DBT Distress Tolerance: Mindfulness and Radical Acceptance

Acceptance is one of the most effective ways to manage pain and difficult experiences, but it’s a little paradoxical and can seem counterintuitive. Why should I accept something that’s making me miserable? Doesn’t it mean giving up or resigning myself to something I don’t like? Shouldn’t I be fighting it or trying to change it instead?

And those are valid questions. In this video, we’ll learn what acceptance is, what we need to accept, why acceptance is important, and how we can practice it.

Acceptance can refer to being passive or surrendering. But in psychology, it has a different meaning. The kind of acceptance we’re talking about doesn’t mean approving of how things are or not trying to change them. It means acknowledging the reality of the current situation, even if we wish it weren’t so.

So acceptance simply means recognizing reality as it is. This is what’s happening whether I like it or not. So we stop fighting the facts, so I might as well accept it.

Acceptance involves a willingness to allow reality to be exactly what it is in this moment, even if it’s painful or unfair. But we’re not choosing to accept things because we’re giving up, but because refusing to accept reality doesn’t change the facts. And struggling against reality usually makes us feel worse. and we can’t take action about something, we’re still denying or resisting.

So, acceptance is often just the first step, which is then followed by trying to change what we can.

Acceptance plays a large role in mindfulness-based therapies, including DBT, where reality acceptance is one of the two main distress tolerance skills along with crisis survival. And the main component to reality acceptance is called radical acceptance, which just means fully opening ourselves up to reality as it is in this moment. even if it’s painful or we don’t like it.

The goal of radical acceptance is to reduce suffering and increase a sense of freedom by coming to terms with the facts of our lives. And it’s especially relevant when faced with situations we didn’t choose or don’t want.

Let’s look at what needs to be accepted. Facts about the present and past. I lost my job. I don’t have any close friends at this moment. Someone was just really rude to me. I’m running late and I’m stuck in traffic. My parents were emotionally abusive growing up. I woke up feeling sad for no apparent reason.

We can accept these facts without needing to like or approve of them. This is what’s happening even though I don’t like it, without distorting them and that’s completely ruined my life forever or adding judgments or other negative reactions.

And we also need to accept realistic limitations about the future. Some relationships may never heal. I might never have children. I’m not going to be able to pursue the career I want given my current qualifications. Managing this physical or mental health issue might always be a part of my life.

But thoughts and fears about the future like I’m never going to find another job. I’ll always be alone. I’ll never feel any better aren’t facts. They’re just predictions. So, we don’t need to accept them as true.

So, why is acceptance so important? Non-acceptance could look something like, “This is so unfair. It’s ruining my life. I can’t stand this.” And these reactions are understandable, but they don’t help us cope or feel any better.

Now, some amount of pain is unavoidable. It’s part of life. And when we refuse to accept this pain, we usually make it worse because we add distressing thoughts and emotions about what we’re going through on top of the original pain.

Pain is pain and it’s unpleasant. But pain plus non-acceptance of this pain equals suffering. Acceptance doesn’t remove the pain, but it prevents all that extra suffering from building up around it.

Acceptance could be something like this is painful and upsetting and it’s not fair that it happened, but it did and there’s nothing I can do now to change or undo that. And the sooner I accept this, the sooner I can start doing what I can to try to improve the situation or how I feel about it and figure out how to move forward.

So, how do we practice acceptance? The first step is simply noticing when we’re resisting rather than accepting reality. We might find ourselves thinking, “This shouldn’t be happening. It’s not fair. I can’t cope with this.” Then we describe what we need to accept. It could be a situation or circumstance or a thought or a difficult emotion.

And then we can say things to ourselves like, “That’s just reality. That’s just the way things are, even if I’d prefer it be different.” Or the cliche, “It is what it is.”

For difficult thoughts like, “I can’t cope with this,” or, “I’m always going to be alone.” We can practice accepting them rather than reacting to them or getting caught up in them by telling ourselves, “This is just a thought.” Or, “I’m just having the thought, I can’t cope with this. I’m just having the thought, I’m always going to be alone.”

Acceptance puts some distance between ourselves and our thoughts and takes away their power over us. And then we don’t need to do anything with these thoughts except allow them to be here until they pass on their own.

Acceptance also helps manage difficult emotions. So we start by naming the emotion. I’m feeling sad and then we accept it. And it’s natural to feel sad. I’m feeling frustrated and it’s okay to be frustrated. I’m feeling anxious and that’s uncomfortable but it’s okay.

Once we accept how we’re feeling, our emotions become more manageable. And resisting reality often shows up in the body as tightness, tension, or discomfort. So, we start by naming and accepting these sensations. There’s a lump in my throat, but that’s okay. It’s just a feeling of sadness. My heart’s beating faster, but that’s nothing to worry about. It’s just anxiety.

And mindful breathing can help. First slowing down our breathing. Breathing in through our nostrils for a count of two. Pausing and then breathing out through our mouths for a count of four. And then using our breath to bring our awareness to where the discomfort is strongest.

Breathing into the discomfort as we inhale. And then breathing out of it and allowing it to soften and relax as we exhale. And as we breathe, we can silently repeat to ourselves some phrases that promote acceptance.

Breathing in, I feel calm. Breathing out, I relax. Breathing in, I recognize the pain. Breathing out, I accept it. Breathing in, I acknowledge reality. Breathing out, I accept it.

Mindful breathing can be a really effective way to promote acceptance. And once we’ve accepted that this is the reality of our situation, we can ask ourselves, is there anything I can do now to improve things or help me cope? And often there is.

We might engage in problem solving or use various emotion regulation techniques to help us feel better or try changing our perspectives about the situation even if we can’t change the situation itself.

But before we can do any of that, we need to face the facts and accept what’s actually happening. Not approve of it or like it, resign ourselves to it and give up or be passive and not do anything, but just accept reality, which in itself usually makes things start to feel a little better and then we can proceed from there.

When we talk about acceptance in the context of mindfulness, what we mean is a need to accept those things that are outside of our control, the way that they are in the present moment. This includes external things outside of our control: things going on in the world around us; past events and things that have already happened; other people’s actions and behavior. We also need to accept our internal experiences: feelings and emotions, spontaneous thoughts and memories that arise, and certain types of pain and body sensations.

The reason we need to accept these things is because they’re outside of our control. And so there’s nothing we can do to change them. So we have two choices: accept them the way that they are; or to struggle with them and resist them, or get angry or frustrated or annoyed by them, and fight against them in a battle we have no chance of winning and end up making things even harder on ourselves. And so acceptance is a way of limiting the negative impact or effect of any unpleasant experiences we have that are outside of our control.

In an earlier video we looked at the parable of the two arrows and how the way we react to our negative experiences often ends up making things worse:

When touched with a feeling of pain the untrained person sorrows grieves and laments beats their breasts and becomes distraught. And so they feel two pains. Just as if they were to shoot someone with an arrow and then right afterwards were to shoot them with a second arrow so that they would feel the pain of two arrows. The first arrow causes us pain, and the second arrow causes us to suffer.

Now that first arrow isn’t something we can avoid. If we can accept the fact that we’ve been struck by that first arrow, our acceptance acts as a shield that protects us from being hit by that second arrow. And so our acceptance inoculates us from the suffering that that second arrow can cause.

And it’s important to realize that acceptance is different than resignation. Resignation means giving up. You’re resigning yourself to the way things are without any hope that they’ll ever be different. You’ll tolerate them but you’re not happy about it, and you wish things didn’t have to be this way. People resign themselves to all sorts of things, being stuck in a job that they hate, or in an unfulfilling relationship. Some people even resign themselves to the fact that they could never be happy again.

But acceptance isn’t like this. Acceptance doesn’t mean giving up. It isn’t the loss of hope or resigning yourself to things. Acceptance is simply the willingness to see things the way that they actually are, whether we’re accepting our internal experiences of thoughts feelings and emotions and body sensations, or accepting our external experiences and the things going on around us. Acceptance is simply an acknowledgement of how things are in this particular moment in time. It says nothing about how things are destined to be in the future, only that this is how things are right now.

By accepting things that are outside of our control we limit the impact they have on us, as we experience them only as they are without making them any stronger or adding any additional layers as we would if we refuse to accept them and tried to fight with them instead. And so once we learn to accept our experience in the present moment, whatever it is, even if it’s something we don’t like or that we wished we didn’t have to accept, our acceptance of what we can’t change, at least not in this moment, tends to make even our unpleasant experiences more manageable, more tolerable and can often lead them to subside. Now acceptance, especially of things that are unpleasant can be difficult and so in the next video we’ll learn how to practice acceptance by allowing and letting be.