DBT - Distress Tolerance - Radical Acceptance

Hey guys, it's Dr. May here,

I'm here to talk to you today about Radical Acceptance, a Distress Tolerance skill.

It's one of the most popular and meaningful Distress Tolerance skills that we have. So I'm really excited to talk to you about that today.

Have any of you guys heard of radical acceptance before? I hope so. Otherwise, today's your lucky day, my friends, we're going to go over it in a lot of detail.

So a quick review of distress tolerance. There are a group of skills that allow us to get through difficult situations when we're not able to change them, at least not right away, and help to survive them and do it safely, and not make anything worse.

So today's skill for distress tolerance is radical acceptance. Okay? So radical acceptance is accepting situation, even if you don't like it as a way to ground yourself in reality, and deal with the truth. Okay? It's radical, because it's complete acceptance, deep acceptance, and sometimes acceptance just for the sake of acceptance without expecting anything from it.

So sometimes we say, Well, I accept it, oh, come on change, can you change. So we secretly are forcing a change, but when so if you have an agenda behind it, and you're trying to get it to change, it's not pure radical acceptance. So the pure radical acceptance is accepting for the sake of acceptance. Alright, so it's really about our relationship to the truth, when we really come down to it.

A lot of times, we have a hard time accepting what the reality of the situation is. Because it's hard, it's painful, right? It's not exactly how you want it to go. Maybe it's exactly the opposite of how we want something to go. And it brings up a lot of uncomfortable disturbing feelings, and disappointments, and shame and everything else. Okay, so letting the truth in is a big challenge.

And that's often why they say we practice radical acceptance, you don't just accept it, and then it's all over. Okay? Sometimes it's an ongoing process of accepting reality. Okay. And so it's important to start to think about, like, what truths in my life, about myself about other people about my situation, are hard for me to let him and why.

And that's something you can go over in a journal maybe, or the therapist or a friend. But it's important to identify those areas in your life that you're struggling to radically accept, as those are the ones that are gonna need the most work. So what is radical acceptance involves, so we're just going to unpack it a little bit, give you a little more information about how to do this, since we're going to keep talking about it. Alright, so one of the things that involves is to try to step back from your emotional mind, and put on your glasses, even if they're metaphorical glasses, so you can see reality clearly, and allow yourself to let in the truth. It's acknowledging it what is in this moment, even if you don't like it, and a lot of times the situations where you really need to practical rep, practice radical acceptance or situations that you really don't like. It's about letting go of struggling and fighting against reality. So what does that actually look like? Does that mean like we're putting on our boxing gloves and fighting reality?

Well, maybe not literally. But sometimes we keep telling ourselves a story about how reality is, but it's not the truth, or we keep defending ourselves, or we keep engaging and target behaviors that take us away from reality, and do all kinds of avoidance mechanisms.

It's letting some of that go, and stopping the fight, trying to just allow it to be there. And know that you could survive it if you start to let it in, perhaps with support, but you really can't survive it. So it's moving from the fantasy you've created in your mind to the reality of choosing facts.

Ultimately, whenever something happens, we tell ourselves a story about it. And the story we tell, may or may not be really based much in the truth.

Sometimes we lie to ourselves, because the lies are easier to accept the truth. So we have to slowly start to let go of some of these false stories and fantasies. So we can deal more clearly with that what's actually happening. And part of the radical is accepting with your mind, body and spirit or soul.

So it's completely allowing yourself to let it in. Okay, not just on an intellectual level, but in your heart too. Okay, here's a diagram.

That's kind of are useful for this skill. So every event that occurs has multiple causes. And if you've ever done a behavior chain analysis to look at maybe one of your target behaviors and how they happen, you'll realize that a lot of things lead up to every single moment.

And if we keep doing the same things and exposing ourselves to the same people in the same situations, and the same interpretations of events, we're going to keep recreating the same types of realities. So if we want reality to change, we need to create different causes. Otherwise, we can't expect anything else. So part of the radical acceptance is saying,

Listen, I readily accept that if I keep exposing myself to these same causes over and over and over again, it makes sense that I keep experiencing this kind of reality over and over again, I radically accept that this is what comes from that.

And therefore everything is as it should be, because all these clauses lead to this reality. And that makes total sense. O

So how do we replace the clauses? Well, we got to be aware of what we're doing. Right?

We have to have some acceptance of like, this is actually what's happening. Okay, I'm going to tell you a little story. Um, a number of years ago, when I was still a psychology student, as an extern, I was working with a man who lived in a supportive apartment with a few other guys. And every time he would come to therapy, he would say, they stole my money. They came into my room, and they stole my money again. I said, Well, did you lock the door? And say, No. I said, Well, where do you put your wallet? He said, Well, I left it on my dresser. I said, Well, why do you keep leaving your wallet in your dresser and leaving your door open? He said, Well, I don't want to have to lock my door. I don't want to live that way. Right? So how could he complain? If every week he's doing the same thing and getting the same result? You have to radically accept that if you do those actions, that's the result you're going to get if he decided to change, which I don't think he actually did. Yeah, you know, if, if he decided to put his wallet locked up, or you locked his door, or you put his money in his sock when he was sleeping, maybe his money wouldn't get stolen, it would be a completely different result. So he wouldn't have to keep radically except something the same problem, because he did something differently. Right?

How many times have we done stuff like that? You know, we keep dealing with the same people that bother us. And then we wonder why we're upset all the time. Right? Or we keep rethinking the same bad thoughts over and over again, we wonder why we're upset. So we have to radically accept that if I do this, this is the result that's going to happen. All right.

And then from there, from that truth, we can make a different decision. Okay, so some people resist acceptance, and I kind of get it right, because, you know, forget, forget about the fact that it's hard. We also have some misconceptions or myths about radical acceptance. So you can see the unicorn here, right? So kind of like that's a myth, we create our radical acceptance myths, okay, so one of the ones that comes up a lot is like, well, if I refuse to accept something, somehow, it just won't be true. Right. So if that guy refuse to accept that, I, you know, that these guys keep coming in his room and stealing his money, then maybe he doesn't have to change at all, maybe he can just keep leaving his money on his dresser and leaving his door open, and somehow it won't happen. Right? So it doesn't actually change the situation.

If you accept your painful situation, it will continue indefinitely and won't change. So we're afraid of the opposite to, like, if I'm, if I realize I'm an addict, I'm gonna be like, Oh, my God, well, I'm screwed, right? It's a genetic thing, or, you know, it's built into my biology, I'm going to be an ag forever, and oh, my god like that. That's the end of my world, right? But that's not necessarily true. Sometimes if you accept, you're an addict, now you can get help.

Or if you accept you have a mental illness, now, you could actually take the right medication and get the right kind of treatment for it. So knowing what the truth is, allows us to make better decisions. It doesn't like mean, okay, I know this truth is true. And now it's gonna be like that forever and ever and ever. Okay, so that's a myth.

Another myth, accepting something means that you like it, or approve of it. Alright, and that's, you know, a common misconception, because in other contexts, when we say except, we mean that we like, like, well, I really accept you, you know, you're a good person. Well, sometimes it means that but in the DBT sense, acceptance doesn't necessarily mean liking.

It just means that I accept that this is the reality, I understand that this is what the reality is. And it can mean I don't like it at the same time, both are possible at the same time. Okay. So it doesn't necessarily mean you like the situation or you like or love the person, which is the last one at the bottom. For example, impatient sometimes.

There's other patients on the ward that are more symptomatic, and maybe they behave in ways that people don't like maybe they yell and scream, or they're more agile. cated and people can't stand that it's really disruptive to their life, it creates more stress, and they don't like it. But sometimes people can get to a place where they can radically accept that this is just how this person is behaving right now, maybe they're sick. Or maybe they can't control themselves and don't have the skills yet. So they may not like that behavior or like that person. But they accept that that's exactly how they're behaving right now. And now that I understand that reality, I can make a better choice about what to do.

Okay, you kind of see how that works. All right, I hope so. Okay, whoops, sizes really scrolling fast today. Okay, so here's a few examples of things that people often need to work on radically accepting. Right. One is that you can't change your past. I know, on some intellectual level that sounds like kind of obvious, but how many times do we keep rethinking things from the past? As if we can reconstruct them and sort of make them a little bit different? or somehow make them not really happen? or How many times do we like maybe try to block out memories of the past by engaging in target behaviors, okay.

So even though you can't change your past, you know, you can still learn to relate to it differently, so that it's not, as, you know, powerfully uncomfortable or painful in your life. Alright, but you can't change what actually happened, what happened happened, alright, just, we can just change our approach to it now. We can't control everything.

Again, something obvious on an intellectual level, but how many times have you tried to control things, you try to control how fast things are supposed to happen, or what's going to happen, or how people are going to behave, how they should behave, okay. But ultimately, there's a lot of stuff out of our control. The fact that nobody's perfect, and we all make mistakes. Sometimes we have a sense, like, you know, if I'm just perfect enough, people will like me, or they'll leave me alone, or they will criticize me.

We try to be perfect all the time. But ultimately, we have to radically accept that we're human, and we're not perfect, and we do make mistakes. And it's still okay.

You can't always get what you want, and part of distress tolerance is tolerating, what happens and how things feel when we don't get what we want. And that's can be really hard, especially if your expectations are really strong, or something was really important to you.

And sometimes, you know, as much as we wish it would happen, it's just not going to happen, or at least not right now. Alright, so really important to work on acceptance of that, and know what about that we can change? What about that we cannot. radically accepting our thoughts and feelings. Oh, big one, right, we might have really painful thoughts, flashbacks, memories, uncomfortable feelings are so difficult.

But ultimately, the more we radically accept those different experiences and parts of ourselves, the more inner peace we're going to have, and the more whole we're going to feel, the more healthy we're going to be. Okay. And finally, nothing lasts forever, which really means in permanence, that things are meant to pass, everything passes at some point, the bad things, fortunately, but also the good things, okay. And sometimes when we try to hold on to things too long, or cling to things that are meant to end, such as relationships, creates a whole lot of more suffering. So we need to understand that not everything is going to last forever, and certain things are meant to move on. So we can make space for other things in our life. Okay, so these are again, just some common examples of things we have to work on radically accepting. Okay, here's a diagram that I created. It's not from DBT, but I think kind of illustrates the point of how radical acceptance can help.

Okay, so as you can see, on the both the left side, and the right side, on the blue circle represents the original pain that we have of the situation. Okay, so whatever it is, that happened, it creates a certain level of emotional distress or pain.

How we respond to that can make a really big difference. So on the left side, is what we end up doing more commonly like reflexively, more out of habit. So if we are in pain, and then we start to think, Oh, this shouldn't happen. And this sucks. And this is stupid. And I'm going to engage my target behaviors to distract myself from this, or I'm going to show you and I'm going to do this and that, right, all of a sudden, the situation is getting bigger, it's getting worse. It's like throwing logs on the fire. So the red circle that's bigger than the blue circle is a representation of how that pain starts to expand when we respond to it in the ways that I described below. Right? So in these ways, that kind of represent a lack of acceptance, it just makes the situation more painful, and maybe last longer.

Okay, on the right side, I'm also same original pain may be triggered by the same situation, but when you respond to it with radical acceptance, you radically accept that this is what happened. And this is what it is. Maybe we even are able to be kind to ourselves or our emotions in that situation, maybe we could forgive the person that offended us or forgive ourselves for what how we responded, maybe we can have compassion toward the other person or ourselves, or some level of validation. Oh, that makes the pain not have to get worse. And sometimes it actually makes it better. So, while the pain may always be part of life, we could also have a choice about how we respond to it.

Okay, so keep these diagrams in your mind and mindfully recognize what your habitual way of responding to the pain is. And then perhaps choose radical acceptance instead of the usual and see what happens. try and experiment. Okay, so willfulness and willingness, important concepts to keep in mind with regard to radical acceptance. So the willfulness is what we do when we're fighting reality, when we're not willing to open our eyes to the truth, when we're kind of like that stubborn mule on the top left side of the screen, you know, it's not true, I don't want to deal with it, it should be different. It's not fair. That's all that stubborn mule kind of stuff, or the kid with his fingers in his ears, I don't want to hear it, I don't want to see it. I don't want to deal with it. Right?

That's not radical acceptance. That's kind of like the stuff that makes things worse, worse, and create more suffering.

On the right. willingness is more associated with radical acceptance. So that's kind of like allowing reality in being willing to listen, what the reality is trying to tell us.

And like it says in the bottom, facing reality as it is not as it was, or as you wish it would be. Okay? Totally being receptive to the truth. Okay, and therefore, the choices that we're going to need to make based on that truth.

Alright, so talking about radical right, so like I said before, it's not just an intellectual thing. It's a mind body spirit thing. So how do we radically accept with our body, all right, starts with a posture, right? If you think about a posture for lack of acceptance, I bet you've come up with it is probably something like hands folded across your chest, kind of like tightening up, okay, maybe closing your eyes, not letting it in. Okay, so that's a posture of not accepting. And if you check in with yourself, and you notice that you're holding that posture, it's going to be much harder to radically accept the situation, because your body's going to communicate a lack of acceptance to your mind. So if you start by changing your posture, to a more open, relaxed, willing stance, actually helps your mind to radically accept DBT later talk about willing hands, which are kind of shown in the picture on the top right, and also on the bottom left. So it's hands open and receptive as if you're receiving the reality as if it just going to fall into your hands, and you're going to take it with you.

A lack of acceptance would probably be more like, a closed fist, like, you're not going to receive anything, you're gonna fight. Um, another one is, think about breath. breath is very symbolic in a way. So we help we're letting things in. And when we exhale, we're letting things out. When we're not accepting, chances are our breath is reflecting that we're reading in a more shallow way.

When we are accepting, we're able to breathe in more deeply and fully, because we're taking in with our breath, the reality. We can also add a half smile to that, which is kind of just a small, serene, relaxed, kind of smile. Nothing fake, not like, that kind of thing. But it's sort of like another more open way of allowing the reality and another one is hand on your heart.

So you're with your heart, centering your heart center, with the acceptance of reality, as it's not just here we're trying to accept here. Okay, and one of the things to remember again, which I did say briefly before, but I'm going to emphasize is that radical acceptance is a process.

You can't just say, Alright, well right now, okay, I radically accepted this situation and I'm good to go. Okay, not always that simple. Because I could radically accept it right now. And be like, you know what, I get it. I radically accept that. And then an hour from now something else could trigger you. And you'd be like, God dammit, I wanted that have to happen. It shouldn't be that way.

We kind of circle around that around between accepting it and not accepting it, accepting it and not accepting it. So what we have to do is to mindfully recognize when we're not accepting it, and being willing to turn on my back to acceptance. Okay?

So that's the key that we are going to slip back to non acceptance most likely, but it's the turning it back around. That's the key. Right? So, keep going through that circle, be patient with yourself, okay, we're certain things that are really hard to accept this right take quite a while. But it's okay. So long as you're still in the game, you're still trying.

That's the main thing.

And one of the bonuses, not the initial goal, because this is radical acceptance, is that once you accept what the reality is, you're in a better position to change it.

Because you have to be grounded in the truth, before you can make a good decision about it. If you're making a decision based on your wish or your fantasy, it's going to be perhaps not the best decision. Alright, once you're grounded in the truth, as it says, In the left, acceptance is the road to all change. Okay, you'll be in a wise mind space.

Radical acceptance is a wise mind kind of a thing. And now, from there, the decision can come. And sometimes we know what we need to do. But we're a little afraid to do it maybe involves Something about like taking a risk, like saying something to somebody that can be a little scary to say, or trying something new, or making a bold decision such as quitting a job that's really not right for you are leaving a relationship that's really not right for you.

So it can be scary to make the change that comes with facing the truth, you might actually have to do something that you weren't sure you really want to do. But if you have the courage to do what you need to do, which you know, is the right thing. That's the next step. And get support if you need it. Sometimes it's hard to make that big bold move alone.

Okay, and that's that's the end of the radical acceptance talk. pretty deep stuff, right? Man. Oh, man, we did a lot today. So may not take this all at once. It's okay. Practices over time.

As situations come up, refer the video again if you need it for the DBT materials. Um, but this is incredibly powerful, helpful skill. I hope you guys give it a chance.

All right. Have a good day, and see you the next time. Okay, bye, everybody.

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