Tag Archives: Distress Tolerance

What is Cognitive Behavioral Therapy (CBT)?

CBT is a type of therapy that focuses on the way our thoughts, feelings, and behaviors are connected. It helps people recognize negative thinking patterns and replace them with more helpful and realistic thoughts.

How Does CBT Work?

CBT follows a structured approach where a therapist helps a person:

Identify Negative Thoughts – People struggling with depression or anxiety often have automatic negative thoughts (e.g., “I’m a failure,” “Nothing will ever get better”). These thoughts can make them feel worse.
Challenge These Thoughts – A therapist helps examine whether these thoughts are based on facts or assumptions.
Replace Negative Thoughts with Healthier Ones – Once a person understands that their thoughts aren’t always accurate, they can learn to change them. Instead of thinking, “I’m a failure,” they might reframe it to, “I made a mistake, but that doesn’t mean I’m a failure.”
Change Behavior to Improve Mood – Depression often makes people withdraw from activities they once enjoyed. CBT encourages small, achievable actions that can help improve mood over time.

What is CBT Used For?

CBT is one of the most widely used and researched types of therapy. It is highly effective for treating:

Depression – Helps people break out of negative thinking loops and take small steps to improve their mood.
Anxiety Disorders – Teaches people how to manage worry, panic attacks, and social anxiety by shifting unhelpful thinking patterns.
Obsessive-Compulsive Disorder (OCD) – Helps individuals face fears and resist compulsive behaviors.
Post-Traumatic Stress Disorder (PTSD) – Guides people in processing traumatic memories in a way that reduces emotional distress.
Phobias – Uses gradual exposure techniques to help people overcome irrational fears.
Eating Disorders – Helps people challenge negative beliefs about food, body image, and self-worth.

Key Benefits of CBT

Structured and Goal-Oriented – CBT follows a plan with clear steps to help people improve their mental health.
Short-Term – Unlike traditional therapy, which can last for years, CBT often lasts for 12–20 sessions.
Evidence-Based – Decades of research have proven its effectiveness for a wide range of mental health issues.
Homework and Practice – CBT involves practicing skills outside of therapy sessions to make lasting changes.

What is Dialectical Behavior Therapy (DBT)?

DBT is a specialized form of CBT designed to help people who struggle with intense emotions and self-destructive behaviors. It was originally developed to treat people with Borderline Personality Disorder (BPD), but it has since been adapted for other conditions.

How Does DBT Work?

DBT helps people balance two important ideas:

Acceptance – Learning to accept emotions and experiences without judgment.
Change – Learning skills to regulate emotions, improve relationships, and reduce harmful behaviors.

Key Skills Taught in DBT

DBT teaches four main skills that help people manage their emotions and behaviors:

1. Mindfulness (Staying Present in the Moment)

Many mental health struggles involve dwelling on the past or worrying about the future. Mindfulness teaches people to focus on the present, accept their thoughts and feelings without judgment, and respond calmly instead of reacting impulsively.

2. Distress Tolerance (Coping with Intense Emotions Without Making Things Worse)

This skill helps people deal with emotional pain in healthy ways. Instead of turning to self-harm, drugs, or reckless behavior, DBT teaches techniques like deep breathing, distraction, and self-soothing activities (e.g., listening to music, taking a warm bath).

3. Emotion Regulation (Managing Strong Feelings)

People with intense emotions may feel like their mood swings are uncontrollable. DBT teaches how to:

Identify and label emotions
Reduce emotional sensitivity
Use coping strategies to prevent emotions from overwhelming them

4. Interpersonal Effectiveness (Improving Communication and Relationships)

DBT helps people build healthier relationships by teaching them how to:

Ask for what they need in a respectful way
Set boundaries without feeling guilty
Handle conflicts without escalating them

What is DBT Used For?

DBT is especially helpful for people who experience extreme emotions and difficulty controlling them. It is commonly used to treat:

Borderline Personality Disorder (BPD) – Helps with emotional instability, self-harm, and difficulty maintaining relationships.
Chronic Suicidal Thoughts & Self-Harm – Teaches coping strategies to prevent self-destructive behaviors.
Substance Use Disorders – Helps people manage cravings and emotional triggers that lead to addiction.
Eating Disorders – Supports emotional regulation and healthier coping mechanisms for people struggling with binge eating or restriction.
Severe Mood Disorders – Can be helpful for depression and anxiety, especially when emotional regulation is a challenge.

Key Benefits of DBT

Comprehensive Approach – DBT combines individual therapy, group skills training, and phone coaching to support individuals outside of sessions.
Focuses on Emotional Stability – Teaches practical skills to manage overwhelming emotions.
Balances Acceptance and Change – Helps people accept themselves while also working toward personal growth.
Long-Term Benefits – The coping skills learned in DBT can be applied throughout life.

CBT vs. DBT: What’s the Difference?

Feature	CBT (Cognitive Behavioral Therapy)	DBT (Dialectical Behavior Therapy)
Main Focus	Changing negative thoughts to improve emotions and behaviors.	Managing intense emotions and improving relationships.
Best For	Depression, anxiety, OCD, PTSD, phobias, eating disorders.	BPD, self-harm, extreme mood swings, substance use, eating disorders.
Treatment Structure	Short-term, structured, goal-oriented.	Long-term, includes individual therapy, group skills training, and phone coaching.
Skills Taught	Cognitive restructuring (changing thoughts), problem-solving.	Mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness.
Approach to Emotions	Identifies and challenges negative thoughts that cause distress.	Accepts emotions while teaching skills to manage them.

How Do CBT and DBT Help with Depression?

CBT for Depression

CBT is one of the most effective treatments for depression because it directly targets negative thinking patterns that keep people feeling stuck. Depression often makes people:

Feel hopeless about the future.
Withdraw from activities and isolate themselves.
Blame themselves for things that aren’t their fault.
Struggle to find motivation to do anything.

CBT helps by:
✔ Teaching people to recognize and challenge negative thoughts.
✔ Encouraging small, manageable actions to increase motivation and positive feelings.
✔ Helping break the cycle of avoidance and inactivity.

DBT for Depression

DBT is particularly useful for people whose depression is linked to emotional instability or intense mood swings. If someone:

Feels emotions very strongly and has trouble controlling them.
Gets overwhelmed by feelings of anger, sadness, or frustration.
Has self-harming thoughts or suicidal feelings.
Struggles with relationships due to mood instability.

DBT helps by:
✔ Teaching skills to regulate emotions and avoid extreme reactions.
✔ Providing tools to cope with distress without self-harm.
✔ Helping improve relationships and communication.

Which Therapy Should You Choose?

If you struggle with negative thinking, depression, or anxiety, CBT is usually the best choice.
If you experience intense emotions, self-harm, or difficulty controlling reactions, DBT may be more effective.
Many therapists use a combination of both approaches depending on an individual’s needs.
You can learn both!

If you’re unsure, a mental health professional can help guide you to the best approach for your situation.

Here are sources that provide information on Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), their differences, benefits, and applications in treating depression:

Here to Help – Explains the key differences between CBT and DBT, focusing on validation and relationships in DBT. It highlights how DBT emphasizes acceptance of experiences and the importance of the therapeutic relationship.
https://www.heretohelp.bc.ca/q-and-a/whats-the-difference-between-cbt-and-dbt
SBTreatment.com – Discusses how CBT helps change problematic thinking, making it effective for conditions like depression and anxiety, while DBT focuses on emotional regulation and is beneficial for disorders such as Borderline Personality Disorder (BPD) and eating disorders.
https://sbtreatment.com/dialectical-behavioral-therapy/dbt-vs-cbt/
Verywell Health – Provides an overview of both therapies, noting that CBT is more established while DBT is newer and being studied for its effectiveness in various applications.
https://www.verywellhealth.com/dialectical-behavior-therapy-vs-cognitive-behavioral-therapy-uses-benefits-side-effects-and-more-5323767
Palo Alto University – Highlights CBT’s effectiveness in treating depression, anxiety, PTSD, OCD, phobias, and panic disorder. It also notes that DBT, originally developed for BPD, is useful for eating disorders, substance-use disorders, and self-harm behaviors.
https://concept.paloaltou.edu/resources/business-of-practice-blog/cbt-dbt
Psych Central – Compares CBT and DBT by explaining that CBT focuses on changing thought patterns and behavior, whereas DBT emphasizes how individuals interact with the world, themselves, and others.
https://psychcentral.com/lib/whats-the-difference-between-cbt-and-dbt
Choosing Therapy – Discusses philosophical differences, stating that CBT is focused on the present, while DBT processes past trauma to facilitate healing. It also notes that DBT encourages acceptance, whereas CBT primarily seeks to change maladaptive thinking patterns.
https://www.choosingtherapy.com/dbt-vs-cbt/
Simply Psychology – Provides an overview of the key differences between CBT and DBT, including their target populations, philosophical foundations, and treatment approaches.
https://www.simplypsychology.org/whats-the-difference-between-cbt-and-dbt.html
Hillside Atlanta – Explains how CBT helps clients identify and change problematic ways of thinking and behaving, while DBT helps clients regulate extreme emotions to improve relationships through validation and behavior change.
https://hside.org/dbt-vs-cbt/
First Session – Provides success rates for CBT and DBT, noting that both therapies have an overall success rate of 50-60% in treating various mental health conditions.
https://www.firstsession.com/resources/cbt-vs-dbt-understanding-the-differences-and-benefits
Health.com – Discusses how DBT focuses on emotional regulation, acceptance, and coping strategies, while CBT primarily aims to identify and change negative thought patterns.
https://www.health.com/dbt-vs-cbt-8694023

Depressed Anonymous

Two Sides of the Same Storm: Understanding the Intersection of Anxiety and Depression

July 19, 2025 Chris M

Introduction: A Personal Note

For many of us in recovery, we came to DA thinking we just had depression—until we realized we were also battling something else beneath the surface: anxiety.

This was certainly true for me, sure I had dealt with anxious moments and looking back I can see that I interpreted anxiety as stress. However these weren’t regular concerns and were at best sporadic, until I found myself in a severe depressive episode for 3 years, following which I was diagnosed with MDD, Major Depressive Disorder.

The anxiety was secondary to the bone deep sadness but it was there, a constant that would rear up. At the very least it would complicate my depression further but at times it felt like my heart would suddenly stop because it was beating so fast.

Whether it showed up as racing thoughts, obsessive worries, social dread, or chest-tightening panic, anxiety often walks hand-in-hand with depression, complicating both diagnosis and healing. These two conditions can seem like opposites, one sluggish, one agitated, but in truth, they often share the same root system.

Understanding how anxiety and depression intersect can help us untangle our emotions, validate our lived experiences, and take more effective steps toward recovery. This article explores how they relate, why they frequently show up together, and what we can do when they do.

I hope it helps.

Section 1: Shared Symptoms, Different Faces

“Having anxiety and depression is like being scared and tired at the same time. It’s the fear of failure, coupled with no urge to be productive. It’s wanting friends but hating socializing. It’s wanting to be alone but not wanting to be lonely.”
— From “What Does Depression Feel Like?”

Anxiety and depression are distinct diagnoses, but they often present overlapping symptoms that can confuse even experienced clinicians. This overlap can also lead to misdiagnosis or underdiagnosis, especially in people who have learned to mask or intellectualize their distress.

Shared Symptom	Anxiety	Depression
Trouble sleeping	Racing thoughts, restlessness	Early waking, low energy
Poor concentration	Distracted by fear and worry	Foggy thinking, low motivation
Physical tension	Muscle tightness, stomach issues	Heaviness, body fatigue
Irritability	Hyper-alert, easily triggered	Easily overwhelmed, emotionally numb
Sense of dread	Fear of what might happen	Hopelessness that nothing will change

What differs is the direction of energy. Anxiety feels like a motor revving too high. Depression feels like the battery’s gone flat. But both come from a dysregulated nervous system—just two sides of the same storm. In practice, many people swing between both poles, which can make day-to-day functioning unpredictable and exhausting.

Section 2: Why They Show Up Together

“Worrying doesn’t empty tomorrow of its sorrows; it empties today of its strengths.”
— Corrie Ten Boom

Roughly 60–70% of people with depression also experience anxiety. It’s not a coincidence—these conditions often grow from the same soil and thrive in the same environments. If we think of them as plants, anxiety is the vine wrapping tightly around your chest, and depression is the slow wilting of your will to move.

Brain Chemistry Imbalance:
Both conditions involve disrupted neurotransmitters—serotonin, dopamine, and norepinephrine—which affect mood, motivation, and stress response. When these chemicals are out of balance, even basic functions like sleep, appetite, and attention become compromised.

Chronic Stress and Cortisol:
When the body is under constant stress, it releases cortisol. Over time, this “stress hormone” wears down your brain’s fear-regulation and mood-regulation centers. Think of it like an alarm that never gets shut off—it keeps the system on high alert until it crashes. This wears down the hippocampus, impairs memory, and can shrink the prefrontal cortex—the area responsible for decision-making and emotional regulation.

Neuroplasticity (In Simple Terms):
The brain learns from experience, good or bad. The more time we spend in anxious or depressed states, the more wired-in they become. But the reverse is also true: we can rewire our brains through new, healing experiences. Every time we reach out for help, take a small risk, or try something new, we plant seeds of recovery in our neural pathways.

Emotional Exhaustion:
Living with constant anxiety such as hypervigilance, intrusive thoughts and shame can wear us down until collapse. That collapse is often depression. Likewise, being stuck in depression, feeling useless or numb, can trigger anxiety about falling behind, failing others, or never recovering.

This collapse is not weakness. It’s a nervous system that’s overloaded and out of balance. It’s a biological and psychological consequence of too much fear with too little relief.

That’s why recovery can feel so confusing: do we treat the sadness or the fear? The answer is both. Because they often show up together—and heal together too. DA provides a structure for emotional and spiritual maintenance, but it’s okay to seek support beyond it if you’re navigating both conditions at once.

Section 3: The Cycle of Mutual Reinforcement

“Anxiety is a thin stream of fear trickling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.”
— Arthur Somers Roche

Anxiety and depression feed off each other. They create what I call “A Paralyzing Spiral”—a loop of fear, shame, and inaction that deepens the longer it runs. Once inside this loop, we often lose access to clarity, motivation, and even language for what we’re experiencing.

Here’s how that can look:

What if I mess up the meeting?
→ “I’m going to fail again.”
→ “Why even bother?”
→ Isolation, numbness, more fear next time.
→ Delay, dread, despair.
→ Repeat.

Avoidance plays a key role. You might put off checking your bank balance, calling a friend, or starting something important. Anxiety says “What if it goes badly?” Depression follows up with “Why try?” Eventually, you stop doing the things that once brought relief, further deepening the cycle.

The more we avoid, the more guilt and dread we feel—just like the addiction cycle. Many of us in DA know this rhythm well: discomfort → avoid → short-term relief → worse long-term pain. The spiral is exhausting—but it can be interrupted. Naming the pattern is the first step to weakening it.

Section 4: What This Means in Recovery

“Good humor is a tonic for mind and body. It is the best antidote for anxiety and depression…”
— Grenville Kleiser

If you’re working the Steps and still feel stuck, anxious, or flooded—it’s not a failure. It might be anxiety interfering with your ability to heal. Recovery is rarely linear, and our emotional barriers often surface at different points in the journey.

You’ve done Step 4, but you lie awake replaying what you should have said.
You want a sponsor, but the idea of reaching out makes your chest tighten.
You want to share in a meeting, but you’re convinced you’ll say the wrong thing.
You start to feel better—and then panic, waiting for the other shoe to drop.

This isn’t laziness or resistance, it’s often unconscious self-sabotage driven by fear. For trauma survivors, it can also be emotional flashbacks such as when an interaction triggers a flood of emotion from the past, and you suddenly feel unsafe, ashamed, or small. These flashbacks are not memories in the traditional sense but full-body reactions that reflect unresolved emotional trauma.

DA work may stir old wounds.

Knowing this can help you approach your recovery with more self-compassion, not judgment. Bringing these patterns into the light with a sponsor or trusted peer can ease the intensity and help you stay present for the process.

Section 5: Tools That Help Both

“When you’re going through hell, keep going.”
— Winston Churchill

The best part? Many of the tools that help with depression also soothe anxiety—when practiced with intention and patience. Even small, imperfect efforts can send signals of safety to a nervous system stuck in survival mode.

Why Behavioral Activation Works:
Action creates feedback. When we move our body, make a call, or complete something small, it tells the brain: “I can do hard things.” This rewires the circuits of avoidance and helplessness. The reward doesn’t come first—it comes after we take the step. The trick is doing the thing even if it feels pointless in the moment.

Three Step-Focused Practices for Anxiety Awareness:

10th Step Check-ins: Ask “What fear drove my choices today?” Write it down or voice-note it.
Fear Inventory in Step 4: Write out fears as patterns, not just events. Look for recurring beliefs: “I’m not good enough,” “They’ll leave me,” etc.
DA Call and Response: When anxious, call someone with a structure: “Here’s what I’m afraid of, here’s what I’m doing anyway.” Even just voicing the fear can take away its power.

When to Seek Clinical Help:
If anxiety or depression blocks you from doing basic DA work (eating, sleeping, sharing, calling), it’s okay to seek therapy or medication. These are not betrayals of the Steps—they can make the Steps more accessible. Sometimes we need support regulating the nervous system before we can fully show up emotionally or spiritually.

Section 6: A Word on Shame

“I often wonder how many others are sitting near me, stuck in their own quiet battles…”
— Carlee J. Hansen

Shame is the silent partner to both anxiety and depression. It tells us we’re broken, unlovable, or weak for feeling this way. It tells us we’re a burden. That we’re falling behind. That we should be better by now.

Here’s the truth: there’s a difference between toxic shame and healthy remorse.

Remorse says, “I made a mistake.”
Toxic shame says, “I am a mistake.”

As Brené Brown writes, “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging.”
This is what’s called a disconnection wound—the kind of emotional pain that comes from being unseen, unheard, or unaccepted by the people we needed most. That wound doesn’t disappear just because we join a program. In fact, recovery often exposes how deep that wound runs.

Sometimes, depression and anxiety aren’t just brain chemistry—they’re survival strategies. Emotional numbness is often how the body protects itself from overwhelming feelings, especially if those feelings were never safe to express. Many of us grew up learning that vulnerability was dangerous, that tears meant weakness, or that we had to hold it all together.

If that’s your story, you’re not lazy. You’re not cold. You’re healing. And you’re not alone.

Conclusion: Calm Within the Storm

Anxiety screams. Depression whispers. But both are asking the same thing: Am I safe? Am I allowed to feel this?

It’s okay not to have the answer yet.

“Anxiety is the lightning. Depression is the fog. But both can clear when we step outside our heads and into connection.”

So take one small step. Call someone. Go to a meeting. Do something that tells your brain, “I’m allowed to live.” Even a deep breath counts.

Recovery isn’t about doing it perfectly. It’s about knowing you don’t have to do it alone.

Acceptance, Choice, Helpful, Helpful Thinking, Mindfulness, Mutual Aid, Necessity, Serenity, Stinking Thinking

Radical Acceptance – The First Step Toward Healing in Depression

June 5, 2025 Chris M

In a 2019 study published in The Journal of Affective Disorders (DOI: 10.1016/j.jad.2019.07.035), researchers found that individuals who practiced acceptance-based coping strategies reported a 30% decrease in depressive symptoms over six months compared to those who used avoidance-based coping. This highlights a crucial reality: resisting painful emotions often intensifies suffering, whereas acknowledging them can lead to significant relief.

Imagine a person struggling with deep sadness due to a recent job loss. Instead of fighting their feelings by telling themselves they shouldn’t feel this way, they choose to sit with their emotions, allowing themselves to process the grief. Over time, this acceptance enables them to regain control over their thoughts, consider new opportunities, and move forward. This is the essence of Radical Acceptance, a core component of Dialectical Behavior Therapy (DBT) that has transformed countless lives.

Researching and writing this article deeply resonated with me. Radical Acceptance was the first DBT technique that truly connected with me because I had come to rely on it in the period immediately following my intent to end my life. It was the foundation that helped me begin the process of healing, giving me the space to understand my emotions instead of being consumed by them. By embracing Radical Acceptance, I found a way to regain control, one moment at a time.

Why Fighting Reality Makes Depression Worse

“I shouldn’t feel like this. This isn’t fair. Why does this keep happening to me?” These thoughts might feel familiar to anyone struggling with depression. It is natural to resist painful emotions, to wish them away, or to believe that if we fight hard enough, we can overcome them by sheer willpower. However, this resistance often has the opposite effect, intensifying our distress and making it even harder to cope. Instead of alleviating suffering, resistance compounds it, leading to frustration, self-blame, and exhaustion.

Radical Acceptance, a core skill in Dialectical Behavior Therapy (DBT), provides an alternative path—not just conceptually but through empirically validated methods. Numerous studies have demonstrated the effectiveness of DBT in reducing emotional distress, improving distress tolerance, and enhancing emotional regulation. Research, such as a meta-analysis by Valentine, Bankoff, Poulin, Reidler, and Pantalone published in Clinical Psychology Review (2014), has shown that DBT interventions significantly decrease symptoms of depression and anxiety, supporting the role of Radical Acceptance in mental health treatment.

By incorporating these scientifically-backed techniques, individuals can develop healthier coping mechanisms and build resilience. one of resignation but of acknowledgment. Developed by Dr. Marsha Linehan, DBT incorporates mindfulness and acceptance strategies rooted in both psychological research and Eastern contemplative practices. Studies have shown that acceptance-based approaches can significantly reduce emotional distress and increase psychological flexibility, making it easier to cope with difficult experiences. By fully recognizing reality without resistance, we can shift our energy from futile struggle to meaningful healing. This article will explore what Radical Acceptance is, how it alleviates depression, how it serves as a foundation for other coping strategies, and practical ways to cultivate and maintain it.

The Science Behind Dialectical Behavior Therapy (DBT) and Radical Acceptance

Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan in the late 1980s as a treatment for individuals with borderline personality disorder (BPD). Over time, research has demonstrated its effectiveness in addressing a range of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). One of DBT’s core pillars is Radical Acceptance, which has been shown to play a significant role in emotional regulation and distress tolerance.

Research Supporting DBT and Radical Acceptance

Numerous studies support the efficacy of DBT, particularly in reducing emotional distress and improving overall well-being. A 2006 study by Hayes, Luoma, Bond, Masuda, and Lillis published in Behavior Research and Therapy (DOI: 10.1016/j.brat.2005.06.006) found that individuals who practiced acceptance-based strategies, including Radical Acceptance, experienced a significant reduction in emotional suffering compared to those who engaged in suppression or avoidance. Similarly, a 2014 meta-analysis in Clinical Psychology Review reported that DBT-based interventions led to improvements in mood regulation and a decrease in self-harming behaviors.

A study conducted by Neacsiu, Rizvi, and Linehan (2010), titled “Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder,” found that patients who underwent DBT showed greater emotional resilience and improved distress tolerance. Their findings suggest that Radical Acceptance helps individuals break the cycle of avoidance, allowing them to process emotions more effectively rather than getting trapped in self-perpetuating cycles of resistance and frustration.

The full study is available at https://doi.org/10.1016/j.brat.2010.06.001. And found that patients who underwent DBT showed greater emotional resilience and improved distress tolerance. Their findings suggest that Radical Acceptance helps individuals break the cycle of avoidance, allowing them to process emotions more effectively rather than getting trapped in self-perpetuating cycles of resistance and frustration.

Why Radical Acceptance Works

From a psychological standpoint, Radical Acceptance reduces what is known as “secondary suffering”—the distress caused by resisting or suppressing emotions. When individuals accept their emotions as they are, they shift their focus from trying to control or eliminate their pain to managing it in healthier ways. This aligns with research in mindfulness and cognitive behavioral therapy (CBT), which emphasizes the importance of acknowledging emotions without judgment.

Furthermore, neuroscience has demonstrated that acceptance-based strategies can reduce activity in the amygdala—the brain’s fear and stress center—while increasing activation in the prefrontal cortex. A study by Goldin et al. (2010) published in Biological Psychiatry found that individuals practicing mindfulness and acceptance techniques showed decreased amygdala reactivity to negative stimuli, suggesting that these strategies enhance emotional regulation by shifting neural activity toward rational processing. This shift enables individuals to respond to distress with greater clarity and emotional control rather than impulsive reactivity. brain’s fear and stress center—while increasing activation in the prefrontal cortex, which governs rational thinking and problem-solving. This shift enables individuals to respond to distress with greater clarity and emotional control rather than impulsive reactivity.

Radical Acceptance, therefore, serves as both a philosophical approach and a scientifically supported method for improving mental health. By embracing reality as it is, individuals can cultivate greater emotional stability, resilience, and overall well-being.

What Is Radical Acceptance?

Radical Acceptance is the practice of fully acknowledging reality as it is, a concept deeply rooted in Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan. Linehan introduced Radical Acceptance as part of a broader strategy to help individuals regulate emotions and tolerate distress without becoming overwhelmed. Drawing inspiration from both Western cognitive-behavioral therapy and Eastern mindfulness traditions, DBT integrates acceptance-based strategies to help individuals break cycles of avoidance and resistance. This approach has been particularly effective in treating borderline personality disorder, depression, and anxiety, as it enables individuals to fully engage with their emotions and circumstances without being controlled by them. without trying to deny, minimize, or change it. It is about seeing things clearly and allowing ourselves to experience emotions without judgment or resistance. This does not mean approval of suffering or accepting a miserable fate, but rather recognizing the present moment so that we can respond effectively.

What Radical Acceptance Is Not:

Not approving of suffering: Accepting something does not mean we like it or agree with it.
Not resigning to a miserable life: It is about reclaiming energy to create change, not giving up.
Not ignoring emotions: Acceptance allows emotions to be processed fully, preventing them from overwhelming us.

Resistance vs. Acceptance

Imagine waking up feeling deeply depressed.

Resistance Thought: “I hate that I feel this way. I shouldn’t be depressed. Why can’t I just be normal?” This response adds shame and frustration, making emotions feel even heavier.
Acceptance Thought: “I feel depressed today. This is my reality right now, and I can work with it.” This response removes unnecessary struggle, creating space for self-compassion and coping strategies.

Radical Acceptance does not eliminate pain, but it prevents additional suffering caused by resistance. By acknowledging our emotions without fighting them, we create a foundation for moving forward.

How to Achieve Radical Acceptance

Cultivating Radical Acceptance is an ongoing process that requires conscious effort and practice. It is not something that happens overnight but a skill that can be developed over time. Here are some key steps to achieve and maintain Radical Acceptance:

1. Acknowledge Reality as It Is

The first step in Radical Acceptance is to simply recognize what is happening in the present moment. This means allowing yourself to see reality without judgment or denial. When you find yourself resisting a situation, pause and remind yourself: This is what is happening right now.

2. Observe Your Thoughts and Emotions Without Judgment

Mindfulness is a crucial part of Radical Acceptance. Practice observing your thoughts and emotions as if you were watching clouds drift across the sky. Instead of getting caught up in judgments like this is terrible or I shouldn’t feel this way, try thinking, I notice that I am feeling sad right now.

3. Use Validation Techniques

Self-validation helps reinforce acceptance by acknowledging that your emotions and reactions make sense given your circumstances. Instead of dismissing your feelings, try statements like:

It’s understandable that I feel this way given what I’m going through.
This emotion is valid, even if it’s uncomfortable.
I can accept that this is how I feel in this moment.

4. Shift from “Why Me?” to “What Now?”

When we resist reality, we often get stuck in self-pity or frustration. Instead of asking Why is this happening to me? shift your focus to What can I do to take care of myself in this moment? This shift in perspective opens the door to constructive action rather than prolonged suffering.

5. Use Acceptance-Focused Mantras

Repeating simple phrases can help reinforce Radical Acceptance, such as:

It is what it is.
I don’t have to like this to accept it.
Fighting reality only increases my suffering.
I choose to work with what is, not what I wish it to be.

6. Practice Deep Breathing and Grounding Exercises

Physical techniques can help the body relax into a state of acceptance. Deep breathing, progressive muscle relaxation, and grounding exercises like focusing on sensory experiences can shift the nervous system from resistance to calm acceptance.

7. Accept Incrementally When Full Acceptance Feels Impossible

Sometimes, fully accepting a painful situation feels overwhelming. In such cases, break it down into smaller steps:

Instead of saying I fully accept my depression, start with I accept that I am feeling depressed at this moment.
Take acceptance one moment at a time, allowing yourself to adjust gradually.

Using Radical Acceptance as a Springboard for Recovery

Radical Acceptance is not about surrendering to suffering but about using it as a foundation for change. Once we accept a situation fully, we can better understand it. And with understanding comes clarity—allowing us to process emotions, work through pain, and begin healing. Acceptance grants us the mental space to focus on solutions, whether that means seeking professional help, using coping strategies, or simply finding small ways to re-engage with life.

To accept something is to enable ourselves to understand it, and to understand it is to equip ourselves with the tools to move forward. When we remove resistance, we create space for growth, healing, and recovery. By embracing Radical Acceptance, we set the groundwork for transformation, allowing us to regain control over our emotional and mental well-being.

The Power of Letting Go of Resistance

Depression is painful enough on its own, and resisting reality only adds to the suffering. Many individuals believe that if they resist, deny, or fight against what they feel, they can somehow force it to disappear. However, this struggle often leads to greater frustration and self-defeating thoughts. Letting go of resistance does not mean embracing passivity—it means allowing reality to be what it is without additional self-imposed suffering.

When we stop fighting against reality, we gain the power to change it. This is the paradox of Radical Acceptance: when we let go of resistance, we open ourselves to new possibilities, emotional healing, and the ability to take purposeful steps forward. The journey to healing begins with a simple but profound truth—acceptance is the first step toward lasting change.

Courage, Hope, Mindfulness, Positivity

DBT Grounding Techniques – Part 2 Distress Tolerance

January 31, 2025 Chris M 1 Comment

Part 2: Distress Tolerance – Riding Out the Storm

When emotions become overwhelming, it can feel like you’re trapped in a tidal wave of distress. In these moments, it’s easy to fall into impulsive reactions that might bring short-term relief but create bigger problems in the long run. Distress tolerance is about getting through the moment safely—without making things worse.

These techniques won’t solve the underlying issue, but they will help you stay grounded, regain control, and make it to the other side with clarity. Let’s explore practical DBT strategies that can help you endure emotional intensity while keeping your well-being intact.

Distress tolerance focuses on managing emotional pain without resorting to harmful or impulsive behaviors. These skills are not about solving problems, but rather about enduring intense moments in a way that allows you to regain control. Below are grounding practices drawn from this module to help you survive difficult situations.

1. TIPP Skills: Physically Resetting Your Emotional State

The TIPP skills are designed to help regulate your body’s physical and emotional response to distress. By addressing your physiological state, you can interrupt the cycle of emotional overwhelmedness.

How to Practice TIPP:

Temperature: This shocks your system and stimulates the dive reflex, which can lower your heart rate and help you feel calmer.
- Use cold sensations to quickly reduce emotional intensity.
- Example: Hold an ice cube in your hand, splash cold water on your face, or place a cold pack on the back of your neck.
Intense Exercise: This releases endorphins, which naturally improve mood and reduce stress.
- Engage in a brief burst of physical activity to channel nervous energy.
- Example: Try jumping jacks, push-ups, running in place, or a brisk walk.
Paced Breathing:
- Focus on slowing your breath to calm your nervous system.
- Example: Inhale deeply for 4 counts, hold for 4 counts, and exhale slowly for 6-8 counts. Imagine each exhale as a release of tension, activating your parasympathetic “rest and digest” system.
Progressive Muscle Relaxation: This technique reduces physical tension and signals safety to your brain.
- Tense and relax muscle groups systematically, starting from your feet and moving upward to your head.
- Example: Tense your feet for 5 seconds, release, and notice the relaxation. Then move to your calves, thighs, etc.

2. Self-Soothing Using the Five Senses

Self-soothing involves nurturing yourself by engaging your senses in comforting ways. This practice can help you feel grounded and cared for during moments of distress.

How to Practice:

Touch:
- Wrap yourself in a soft blanket, hold a stuffed animal, or apply lotion with a calming scent.
- Feel the comforting texture and focus on the sensations.
Taste:
- Sip a warm cup of tea, savor a piece of chocolate, or chew mint gum.
- Focus on the flavors and how they change with each bite or sip.
Smell:
- Light a scented candle, use essential oils, or smell something familiar and comforting, like freshly baked cookies or a favorite lotion.
Sound:
- Listen to calming music, nature sounds, or a playlist of songs that uplift you.
- Pay attention to the rhythm, melody, or lyrics.
Sight:
- Look at soothing images, like photos of loved ones or nature scenes you like.
- Focus on the colors, patterns, and details.

3. Distract with ACCEPTS: Redirecting Your Focus

ACCEPTS is an acronym for distraction techniques that help you shift your attention away from distressing emotions to regain control.

How to Practice ACCEPTS:

Activities:
- Engage in something productive or fun, like cleaning, painting, gardening, or watching a movie.
- Keep your hands and mind busy.
Contributing:
- Shifting focus to others can provide a sense of purpose.
- Example: Help someone else by volunteering, sending a kind message, or running an errand for a friend.
Comparisons:
- This helps reframe your mindset and build resilience.
- Example: Compare your current situation to a past challenge you have overcome or think of someone who inspires you.
Emotions:
- By sparking new emotions, you can shift out of distress.
- Example: Seek something that elicits a positive emotion or one that is different from what you are currently feeling, like watching a funny video or listening to upbeat music.
Pushing Away:
- Mentally set aside the problem for now. Visualize putting it in a box and “shelving” it.
- Remind yourself you can return to it later when you feel more capable.
Thoughts:
- Intellectual focus can disrupt ruminative thoughts.
- Example: Distract your mind by counting backward from 100 by sevens, solving a puzzle, or reading something engaging.
Sensations:
- Introduce a physical sensation to interrupt emotional overwhelm, like holding a stress ball, taking a hot shower, or chewing something crunchy.

Combining Practices

In moments of intense distress, you can layer these techniques for maximum effect:

Begin with a TIPP skill to quickly reset your body’s emotional state.
Transition into Self-Soothing to create a sense of comfort and safety.
Use ACCEPTS to redirect your focus and engage with activities that help you feel in control.

These skills empower you to endure emotional pain, giving you time and space to process it without reacting impulsively.