Radical Acceptance: A DBT Skill for Coping with Difficult Emotions and Reality

Written By Z. Hamilton Avery

Radical Acceptance is the practice of acknowledging reality as it is in this moment without adding extra suffering by fighting what has already happened or what is currently true. It does not mean approving, liking, excusing, forgiving, giving up, or deciding that something is okay. It means seeing clearly: This is what is happening. This is what has happened. I may not be able to change this moment by arguing with it, but I can choose how to care for myself and what to do next. Acceptance creates room for grief, protection, boundaries, problem solving, and wise action.

Radical Acceptance comes from Dialectical Behavior Therapy (DBT) and is closely related to acceptance-based approaches that teach people to reduce struggle with painful internal experiences while still moving toward meaningful action. Peer-reviewed research on DBT suggests that skills training can improve emotion regulation and reduce high-risk or dysregulated behaviors. Furthermore, acceptance-based models emphasize that fighting reality can increase distress when the situation itself cannot be immediately changed.

A simple practice is to pause, breathe, and name the reality in one honest sentence: “This is painful and it is what is happening right now.” Then ask yourself, “Given that this is true right now, what is one wise next step?” The goal is not to feel peaceful immediately. The goal is to stop pouring energy into arguing with reality so more energy becomes available for coping, grieving, setting boundaries, problem solving, or taking care of yourself.

Important Note

Radical Acceptance should never be used to pressure someone to tolerate abuse, injustice, neglect, or unsafe conditions. In unsafe or unjust situations, accepting reality means clearly naming what is happening so protection, advocacy, boundaries, or change can become possible. 

References

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006 ⁠

Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936-951. https://doi.org/10.1037/a0021015 ⁠

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766. https://doi.org/10.1001/archpsyc.63.7.757 ⁠

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. https://doi.org/10.1001/jamapsychiatry.2014.3039 ⁠

Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy, 59, 40-51. https://doi.org/10.1016/j.brat.2014.05.005

Z. Hamilton Avery

Z. Hamilton Avery, LCSW, BC-TMH, CMT, CYT-1,000, TIYT (he/they) is a queer and non-binary therapist, health educator, wellness coach, body and energy worker, yoga and meditation teacher, and abstract artist in Tulsa, Oklahoma. In addition to having obtained over a dozen certifications in various modalities of complementary and alternative medicine (CAM), Z holds an associate’s degree in pre-nursing studies, a bachelor’s degree in psychology, and a master’s degree in social work. When supporting clients and students, Z takes a humanistic, person-centered, strengths-based, trauma-informed approach. Their practice is grounded in compassion, harm reduction, inclusivity, social justice, and evidence-based interventions. Ultimately, Z’s mission is to provide a safe and non-judgmental space for adolescents (13+) and adults who are navigating challenges such as anxiety, depression, trauma, addiction, pain, and chronic illness; he does this by offering sessions, classes, groups, workshops, retreats, and trainings.

Understanding that mental health is interconnected with many other facets of life, Z takes a holistic approach to therapy. Knowing that there is no one-size-fits-all treatment, he strives to honor the uniqueness of each client by custom-tailoring his approach to best meet the needs, preferences, and goals of each individual. For this reason, Z believes that it is imperative to be cross-trained in many different treatment approaches. As a therapist, they utilize a variety of evidence-based practices, including motivational interviewing (MI), cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and written exposure therapy (WET). As a body and energy worker, Z is certified to practice massage therapy, Thai yoga massage, myofascial release, craniosacral therapy, and reiki. They are also certified in both Chinese and Japanese styles of acupuncture. After completing more than 1,000 hours of accredited yoga teacher training (primarily in India), Z is certified to teach various styles of yoga, including Hatha, Kundalini, yin, and restorative. He also researches and writes about topics including stress, trauma, self-care, mindfulness, self-compassion, holistic health and well-being, CAM, HIV/AIDS, and issues related to the Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, agender, plus (2SLGBTQIA+) community.

https://www.therapywithz.com
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