At Four Winds Hospital, we teach mindfulness as part of Dialectical Behavior Therapy. In DBT, mindfulness is the foundation for the extensive list of coping skills taught to patients. As patients are exposed to the curriculum of DBT skills, they learn that it is impossible to regulate their emotions without the ability to pay attention to their internal state in a flexible, moment-to-moment manner. Mindfulness is equally essential to the use of distress tolerance skills—for example, when faced with an undesirable situation in their environment, patients must choose between trying to change the situation (problem-solving skills), or trying to accept it (distress-tolerance skills). Mindful attention to both the internal and external environment is essential to the decision-making process. Finally, patients learn that mindfulness is crucial for positive interpersonal relationships, where it’s so easy to fall prey to one’s expectations and interpretations about others, rather than to limit oneself to objective observation.