Dialectical behavior therapy – or DBT – is a form of therapy created specifically for individuals with borderline personality disorder. Through DBT, highly sensitive people learn distress tolerance skills that allow them to navigate uncomfortable or painful situations and manage urges to engage in harmful behaviors. DBT creator Marsha Linehan, divides distress tolerance skills into three categories:

The intensively trained DBT treatment team at Skyland Trail helps clients in our DBT residential treatment program learn and practice these skills as they work toward ending the painful cycle of feeling stuck and out of control. In this blog post, we’ll explore reality acceptance.

What Is Reality Acceptance?

Inevitably, we all experience pain in life, whether it be physical or emotional. Pain is a natural occurrence that signals something is wrong. How we choose to deal with pain however, has a significant impact on our overall well-being. Often, people choose to ignore or reject certain kinds of pain or use unhealthy coping habits to minimize the discomfort in the short term. By not accepting reality, pain turns into suffering, which causes ongoing distress. Typically, people respond to pain in four ways.

Problem Solving – Accept the reality of the situation and do what you are able to change, alleviate, or leave the situation. Changing Feelings – Understanding the issue at hand, observing its meaning, and seeking a positive out of the negative. Acceptance and Turning the Mind – Recognizing reality without approving the experience. Something may be difficult, but that doesn’t mean we have to enjoy it or let it continue. Remaining Miserable – By not accepting reality, individuals choose to suffer, which can exacerbate already difficult and distressful situations.

The only way to end suffering, which occurs as a result of pain and non-acceptance, is to accept reality and face the pain head on. DBT teaches three reality acceptance skills that can help individuals find respite from suffering.

DBT Skill: Radical Acceptance

Radical Acceptance DBT Boardgame

Radical acceptance is when you stop fighting reality, stop responding with impulsive or destructive behaviors when things aren’t going the way you want them to, and let go of bitterness that may be keeping you trapped in a cycle of suffering. To truly accept reality, we must understand the facts about the past and present, even if they may be uncomfortable or undesirable. By examining the cause of events or situations that cause pain, we can be better equipped to move forward with a life worth living even when pain may arise.

By embracing reality rather than rejecting it, individuals are able to break the cycle of suffering, unhappiness, bitterness, anger, shame, guilt, or other undesirable emotions. Getting through tough times isn’t easy. By choosing to do nothing about pain and suffering or using unhealthy coping habits rather than accepting pain is what makes many people feel stuck. Once individuals can accept reality while simultaneously not approving of it is when change can be made.

DBT Skill: Turning the Mind

Imagine you are at a fork in the road. To one side is a path of rejection and continued suffering. To the other side is acceptance. Here is where one must make a choice. Turning the mind towards acceptance takes you down a path towards ending the suffering. To turn our minds, we must observe that we are not accepting of a situation. Emotions like anger, bitterness, or thinking “why me?” are indicators of non-acceptance. We must make an inner commitment to accept reality as it is. Keep making this inner affirmation to turn your mind towards acceptance each time you are faced with pain or suffering and develop a plan for catching yourself in the future when you drift away from acceptance. Once you are able to turn your mind, you are choosing to take another step towards feeling better.

DBT Skill: Willingness

Another incredibly important factor of reality acceptance is about being willing and ready to participate fully in life and living. Willingness might not be the most fun or exciting part of recovery, but it signals that you are doing what is necessary wholeheartedly. Listen carefully to your Wise Mind and separate willingness from willfulness. Willfulness may look like refusing to tolerate the moment or make necessary changes, giving up, or an insistence on being in control or fixing every situation. Flipping willfulness to willingness gives the power back to the individual to truly be at peace with reality.

10 Steps for Practicing Radical Acceptance Using DBT

Observe that you are fighting against reality. (Ex: “It shouldn’t be like this.”)

Remind yourself that the unpleasant reality cannot be changed. (Ex: “It happened.”)

Acknowledge that something led to this moment. (Ex: “This is how it happened.”)

Practice acceptance with not only your mind, but your body and spirit. Be mindful of your breath, posture, and use skills like half-smiling and willing hands.

List what your behavior would look like if you did accept the facts then act accordingly.

Plan ahead with events that seem unacceptable and think about how you should appropriately cope.

Remain mindful of physical sensations throughout your body such as tension or stress.

Embrace feelings such as disappointment, sadness, or grief.

Acknowledge that life is worth living even when there might be temporary pain.

If you find yourself resisting, complete a pros and cons exercise to better understand the full impact of your choice.

At Skyland Trail, we use dialectical behavior therapy and reality acceptance to help individuals regulate their emotions and responses to stimuli. DBT is one of the most researched treatments for borderline personality disorder and is significantly effective in reducing harmful thinking, behaviors, and impulsivity. Clients admitting to our residential psychiatric treatment programs aren’t given a one-size-fits all treatment plan. Our integrated treatment teams utilize a combination of individual and group psychotherapy, expressive therapies, pastoral counseling, and physical activity to help clients find recovery from mental illness and get back to a life worth living.

These DBT Distress Tolerance skills can be found in DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha Linehan.