4. Observe your judgmental facial expressions, postures, voice tones.
‰‰‰‰‰‰5. Change judgmental expressions, postures, voice tones.
‰‰‰‰‰‰6. Stay very concrete and describe your day nonjudgmentally.
‰‰‰‰‰‰7. Write out a nonjudgmental description of an event that prompted an emotion.
‰‰‰‰‰‰8. Write out a nonjudgmental blow-by-blow account of a particularly important episode in
your day.
‰‰‰‰‰‰9. Imagine a person you are angry with. Imagine understanding that person.
‰‰‰‰‰‰ 10. When you feel judgmental, practice half-smiling and/or willing hands.

Describe the situation and how you practiced nonjudgmentalness:

Practice one-mindfulness: Check off an exercise each time you do one.

‰‰‰‰‰‰ 11. Awareness while making tea or coffee.
‰‰‰‰‰‰ 12. Awareness while washing the dishes.
‰‰‰‰‰‰ 13. Awareness while hand-washing clothes.
‰‰‰‰‰‰ 14. Awareness while cleaning house.
‰‰‰‰‰‰ 15. Awareness while taking a slow-motion bath.
‰‰‰‰‰‰ 16. Awareness with meditation.

Describe the situation and how you practiced one-mindfulness:

Practice effectiveness: Check off an exercise each time you do one.

‰‰‰‰‰‰ 17. Give up being right
‰‰‰‰‰‰ 18. Drop willfulness
‰‰‰‰‰‰ 19. Doing what is effective

Describe the situation and how you practiced effectiveness:

List any and all wise things you did this week:

From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis-
sion to photocopy this worksheet is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills
Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)
 MINDFULNESS WORKSHEET 2C (p. 1 of 2)
(Mindfulness Handouts 2–5c ) 36–94 . pp ;

Mindfulness Core Skills Calendar

Due Date: Name: Week Starting:

Check off skills to practice this week:

Wise Mind Observing Describing Participating Nonjudgmentally One-mindfully Effectively
While you are practicing skills, stay as aware and mindful as you can. Write it down later.
Describe your experience, including body
How did you practice sensations, emotions, and thoughts while What is your experience now,
Name(s) of skill(s) the skill? practicing the skill after using the skill?
Example: Participating I went to a party and joined I felt a tig ht knot in my stomach, shallow breathing , dry mouth, I feel amazed that I manag ed to do
in conversations with other anxiety that other people would not like me; later I enjoyed the this and felt g ood about myself. I am
people. conversation, smiled, noticed other people around me, and thinking I may be able to do this ag ain.
ended up having a g ood time.
Monday:

Tuesday:

Wednesday:

(continued on next page)

From DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of DBT
Skills Training Handouts and Worksheets, Second Edition, and DBT Skills Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)
 MINDFULNESS WORKSHEET 2C (p. 2 of 2)

Describe your experience, including body

How did you practice sensations, emotions, and thoughts while What is your experience now,
Name(s) of skill(s) the skill? practicing the skill after using the skill?
Thursday:

Friday:

Saturday:

Sunday:

List any and all wise things you did this week: