Radical Acceptance is a core skill in Dialectical Behavior Therapy (DBT). This skill falls into the category of Distress Tolerance skills. We reach for this skill when we are navigating something big and hard in our life that is outside of our control or influence. The idea behind Radical Acceptance is that we can work to improve our wellbeing even in the midst of the big and hard things.
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To appreciate what Radical Acceptance can offer us, we must first understand the difference between pain and suffering. Pain is an inevitable part of being human in our world. We will all experience pain at different times in our life. Suffering, however, is caused when we make choices that make painful circumstances harder for ourselves. Radical Acceptance seeks to accept pain and reduce suffering. When we reduce suffering, we grow in emotional resilience and wellbeing. 

​Radical Acceptance is the act of fully acknowledging and embracing reality without judgment or resistance. In other words, Radical Acceptance is a choice to stop fighting against reality. Likely something is happening in our life that is hard and beyond our ability to change it, and we are left with the decision to accept (radically) or reject the reality of the situation. The radical part of Radical Acceptance speaks to the complete and total nature of our choice to accept reality. Radical Acceptance is not resignation or apathy, rather it is a conscious choice to yield to what is real. Radical Acceptance also does not require our stamp of approval on the difficult circumstances, instead a simple acknowledgement that it exists and that we will stop fighting against it. Suffering comes when we fight against painful events that we don’t have the power to change, and Radical Acceptance offers us a peaceful alternative.

DBT offers us some step-by-step guidance on how to execute the choice to Radically Accept painful circumstances.

1. Observe the internal resistance to pain or painful circumstances
2. Notice and describe the emotions or sensations related to this resistance
3. Embrace the reality of the present moment
4. Find and acknowledge peace in accepting things as they are

​We can draw upon other DBT skills as tools to help us in this process. Mindfulness skills help us notice what is happening internally and externally and bring awareness to the present moment. Additionally, mindfulness skills call us to self-compassion and nonjudgmental observation of emotions.  We may have an opportunity to reframe negative thoughts about our reality and notice growth opportunities or unexpected benefits. Some nourishing activities like journaling and spending time in nature can help promote acceptance. Often times, Radical Acceptance requires patience and practice, as most painful events will require us to choose acceptance over and over again.

Disclaimer: Radical Acceptance is not an excuse for harmful or abusive dynamics, but it may be a starting point for being honest about the harm that exists. May this honesty open doors for healing and support.

Dialectical Behavior Therapy (DBT) offers a set of skills to help with many different emotional and relational difficulties. The four pillars of DBT are Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance. Each of these pillars offers a number of skills to practice in that area. I have selected three DBT skills that I believe can make a significant difference for those managing depression.
Depression is an experience that includes a slow-down or freeze response in the nervous system. People managing depression may feel numb, detached, hopeless and sad. These internal experiences may cause them to isolate from relationships, get stuck in their difficult emotions, struggle to complete normal activities. Often, those managing depression feel misunderstood by the people in their life, especially when they are encouraged to “think positively” and “just get over it.” In fact, people managing depression are often expending enormous effort to engage in their life in the most simple ways. The following set of DBT skills can be used together or individually to improve depression symptoms and help catalyze healing and forward movement.

1.Emotion Regulation Skill: Opposite Action
When we are using Emotional Regulation skills, we are paying attention to whether or not our emotions fit the situation we are in. Opposite Action is a skill that we reach for when we have determined that our emotions DO NOT fit the facts of the situation. This is often the case with depression. Depression is like a lens that makes life look harder and sadder than it actually is.
All emotions have an action urge, an instinctual action that the emotion makes us want to do. When our emotions DO NOT fit the situation, we benefit from acting opposite to the action urge. Here are some common emotions experienced in depression and suggestions for opposite action.

• Hopelessness --> Action Urge: give up -->Opposite Action: stay engaged, keep trying
• Sadness --> Action Urge: isolate, wallow, freeze --> Opposite Action: share, express, move
• Numb --> Action Urge: disengage, stop moving --> Opposite Action: gentle movement, embodiment

 
2.Interpersonal Effectiveness Skill: Making Requests
Making Requests is a relationship skill that is very closely related to making boundaries. Requests highlight what we need from another person. While they can be vulnerable to make, they are also vital to communicating our needs with others. Loved ones are not mind-readers and need invitations and instructions to know how to care for those managing depression.
People experiencing depression are almost always misunderstood by the people who care for them most. Unless they have experienced depression themselves, loved ones will likely minimize the depressed experience. From the outside, it may appear that it would only take a few simple steps to recover from depression. If only that were true.
In order to stay connected with loved ones and to receive the care they absolutely need, those managing depression need to lean into this skill of making requests. They need to speak about how they are feeling and the effort they are expending to engage with their lives. They need to ask their loved ones to be patient with them, to use encouraging language, to offer comfort and presence rather than solutions.
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3.Distress Tolerance Skill: Radical Acceptance
We reach for distress tolerance skills when we are going through circumstances that are too big and/or too hard for us to change. Depression often comes on the tails of a big and hard life event, such as the loss of a loved one, a difficult transition, a painful event or unmovable circumstances. When there is truly nothing we can do to change our circumstances, we need to shift our focus toward acceptance.
We are using radical acceptance skills when we work to create openness and willingness toward our difficult circumstances. Willingness is a powerful mindset shift and means that we will stop fighting against what is inevitable. Endlessly fighting against unfavorable circumstances is a recipe for suffering. Pain is inevitable in our lives, but suffering is a choice. We can still live meaningful lives in the midst of painful circumstances. When we give up the fight, we are more able to find acceptance. . . and peace.