DBT Distress Tolerance – Reality Acceptance Skills

This week in DBT Skills Group, having finished going through the Crisis Survival skills, we were introduced to the Reality Acceptance skills that make up the second part of the Distress Tolerance module.

The first skill we looked at was Radical Acceptance. The clinicians voiced their collective opinion that this is probably the most difficult skill in all of DBT to master, and all the members of the skills group were in agreement with this notion too. Here is the handout outlining exactly what Radical Acceptance entails, and here is an example.

Now some of the reasons for practising Radical Acceptance may sound pretty horrific – and the chances are that they are. Radical Acceptance is not  easy. However, I can assure you that the alternative will most likely be even worse. Rejecting reality when there is absolutely nothing that can be done about a situation – or when trying to do so increases the likelihood of further complications – will only lead to more suffering.

In my DBT group we try to remember this using a simple equation:

Where Pain + Reality Rejection = Suffering,
            Pain + Radical Acceptance = Pain

Being willing to practice using Radical Acceptance does not mean that pain is avoided; however it does minimise the levels of suffering endured. Pain is a lot easier to manage because it a part of life, it is necessary, it is transient, it can be motivating, and is a valuable communicator that something is causing us to feel a certain way. Suffering, on the other hand, can be avoided.

Additionally, without fully accepting reality as it is, there is no option for change or growth. Sometimes the only way out of distress is through it, which means having to accept it for what is is instead of trying to avoid or push it away.

It reminds me of a quote from the children’s book ‘We’re Going On A Bear Hunt”, which I believe is rather apt –

“We can’t go over it, we can’t go under it…
Oh no! We’ve got to go through it!”

The next skill we were introduced to was Turning the Mind. Turning the Mind is in my opinion a precursor to Radical Acceptance, and it could possibly be helpful to be taught this skill first! Radical Acceptance doesn’t just happen – first you have to take the steps to willingly “turn your mind” towards the Acceptance path. The alternative to this path is the Path of Rejection.

Turning the Mind means making the choice and being willing to walk down the former road and away from the latter. It doesn’t equate to automatically being able to accept, but it does put you onto the path, which is closer to reality-acceptance than doing nothing at all.

With Turning the Mind, imagine visually a fork in the road or something similar with two outcomes. Imagine that one path leads to Acceptance and the other to Rejection. Mentally place yourself onto the Acceptance Path, and imagine yourself walking down this route. When you find yourself straying from the Acceptance Path, which invariably you will, notice the lack of acceptance seeping in, and intentionally re-position yourself onto the path. Commit to yourself that the path of Acceptance is the one you have chosen. Continue to do this, over and over again. Hopefully, Turning the Mind consistently in this way will eventually lead to Radical Acceptance of the situation – the benefits of which are outlined above.

Lastly we looked at the skills of Willing Hands and Half-Smiling, which involve accepting reality with your body in order to help accept reality in your mind. They both result in genuine physiological changes which in turn help lead to a more open and accepting stance mentally.

These two skills are outlined below on the handout where they are summed up beautifully!


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