Zen is a Japanese word that loosely translates to Meditation. Zen originated in China where a monk called Bodhidharma got fed up with the practice of Buddhism and went to China. In China, the practice is known as Chan (which also means meditation). Zen is all about the practice of formal sitting meditation.

Marsha Linehan, the founder of DBT, was looking for a way to include acceptance into good behavior therapy. The emphasis on change created high levels of dysregulation, but when balanced with acceptance (held together with dialectics), clients could see both the need for change and accept what is. Radical acceptance and the core mindfulness skills come straight from Zen. Zen is a practice and not a religion; it is trans-confessional in nature. At the time, Marsha was developing DBT with other forms of mindfulness that had not yet made their way into psychological treatments.

In Zen we reference Karma – this is often misinterpreted as "I must have done bad things in a previous life." Karma is simply the law of cause and effect. Taking a nonjudgmental stance includes embracing cause and effect – if you want to change later outcomes, you have to change the causes. Adding judgment only causes suffering – we can agree that behaviors are ineffective at reaching desired outcomes – letting go of the judgment allows us to see this.

Think in terms of radical acceptance (which comes straight from Zen) – before anything can change, you have to accept what is. Refusal to accept will keep you in hell – acceptance is the first step in being able to make changes.

Zen is typically done with eyes open, not closed, and without guided imagery. Many of the mindfulness-based treatments incorporate the practice of vipassana meditation. Zen is focused on being present in this one moment.

Both Zen and behavior therapy agree on these elements:

• No self

• Unity

• Individuality

• Non-judgmental stance

• Present focus

• Practice exposure

• Opposite action

Behavior therapy is experimental in nature and Zen is experiential – and somehow they reach the same conclusions.

You can't change what you first don't accept. For example, if I don't accept that my lost car keys are not on their usual hook, I will keep looking in the same place (the hook) and never find them.

If you are fortunate you might have an enlightenment experience, which truly is seeing reality including oneself as it truly is. It is important to note that the real goal of mindfulness practice is mindfulness practice – seeing reality as it is, increased happiness, decreased suffering, and increased connection are just fortunate side effects of doing the practice.

I would say radical acceptance – this is letting go of the attachment that things should be different than they are. Also sitting zazen (formal meditation) every day, which only needs to be for five or ten minutes. Research has shown that this practice will increase happiness and decrease suffering. I need to stress that frequency is more important than duration – every day is best.

DBT mindfulness comes from the practice of Zen, which involves sitting in meditation and asking yourself, "What is this?" Mindfulness practice is an open monitoring of what is; telling your internal narrator to take some time off and be present. You may want to go to a Zen temple and experience the practice in action.

Radical acceptance is the first necessary step to change – you can't change what you haven't first accepted. When we get uncomfortable we tend to avoid, and often in very familiar, maladaptive behavioral patterns. In treatment, the focus becomes on stopping the behavior and then, no one actually solves the problem causing the discomfort. Acceptance is turning the mind towards acceptance. Acceptance is not approval, not resignation, and is not adverse to change. In fact, it has to be the first step toward change

Think of the skill of one mindfully – the only moment that truly exists is the moment that we are living in right now. The past is gone – it no longer exists; the future is not yet here. Only this moment exists – we suffer less when we let go of the attachment that things should be different than they are and allow ourselves to experience just this one moment.