Welcome to an exploration of radical acceptance, a fundamental skill in DBT: Dialectical Behavior Therapy. Radical acceptance means acknowledging reality as it is without making any judgments about it or resisting it. In this article, we will dive into the concept of radical acceptance from a DBT lens, and then explore its relevance and application for LGBTQ+ adults. It comes from the world of Distress Tolerance, a toolbox for withstanding pressure and intense emotions as well as for coming to terms with unchangeable realities. Radical acceptance is most useful for making peace with the parts of our lives we cannot change and the problems that have no solution. As a psychologist specializing in queer mental health, I understand how a distress tolerance skill like radical acceptance can help LGBTQ+ people face the unique challenges and stressors in their lives.

What Is Radical Acceptance

Radical acceptance is a DBT skill that arose out of the desire to learn how to make peace with painful realities. It relies on total openness to the facts of life as they are. Acceptance means recognizing and acknowledging that facts are true. What makes it “radical” is that you accept the truth down to the very depths of your spirit. When you open yourself up fully and completely to the way things are, then you are practicing radical acceptance. Behavioral Tech, the organization that certifies therapists in DBT, quotes the founder of DBT, Marsha Linehan, as saying that radical acceptance is “The fully open experience of what is, just as it is, by unrivaled entering into reality, just as it is, at this moment. Radical Acceptance is the only way out of hell.”

It fits in the wider context of DBT within the set of skills called “reality acceptance.” There are enough types of mental health therapies out there to make your head spin, and one thing uniting all the different “behavior” therapies is the concept of making measurable change. All behavior therapies emphasize making meaningful changes in how you regulate your emotions or respond to threats, with the ultimate goal of changing how you live your life. Some therapies, like DBT or ACT, unite change-based skills with acceptance-based skills, as a way to acknowledge that living in the world is not always so neat. Not every problem can be changed. Not every problem has a solution. Realities like gravity and death, or the order of events that have happened in the past: none of these things can be altered. 

At the core of the acceptance skills within DBT lies the concept of radical acceptance, which means completely embracing reality. Radical acceptance is about acknowledging the present moment fully, in all of its pain and discomfort. At the same time, as you embrace the present moment, how do you release the natural struggle against it?

Applying Radical Acceptance to LGBTQ+ Experiences

As much as radical acceptance helps you tolerate incredible pain, it can also help you bask in joy or pride or pleasure. We use radical acceptance to acknowledge the realities of prejudice and discrimination faced by the queer community, and we can also use this skill to come to terms with our identities and experiences without judgment. Radical acceptance can be a powerful tool for LGBTQ+ individuals to cultivate self-compassion or resilience. This involves acknowledging and processing difficult emotions, such as shame and fear, while recognizing the inherent worth and validity of one's identity.

Challenges Faced by LGBTQ+ Adults

Queer people face challenges that can impact their mental health and overall well-being. From navigating the coming-out process to dealing with stigma and discrimination, sometimes from within the queer community itself, there are lots of barriers in the way of mental wellness for our community. We come to terms with internalized homophobia, or transphobia, or the weight of societal expectations, and each of these can also contribute to feelings of shame or isolation. When it comes to society-wide prejudices, how much of that can an individual queer person hope to change? 

Can We Approach Prejudice as a Solvable Problem?

Radical acceptance is designed for problems that cannot be solved, like terminal illnesses or the mortality of our loved ones. Does prejudice or bias count as a problem with no solution? It is tempting for me to throw up my hands or to say that anti-queer hate is an unchangeable reality. Perhaps I could use a skill like radical acceptance to come to terms with systemic problems that seem too unwieldy or overwhelming to change. I could easily give in to the despair and let the momentum of a tidal wave of anti-trans and anti-queer legislation carry me away, to say that prejudice against LGBTQ+ people is and always will be a part of life in my country. However: I do not accept stigma or discrimination as a fundamental truth about the universe. I say that the systems based in anti-queer hate can still be dismantled, aggressive as they are, and individual biases can still be unlearned. When we approach something like stigma or discrimination as if it will always exist in its current form, we give in to hopelessness, and any change becomes impossible.

That’s why I don’t advocate using the radical acceptance skill from DBT to embrace the existence of prejudice or stigma- it’s too simple. To embrace those things fully, to say “this is the way the world looks and will always continue to look, and I accept that,” is a barrier to changing the way things are. And change is just as fundamental a reality as gravity. 

Point being: Radical acceptance is not about embracing or approving of prejudice and hatred; it is not about existing peacefully with a society that is structured to oppress. Instead, it is about acknowledging the existence of that prejudice, and choosing to respond effectively.

Why to Practice Radical Acceptance

Practicing radical acceptance may seem daunting at first, especially to do so wholeheartedly. Rejecting reality doesn’t work either, or at least, it doesn’t work in the long term. Denial can only last so long, and many problems can be made worse if you ignore them. My example for this is scoliosis. I was diagnosed with this spine problem as a kid and I had to wear a back brace. I burned with shame about having to wear a cast to school under my t-shirt. But fighting reality, pretending that my back was fine and that my spine would just magically straighten out, got me nowhere. The reality is that my spine was doubling over on itself, and without the brace and multiple surgeries, the situation could become life-threatening. Accepting how bad it had gotten (plus the privilege of accessing quality medical care) meant my family and I could make the doctors appointments, schedule the surgeries, and deal with it. That’s why I practice radical acceptance: because pain isn’t going anywhere, and if I continue to reject it, I will only add to my suffering.

Strategies for Practicing Radical Acceptance

1. Notice that you are fighting reality or living in denial. Not for the purpose of judging yourself. For the purpose of acknowledging that there is a reality you want to accept but cannot.

2. Remind yourself that the facts of the case are just that: facts. In the scoliosis example from above, the facts were that my spine was growing twisted, and that it was not going to straighten out on its own. 

3. Get somatic, by which I mean, practice involving your whole human body in the knowledge that what happened, happened. Feel it in your shoulders, stamp it into your feet, get into your body about it. For example, one somatic practice, “willing hands”, looks like adopting a posture where you place your hands down palm up wherever is comfortable, and hold the palm of your hands open while you consider the reality you are trying to accept.

4. Act the way you would act if you DID accept the reality. If I did accept that I had scoliosis, I would wear the brace for longer hours at school, and I would take the time to do the stretches I was supposed to be doing, and I would tell my friends at school what was happening with me, as if it was not shameful, because in reality, it wasn’t. 

If you are trying to accept a loss or a death, you might ask yourself what you would be doing if you truly admitted to yourself that this person was gone. Would you make a plan for what you want to do with their belongings? Would you put the words together to say goodbye to them? Figure out what someone in your position who HAD accepted it would do, and then take that list one small step at a time.

5. Attend to your body’s sensations and emotions, each as they come up. Disappointment and grief are natural and healthy at this time, as much as they are also deeply painful. Notice without judgment whatever emotions or urges or body sensations come up. Sit with them long enough. This step, the sitting with it step, can often be the most difficult step. Mindfulness practices, like meditation or deep breathing exercises, can help you stay present and grounded during powerful waves of emotion. Distress tolerance skills, like self-soothing or distraction, can also make this easier to bear.

6. Come back to radical acceptance over and over, as many times as you need. For me, this looks like noticing when in my adult life I am ignoring the stretches my body needs or the back support I need for my spinal health. Even though I have worked to accept having scoliosis over the years, I still fall into avoidance or denial sometimes. It’s all a part of radical acceptance. This is not a one-time-only-and-you’ve-mastered-it kind of skill. 

Overcoming Barriers to Radical Acceptance

Let’s acknowledge that there may be obstacles to practicing radical acceptance, including fear of judgment and resistance to change. LGBTQ+ individuals may have internalized messages of shame or unworthiness, making it challenging to fully embrace pain. By recognizing these barriers and working through them with grace and compassion, we can begin to cultivate radical acceptance in our lives. It’s a valuable skill for people navigating the complexities of identity or experience. By embracing reality as it is and responding to it with compassion and openness, individuals can find agency. Remember that seeking support from mental health professionals or LGBTQ+ affirming resources is an option. There is support available to help you thrive. If you’re interested in getting DBT, this is one good place to start.