How To Accept Hurt: Insights From DBT

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Do You Carry Impossible Burdens?

Do you need others to change in order for you to be happy?

"If only. . .

My spouse would spend more time with me.

My boss appreciated me more.

My child had more common sense."

Do you need to change the past in order to feel okay about life?

"If only . . .

I had not been abused as a child.

My father would not have died.

I had not made that terrible mistake."

Here is the reality:

* No matter how desperately you need someone to change, they are in charge of their own change processes. To start that process requires that they have the insight, willingness, and strength to do so.
* All the hope and effort in the world cannot change the past.

Carrying impossible burdens is like beating one's head against the wall. It will leave you bloody and bruised without offering you any benefit. No matter what your "if only" happens to be; you cannot escape reality. Drugs, alcohol, suicide, threats, and fantasy do not make good magic wands.

About Dialectal Behavior Therapy (DBT)

The understanding that reality is always in our face has guided the creation of new interventions to help people heal themselves by accepting rather than resisting reality. The new interventions are part of Dialectical Behavior Therapy, more commonly known as DBT. DBT has formulated specific interventions based on four core skill areas:

1. Interpersonal Effectiveness
2. Reality Acceptance (sometimes called Distress Tolerance)
3. Emotional Regulation
4. Mindfulness

Reality Acceptance Skills

Today's post focuses on the Reality Acceptance skills. DBT teaches people to accept and find meaning in the impossible burdens of life. Acceptance of reality is not approval or not caring. Rather, it involves acknowledging the situation and staying calm so that one can use one's "wise mind" to think through whether and how to take action, rather than surrendering to the overwhelming and destructive negative emotions.

The first set of Reality Acceptance Skills can be remembered by the acronym "ACCEPTS". The goal of the "ACCEPTS" skills are to distract you from the emotional pain; to buy some time to think before reacting impulsively or getting swept up in rumination.

* A ctivities that are fun and meaningful. What do you like to do?
* C ontribute by adding value to someone else's day or life.
* C ompare yourself with the less-fortunate or with yourself when you were less skillful.
* E motions (other) -do something to shift your emotional gears-laughter, enjoyment, pride.
* P ush away the hurt to the background. Focus instead on something productive and affirming.
* T houghts-force your mind to think about something else.
* S ensations-stimulate your senses-smell something sweet; taste spicy candy; see art.

There are more Reality Acceptance skills-but first, you should practice these. Write these skills on an index card and put somewhere that is easily accessible. The next time you feel the sting of interpersonal pain, pull out the card and go down the list.

Learn ACCEPTS By Doing

If you would like to try to drop your "impossible burdens" using the ACCEPTS strategies, try this:

1. Write down the ACCEPTS skills on a notepad or index card and put them in an easily accessible place. You might also list some specific ways to do each of the "ACCEPTS" skills.
2. When you feel emotionally flooded, get out the list. Practice one or more of the skills.
3. Evaluate the impact of your practice by asking yourself following questions

Did the skill effectively distract me from the emotional pain?
Did the skill give me time to think through whether and how to deal with problem at hand?


Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization.

She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness. She is author of the website Her email is

Katrina Holgate Miller, PhD, MFT is a freelance medical journalist specializing in mental health.

Her professional experience has encompassed many facets of mental health care, including mental health assessment and treatment, substance abuse, domestic violence, sexual abuse (victims and perpetrators), couples counseling, and adolescent group counseling. For the past five years, Katrina has worked with patients across the country to help them resolve their barriers to adequate and effective mental healthcare and chemical dependency/addiction treatment.

Her writing tells the stories of the patients who used their moxie to overcome their distress.


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