One of The Hardest (and Most Important) DBT Skills For Reducing Your Emotional Suffering: Radical Acceptance
When I was little, I was TERRIFIED of needles. Doctors appointments were always a debacle because I was so upset at even the possibility of getting a shot. Then one day, when I was probably about 5, in the middle of a tussle with a nurse (who had already tried threatening me with the prospect of getting multiple people to hold me down…), she stopped fighting with me and told me something that truly changed my life.
She said that she needed to give me the shot—it was her job. She said that I needed to get the shot—it was my job. And she pointed out that by fighting against her, I was tensing up my muscles, making it harder for her to give me the shot. She compared it to trying out to put the needle in a rock—you’d need to use quite a lot of force to get the needle to in (if you could even do it at all). Then, she had me shake out my arms like jello and pointed out how much easier it is to slide the needle into a soft arm. She didn’t lie to me—she told me it would pinch a little when she put the needle in my arm if it was soft like jello, BUT she highlighted that it would hurt much less than if I continued fighting against her and tensing up my arms. She also pointed out that it would be way quicker without all the fighting.
She asked me to try relaxing my arms as MUCH as I could and said that if she was wrong, I never had to do it that way again.
The difference was like night and day. The shot did pinch a little, but I was SO relieved by how much easier it was when I stopped fighting her. I still think of that nurse and relaxing my body as much as possible when I encounter needles. It works every time.
The takeaway from that nurse’s advice is that accepting your reality doesn’t take away your pain. Life is painful. There’s no way around that. But, accepting your reality takes away all the extra suffering that comes from the act of fighting reality.
Reality Acceptance vs. Radical Acceptance: Reality acceptance is the broad category of skills for getting yourself to stop fighting against painful situations. Radical acceptance is a particular form of reality acceptance reserved for especially painful situations that lead to chronic and severe suffering. For example, I might use reality acceptance to cope with being stuck in traffic, whereas radical acceptance is for situations — like major losses, severe illnesses, and catastrophes — that are exceptionally painful and often seem unacceptable.
My favorite way to illustrate the idea of radical acceptance is with an analogy to walking on a road. This analogy comes from Seth Axelrod, my first DBT mentor.
Imagine: You’re going about your life, walking along a road. As you’re walking along, you develop an idea of where you’d like to go, and how you’ll get there. And you keep walking along, moving toward your destination. Until one day, there’s a rock slide and a boulder rolls into the road and blocks your path. Once you get over the shock that a giant boulder has blocked the road, you start to assess your options.
You start by trying to move the boulder. It won’t budge, so you try to get around it. There’s a cliff on one side and dense forest on the other, so you try to climb it. It’s too high, so you call for help. Even with help and tools, this boulder Is. Not. Budging. At first, you can’t accept it. You had your heart set on going down this road and getting to your destination, and you can’t just let go of it. You keep trying to move it or break or somehow get around it so you can continue on your way to your destination.
But even after all that effort, it’s still not moving. And what you start to realize is that you’re developing shoulder problems from trying so hard to move it, and you’ve broken all of your tools, and the boulder is still there. So, you take a stab at letting go of the boulder and all the efforts to get it to move. And you let yourself consider that maybe, with the resources you have available and the circumstance you’re in, this boulder is here to stay. And in realizing that, there is a huge loss.
You have to grieve that you can’t continue down the path the way you wanted, and there might not be a way to get to the destination you had in mind before. It’s tremendously sad. So sad, that you’re tempted to try to move the boulder again. And sometimes you do go back to trying to move the boulder, but each time, you’re quickly reminded that trying to move the boulder adds to your suffering and doesn’t actually work. So you redouble your efforts to notice and remind yourself that you can’t move this boulder.
As it starts to sink in that the boulder is there to stay and you really and truly cannot get around it, you start to wonder what other paths might be out there. You step back, you look around, and you see that a little bit behind you, there’s a fork in the road. You can’t tell quite where it goes, but it’s there and the road looks clear. So you start down that road. And sometimes, you still feel pulled to go back and take one more shot at moving the boulder out of the way so you can go down the road you wanted to be on all along.
Sometimes, you even start to walk back towards the road with the boulder before you catch yourself, notice and allow the sadness and grief, and remind yourself of your new reality. It’s painful walking down the new road and letting go of the old one. But refusing to acknowledge that the road is blocked doesn’t change the fact that it’s blocked. It keeps you stuck and it adds to your suffering. So you generate the willingness and you do the challenging work of radically accepting. The radical acceptance doesn’t change the painful reality, take the pain away, or make it okay. But, it does reduce your suffering, help you grieve, and give you a way to build a new reality, even though it’s not the one you wanted.
Radical Acceptance, Step by Step:
Observe that you are fighting reality: The first step in radical acceptance (like most DBT skills) is to notice that you are fighting reality. This can be hard to do. Notice when you’re pushing on a boulder that isn’t moving.
To help you notice when this happens , reflect on times in the past when you have had trouble accepting reality. Ask yourself what it looks like when you fight reality – what thoughts, feelings, and behaviors/urges come up? For example, when you face a painful situation, you might have thoughts such as, “I can’t do it,” or, “it’s not fair.” You might have feelings of anger and disappointment. You might have urges to scream or withdraw. If you can identify some of your own common warning signs, you can be more prepared to notice when you’re fighting reality.
Stop fighting reality: Once you notice you are fighting reality, make a purposeful decision to stop. Use the STOP skill (Stop, Take a step back, Observe, Proceed mindfully). Take a pause. Stop pushing against the boulder. Check in with yourself.
Name the painful reality and the loss: Acknowledge the painful reality. Say it out loud. With every painful reality, there is a huge loss. Identify the loss. For example, if a teen is having trouble accepting that their family is moving out of state, there’s the loss of the life they had in their hometown, with their friends, their school, and their community. There’s also the loss of the future they imagined in that town.
Grieve the loss: Allow yourself to experience the sadness and grief associated with the loss. Allow the waves of sadness to come and go. Spend a couple of minutes with something that reminds you of the thing you’ve lost. If you moved to a new town, look at a picture of your old house or your year book from your old school.
Find ways to experience the sadness in doses that don’t overwhelm you (e.g., for three breaths). When it’s the anniversary of an event that reminds you of the loss (e.g., the first day of school or a school dance), pick a small piece of the loss to focus on. For example, focus your attention on not getting to sit at your favorite lunch table, rather than trying to grieve the entire loss at once. Validate yourself (more on this next week!).
Once you’ve allowed yourself to connect with the emotions for a few minutes, redirect your attention to re-engaging with your life and moving on with your day. Balance experiencing the grief with not letting it overwhelm you. Practice self-compassion, self-soothe with your senses, and connect with others who understand, as needed.
Remember that time is the best medicine for grief. It doesn’t usually go away, but time often helps the waves get a bit more manageable, or else helps you build up your ability to ride them and not get pulled under every time.
Repeat the process of grieving as you bump into the emotions. Allow the waves to come and go. If you don’t, you’ll keep fighting reality and getting stuck in the emotions no matter how hard you try. The only way out of emotions is through.
Consider other options: It’s important to remember that the alternative options generally are not as good as the one you lost. It was your preference for a reason. And, the alternatives are generally much better than continuing to be stuck fighting reality. For example, the teen in our example of the interstate move cannot move home. And, they can form new relationships and community and stay in touch with loved ones from their hometown.
Start to live in your new reality: Identify what alternative options you want to pursue. Take small steps towards those options. Often, as soon as we begin to move towards living in our new reality (or even think about doing so), we get sucked back into fighting against reality and feeling overwhelmed by the loss. This is totally normal and part of the process. When this happens, repeat steps 1-5 again, as needed.
For more on radical acceptance, there’s a two part recorded webinar on the topic on our website. Part 1 is an overview of radical acceptance. Part 2 is more focused on practicing radical acceptance.