DBT Radical Acceptance Worksheet
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Looking for a DBT radical acceptance worksheet to use in your practice?
In this article, learn about DBT radical acceptance, how to help clients practice it, and then download a free DBT radical acceptance worksheet to save to your electronic health record (EHR) for future use.
Helping certain clients increase their levels of acceptance can be beneficial.
The term radical acceptance is derived from the distress tolerance component of dialectical behavioral therapy (DBT). Distress tolerance skills can empower clients to better tolerate their highest levels of emotions and pain.
DBT radical acceptance provides steps to help clients move out of rejecting reality, denial, or exacerbate pain. Instead, DBT skills aim to reduce suffering, while also accepting reality.
What does it mean to reject reality?
Though it differs from person to person, at its core, rejecting reality is refusing to accept painful events, emotions, or facts.
This can feel like an internal resistance to what is happening in life and can ultimately keep people stuck.
A person rejecting reality may make any of the following comments:
- “This shouldn’t be going on.”
- “Why is this happening to me?”
- “I hate this!”
- “I can’t handle this.”
These attitudes can cause bitterness, resentment, fear, or despair.
By refusing to acknowledge and accept reality, individuals may increase their emotional suffering and struggle to find healthy ways to cope or make positive changes in their lives.
How DBT radical acceptance can be helpful
The DBT radical acceptance worksheet included with this article can be helpful for clients who tend to reject reality.
As a therapist, you cannot take away the painful situations of clients’ lives or eliminate all their painful emotions. However, you can help them reduce their levels of distress, frustration, and suffering caused by not accepting a situation.
Clients can learn to let go of negative commentary and self-talk, which may be intensifying how they feel. Radical acceptance can turn a willful psychological resistance into a calmer willingness to receive things as they are.
Taking a more neutral stance toward a situation and letting reality be reality can help clients cope with distressing moments and find some peace in the storm.
It is important to clarify what radical acceptance does not entail, as it can be easily associated with other concepts.
Radical acceptance is not:
- Condoning, approving, or loving what has happened
- Forgiveness or compassion towards someone
- Passivity or resisting change through inaction
- Invalidating the pain or effect of difficult situations
To summarize, radical acceptance does not mean celebrating difficult things, condoning bad behavior, or hindering a process of change. The goal is to cultivate acceptance along with honesty, accountability, and change.
How to practice radical acceptance
There are many DBT skills for distress tolerance, but DBT radical acceptance is unique—dealing specifically with a client’s relationship to their lives and the reality of their circumstances.
It is intended to be a holistic and complete acceptance, one that involves a person’s mind, body, emotions, and spirit.
Given this holistic view, there are many ways to practice radical acceptance.
These practices can be suggested for the client to use as part of the client’s treatment plan, and can be shared alongside the DBT radical acceptance worksheet included in this article.
Mental practices
One of the most common ways in which rejecting reality appears is through the client’s thoughts and the stories they tell themselves. This is why it’s essential to help clients develop increased awareness of their own anti-acceptance narratives.
As clients develop these insights, it is important that they also cultivate thoughts, statements, or mantras of acceptance to apply to their difficult situations.
Clients who learn reminders of acceptance give their mind something to latch onto instead of the ingrained patterns and narratives of rejecting reality that they are used to. These could be considered radical acceptance coping statements.
Some examples of these statements include:
- “This is what happened.”
- “This is the reality right now and my starting point.”
- “I cannot change what has happened.”
Behavioral practices
It can be beneficial for clients to think about what they might be doing, or how they might act, if they were in a place of acceptance.
For example, if a client who received a difficult health diagnosis repeatedly reads their medical report in disbelief, their action may be to stop reviewing the medical report. Actions of acceptance can help facilitate emotions, thoughts, and sensations of acceptance.
Physical or somatic practices
In addition to using DBT radical acceptance worksheets, certain movements or exercises can also have an impact on a client’s emotions and facilitate a greater sense of acceptance.
There are two physical acts in particular that are associated with radical acceptance and come from dialectical behavioral therapy distress tolerance techniques.
One such physical act is called Willing Hands. To do this, simply have a client extend their arms in front of them. Then, the client opens their hands and turns their palms upwards as a posture of acceptance.
The second action is known as Half-Smiling. This involves having the client relax their facial muscles completely, then slightly turning the corners of their mouth up, just enough so that they can feel it.
There are many other body-based practices that you can use in your practice. These include deep breathing, vagus nerve stimulation exercises, or progressive muscle relaxation.
All of these exercises help the body communicate to the brain, which in turn, can help clients move toward deeper acceptance—mentally and emotionally.
Spiritual practices
Certain clients with religious or spiritual beliefs may benefit from connecting their spiritual practices to acceptance.
Prayers of surrender, chants, or mantras are some examples of how a client could use spirituality to play a role in their radical acceptance.
10 steps to radical acceptance
Providing clients with these tangible radical acceptance steps, taken from the DBT Skills Training Handouts and Worksheets, Second Edition, may help clients practice radical acceptance outside of therapy:
1. Are you questioning or fighting reality?
2. Remind yourself that the unpleasant reality cannot be changed.
3. Remind yourself that there are reasons for the reality. Acknowledge that some sort of history led up to this very moment. Notice that given these causal factors and how history led up to this moment, this reality had to occur this way.
4. Practice accepting with the whole self (mind, body, and spirit). Be creative in finding ways to involve your whole self. Use accepting self-talk, relaxation, mindfulness of your breath, half-smiling, and willing hands, while thinking about what feels unacceptable. If spiritual or religious, use prayer. You can also imagine going to a place of acceptance.
5. Practice opposite actions. List all the behaviors you would do if you did accept the facts. Then, act and engage in the behaviors as if you have already accepted the facts.
6. Cope ahead with events that seem unacceptable. Imagine believing what you don’t want to accept. Rehearse in your mind what you would do if you accepted what seems unacceptable.
7. Attend to your body’s sensations as you think about what you need to accept.
8. Allow disappointment, sadness, or grief to arise within you.
9. Acknowledge that life can be worth living even when there is pain.
10. Create a pros and cons list if you still find yourself resisting acceptance.
Acceptance is a way of viewing and responding to life.
For many people, it is something that has to be cultivated and practiced. It is helpful to normalize that clients will likely drift back to rejecting reality at times.
Therapists and clients should work together to identify these moments of drifting, acknowledge them without judgment, and then gently shift their focus back to the practices of acceptance.
This is something clients often need to practice again and again and again.
How to use the DBT radical acceptance worksheet
The DBT radical acceptance PDF can be downloaded at the top of this article to facilitate acceptance work with clients.
The DBT radical acceptance worksheet leads clients through a series of questions to help them identify a particular situation where they are rejecting reality.
The following steps can prompt clients to identify situations where they can practice acceptance:
- Clients are prompted to think of a current reality-rejecting situation in their life, how that rejection is manifesting for them, and how doing this is increasing their suffering.
- Then, clients are asked to think about the pros and cons of accepting the situation, which can be especially helpful for those who have not yet embraced acceptance and need to process their ambivalence.
- Next, clients are prompted to think of physical, behavioral, mental, and spiritual practices that they could use to help them facilitate acceptance.
- Finally, clients are asked to think of ways to remind themselves to implement and repeat their practices.
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