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Distress Tolerance Skills Part 2: Reality Acceptance Skills

All posts in this series reference working through DBT® Skills Training Handouts and Worksheets, Second Edition, and all quotes come from that book unless otherwise specified.

To learn more about distress tolerance skills as a whole, why they are important, and the goals the book sets forth for studying them, click here. The Distress Tolerance Skills section of the book is divided into two main types of handouts: Crisis Survival and Reality Acceptance. There will also be some material for "When the Crisis is Addiction". This blog will cover reality acceptance skills.

 Reality Acceptance Skills:

Radical Acceptance: 

The first reality acceptance skill is radical acceptance. Radical acceptance means completely accepting and ceasing to fight:
  • the facts about the past and the present
  • realistic limitations on the future
  • that even painful events have causes
  • that life can "be worth living even with painful events in it"
 Some phrases for practicing radical acceptance are in the graphic below:
https://themighty.com/wp-content/uploads/2018/09/xRadical-Acceptance-Coping-Statements-1-527x750.jpg.pagespeed.ic.iJrZTtApN8.jpg
Found at https://themighty.com/wp-content/uploads/2018/09/xRadical-Acceptance-Coping-Statements-1-527x750.jpg.pagespeed.ic.iJrZTtApN8.jpg
 So, we've covered the "what" and the "how" of practicing radical acceptance, but why should you practice it? The book gives a very good list of reasons (p.342), so I'm going to copy them directly:
  1. "Rejecting reality does not change reality. 
  2. Changing reality first requires accepting reality.
  3. Pain can't be avoided; it's nature's way of signaling that something is wrong.
  4. Rejecting reality turns into pain and suffering.
  5. Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame, or other painful emotions.
  6. Acceptance may lead to sadness, but deep calmness usually follows.
  7. The path out of hell is through misery. By refusing to accept the misery that is part of climbing out of hell, you fall back into hell."
Radical acceptance does NOT mean you approve of the situation or that you are not going to change it.
Some factors that can interfere with radical acceptance are not knowing how to do radical acceptance (lacking skills), confusing radical acceptance with approval or making light of a painful event, or having strong emotions that get in the way.
Below is a step-by-step guide for practicing radical acceptance. If it is too small to read, you can view it here.
https://themighty.com/wp-content/uploads/2018/09/xPages-from-Radical-Acceptance-DBT-1-739x750.jpg.pagespeed.ic.PQn_3OHpAE.jpg
Found at https://themighty.com/wp-content/uploads/2018/09/xPages-from-Radical-Acceptance-DBT-1-739x750.jpg.pagespeed.ic.PQn_3OHpAE.jpg

Turning the Mind:

The next reality acceptance skill is turning the mind. For turning the mind, imagine that you have reached a fork in the road. One path leads to reality acceptance and the other to reality rejection. Turning the mind is deciding to accept reality. That decision alone does not mean that you have accepted reality already, but it puts you on the path. Do this over and over every time you face a situation where you can accept reality or reject it.
Steps to turning the mind:
  • Observe that you are rejecting reality. Look for phrases like "It's not fair" or "It's not supposed to be like this," as well as emotions of "anger, bitterness, and annoyance".
  • "Go within yourself and make an inner commitment to accept reality as it is."
  • Repeat this process every time you find yourself faced with a choice to accept or reject reality.
  • "Develop a plan for catching yourself in the future when you drift out of acceptance."  

Willingness:

"Willingness is readiness to enter and participate fully in life and living." Willingness is doing what is needed for each situation wholeheartedly and listening carefully to your wise mind. You should replace willfulness with willingnness. Willfulness is "refusing to tolerate the moment... giving up... the opposite of "doing what works"... fix[ing] every situation... being in control... attachment to me, me, me". The book offers a step-by-step guide for practicing willingness. It is below:
  1. "Observe the willfulness. Label it. Experience it.
  2. Radially accept that at this moment you feel (and may be acting) willful. You cannot fight willfulness with willfulness. 
  3. Turn your mind towards acceptance and willingness.
  4. Try half-smiling and a willing posture.
  5. When willfulness is immovable, ask, "What's the threat?"

 Half-Smiling and Willing Hands:

Half-Smiling:
  1. Relax your facial muscles one-by-one until your face is fully relaxed. If this is difficult, try tensing each facial muscle and then relaxing it. This is important because a tense smile can tell your mind that you are masking your emotions instead of being willing.
  2. Turn up the corners of your mouth slightly, just so you can feel them. This is not about other people seeing it. This is about you, internally. 
  3. "Try to adopt a serene facial expression. Remember, your face communicates to your brain; your body connects to your mind."
Willing Hands:

Standing: "Drop your arms down from your shoulders; keep them straight or bent slightly at the elbows. With hands unclenched, turn your hands outward, with thumbs out to your sides, palms up, and fingers relaxed."

Sitting: "Place your hands on your lap or thighs. With hands unclenched, turn your hands outward, with palms up and fingers relaxed.

Lying Down: "Arms by your side, hands unclenched, turn your palms up with fingers relaxed."

Mindfulness of Current Thoughts:

Mindfulness of current thoughts is an application of the mindfulness skill from the second section of the book. It is applied as the images below explain:

Found at https://pbs.twimg.com/media/DyKmXl5WoAAYABe?format=jpg&name=large

Found at https://pbs.twimg.com/media/DyKmXl5WoAAYABe?format=jpg&name=large
Found at https://pbs.twimg.com/media/DyKmXl5WoAAYABe?format=jpg&name=large


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