Radical Acceptance – A DBT Distress Tolerance Skill I Still Utilize

by Mandy Nunes, Assistant Director

May 23, 2023

I have struggled with mental health challenges and substance use for most of my life. In my early 20’s I was in and out of psychiatric hospitalizations frequently. I felt everything very intensely and my 20’s were filled with misery, agony, and despair. Though I don’t look back on that time of my life fondly, my difficulties opened the door for me to participate in DBT therapy.

Dialectical behavior therapy was developed in the 1970s by Marsha Linehan. Dialectical behavior therapy (DBT) is a type of therapy based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely. “Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.

DBT skills aim to help enhance your capabilities in day-to-day life. The four skills or modules of DBT include:

  • Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
  • Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
  • Emotion regulation: This means understanding, being more aware of and having more control over your emotions.
  • Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
    • Radical Acceptance is a Distress Tolerance skill that is designed to keep pain from turning into suffering.

While pain is part of life, radical acceptance allows us to keep that pain from becoming suffering. By accepting the facts of reality without responding with extreme anger or intentionally neglecting aspects of our lives. In other words, it is what it is. Radical acceptance is NOT approval, but rather completely and totally accepting with our mind, body and spirit that we cannot currently change the present facts, even if we do not like them. By choosing to radically accept the things that are out of our control, we prevent ourselves from becoming stuck in unhappiness, bitterness, anger and sadness and we can stop suffering. Completely and totally accepting this fact is still challenging and painful, but focusing on what we can control versus what we cannot, can be liberating. It frees up all of the energy we were using to fight reality and helps us use it to focus on how we can effectively cope with the situation and take care of ourselves.

Radical Acceptance allowed me to effectively cope with incarceration. Once I was able to fully accept that I was going to be spending quite a while incarcerated, I was able to focus on the things that I could control, my actions and behaviors, and working towards a life of recovery so I didn’t have to spend the rest of my life there. When I quit feeling sorry for myself, I was able to find and participate in activities that I enjoyed. Jail isn’t meant to be particularly fun, but once I accepted that I couldn’t control if I left (painful reality), I was able to choose to fill my days with things that were beneficial or somewhat pleasant, rather than ruminating on how much I wanted to leave (suffering).

Radical acceptance is a skill I still use today. I have PTSD, a panic disorder, and depression. I would say I use it the most when I’m struggling with anxiety or panic attacks. Panic attacks are awful, but when I fight against them, or ruminate on how awful and out of control I feel, the panic attacks get worse. When I am able to acknowledge that my body is having a physiological response to a perceived threat (trauma response / panic attack) I am able to utilize my senses to evaluate my actual safety. I’m able to use breathing techniques which help reduce anxiety. I’m able to take rescue medication, if necessary, without judging myself for it. Today, because I use radical acceptance around my diagnoses and symptoms, I’m able to be proactive about my mental health, including seeing a therapist.

So, how does one practice Radical Acceptance? Here are the 10 steps to practicing Radical Acceptance according to DBT’s founder, Marsha Linehan:

  • Observe that you are questioning or fighting reality (“it shouldn’t be this way”)
  • Remind yourself that the unpleasant reality is just as it is and cannot be changed (“this is what happened”)
  • Remind yourself that there are causes for the reality (“this is how things happened”)
  • Practice accepting with your whole self (mind, body, spirit) - Use accepting self-talk, relaxation techniques, mindfulness and/or imagery
  • List all of the behaviors you would engage in if you did accept the facts and then engage in those behaviors as if you have already accepted the facts
  • Imagine, in your mind’s eye, believing what you do not want to accept and rehearse in your mind what you would do if you accepted what seems unacceptable
  • Attend to body sensations as you think about what you need to accept
  • Allow disappointment, sadness or grief to arise within you
  • Acknowledge that life can be worth living even when there is pain
  • Do pros and cons if you find yourself resisting practicing acceptance

Radical Acceptance is a fantastic tool to have in your wellness toolbox. It can be combined with many other skills and tools to improve your wellness. I hope the pieces of my story that I shared with you will help you practice radical acceptance and add it to your toolbox as well.



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