radical acceptance and distress tolerance

What are radical acceptance and distress tolerance and why are they always coming up in session?
 

DBT, or Dialectical Behavior Therapy, is a popular mental health intervention originally developed to better understand folks diagnosed with Borderline Personality Disorder. In recent years, the creator of DBT, Marsha M. Linehan, shared her own story with Borderline Personality Disorder, shifting the narrative around those in academic spaces who create evidence-based treatments. A very valid critique of many mental health interventions involves the acknowledgment that those creating and testing these methods are frequently quite separate from the actual lived experience of those on the receiving end of these therapies.

DBT aims to help folks connect with a non-judgmental and compassionate way to understand the emotions that they are experiencing while enhancing forms of coping to help in difficult scenarios. This can be particularly impactful when a person's adaptive, protective response includes self-harm and when someone has experienced trauma. However, the foundational concepts of DBT can be successfully applied to an incredible amount of scenarios, and can be supportive and freeing for many. 

Mindfulness

DBT, including radical acceptance and distress tolerance, draws heavily on a Mindfulness perspective. A note about the adaptation of Mindfulness without contemplative religious context - these ancient practices have been used in Mindfulness-Based Stress Reduction and Pain Management techniques developed in white, secular settings often divorced from meaningful connection to the cultural teachings and meaning of these practices. We can strive to work with individual emotional and autonomic responses while connecting with the systems, community, and spaces around us. We are all connected.

Radical acceptance 

Radical acceptance is a wonderfully inclusive concept that encourages an acceptance of the current moment without judgment. This includes and validates difficult moments, specifically when the environment and systems we live in fail us. 

It is a natural tendency for many of us to focus on what could have gone differently in the past, or all the things that might go wrong in the future when we are in a present moment that is distressing. Acceptance around the present moment allows room for connection with the body and mind, to allow for observation and non-judgmental awareness.

Distress tolerance

Distress tolerance refers to the idea that folks can be empowered to engage with systems of emotional and physiological regulation, even during difficult moments. This idea includes space for the very normal and valid emotional reactions to a challenging or painful experience while also encouraging connection with internal and community support.

It is extremely common to experience a stress response during difficult moments - fight, flight, or freeze, self-harming or self-sabotaging coping, the desire to run or avoid - all of these responses are protective, adaptive, and very understandable. The body and mind are doing what they are supposed to - try to protect and cope. Distress tolerance creates space for additional ways of coping - feeling a sense of agency and ability to focus on what is supportive for self and others.

A brief practice to try

An easy and accessible way to practice the foundation elements of radical acceptance and distress tolerance is by practicing neutral observation during tough moments.

Begin by noticing what is happening in your body during a moment of stress - what sensations do you notice? Observe your thoughts - what is your mind saying? Instead of drawing a conclusion, simply notice, acknowledge, and accept what is happening within you.

To learn more, read some of Marsha Linehan's work - a complete workbook is linked below.

1. Marsha Linehan DBT skills training handouts and worksheets

Thinking of all of you!