146. How to Stop Rejecting Reality & Avoiding Improvement: Skills You NEED if You’re Struggling

May 5

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Today's solo episode is all about how to maintain your mental health (aka avoid making your mental health WORSE) during times when you're struggling! We discuss the background on why keeping your mental health at a net neutral is effective from a DBT perspective and then dive into coping mechanisms and skills you can use to prevent your mental health from getting worse in the short AND long-term. These skills include the STOP, TIPP, distraction, and riding the wave skills as well as the radical acceptance, cope ahead, and accumulating positives skills. This episode is a MUST LISTEN if you struggle with maladaptive coping skills and are looking for manageable ways to keep your mental health from deteriorating during difficult times.

Mentioned In The Episode…

+ She Persisted Episode 138

+ DBT House of Treatment

+ DBT Hierarchy

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: [00:00:00] Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

when you engage in these maladaptive coping mechanisms, there are repercussions and you are the one that's going to take accountability.

And so if we can focus on not even making things better, because that is an overwhelming and distressing prospect at the moment, but just not making things worse, you can save yourself. A lot of challenges [00:01:00] and a lot of problems down the road. hello. Hello, and welcome back to She Resisted.

I'm so excited you're here today. Happy Mental Health Awareness Month. When I was thinking about what I wanted to do for this episode, I wanted to do like a comprehensive deep dive, and I've done these in the past on things like. Skills for depression, skills for anxiety exposure therapy, et cetera. And I wanted to do one of those comprehensive resources where you listen, you learn about the background, the context, and then we talk about the skills you can use to navigate the situation and sprinkling in some personal experiences.

Of course. And so for today's episode, what we're gonna talk about is a new term that I've decided to coin for myself. This concept that is definitely a thing in the therapy world, but it's advice that I always give to individuals when they come to me and they're struggling with their mental health. And it's the idea of.

Keeping things net neutral is what we're calling it. I love a good alliteration. This one is not the best name for this, so if you can come up with a better name for this [00:02:00] concept, please DM me and we'll officially rename it. But the idea with keeping things net neutral is that you're not necessarily focusing on things better, but you're just not making things worse for yourself.

You might be really overwhelmed. You might be struggling with your mental health. The idea of completely shifting your behaviors, your thoughts, your urges, asking for help. Restructuring your support system is incredibly overwhelming. So rather than diving into that and being like, this is what I'm going to do, I'm going to.

Change my entire life. I'm gonna turn my mental health around. , in this moment, what you're gonna focus on is not making things worse. So let's dive into it.

So some context that's very helpful to understand here from D B T or Dialectical Behavioral Therapy. If you're new here, you're like, what the heck is D B T? First off, I have to tell you that I'm doing daily D B T skills on Instagram and TikTok for Mental Health Awareness month. So if you want some D B T skills, some mental health education sprinkled into your feed, go follow me on there.

But DBT stands for Dialectical Behavioral Therapy, it was [00:03:00] a therapy protocol that was developed by Marsha Lenahan that addresses.

Individuals that are struggling with borderline personality disorder and suicidal ideation. So it's individuals that are struggling in a really big way. They're struggling to regulate their emotions, they're struggling to be interpersonally effective, and things across the board are really tough, and they've had challenges in the past with getting support in therapy, seeing things get better, shifting their emotions, their thoughts, their urges, et cetera.

Another interesting caveat here, I'll give you two more kind of interesting things about the development of D B T and the philosophies that kind of guide it. One is that with these patients in particular, they had a history of not being. Super popular we'll say with therapists because they were struggling really intensely with either really overwhelming urges, maladaptive coping mechanisms, suicidal ideations, . And then the one additional caveat that I will give to D B T treatment and the philosophy there that is helpful to understand [00:04:00] is this idea of acceptance and change.

So, When Marshall Lenahan started developing D P t, she found that with these really depressed, suicidal. Struggling patience. That if you told them to accept their situation, they rejected that. They were like, you're saying things can't change. You're saying, I'm stuck like this forever. You're not able to help me.

What the heck is your job? Then they would get really upset and pissed off, but then when you told them to change their situation, , they would say, this is my fault. Like, what are you talking about? Like, I didn't do this to myself. Why do I have to deal with this? This is my problem. And so with D B T, there is this perfect blend of the two.

It's a dialectic, which is why D B T is called dialectical behavioral therapy. So you're balancing acceptance and change and you're accepting the situation that you're in and you're working to change it, and you're doing both of those things at the same time. And Marshall Lenahan found that this was a really effective way to validate patients and also motivate them to work on what it was that they were dealing with.

So, as I mentioned, this [00:05:00] population that D B T was developed for had a lot going on. There was all of these crises that they were dealing with on a daily basis, on a weekly basis. When you came to therapy, it was like, and I can speak from my own experience going to D B T, it was like I had this maladaptive coping mechanism come up.

I got in this giant argument with my parents. I hate this aspect of my life. I'm so hopeless here. I have no motivated, like, Everything is basically a burning fire, overwhelming cold red. Everything is the worst, always all the time. So you have all of these crises going on and in D B T, they've come up with a really effective way to address these in a hierarchy in which you deal with these things to get effective therapy outcomes and to make sure that you're doing the correct order of operations.

We've all heard of order of operations probably from math. Like first we're going to do parentheses and then we're gonna do our exponents, and then we're multiplying and dividing, and then we're doing addition and subtraction. Same thing exists for therapy.

And in therapy[00:06:00] there's four stages. In stage one, we are addressing severe behavioral dis control. In stage two, we're talking about quiet desperation. And stage three we're addressing problems in living. And stage four is incompleteness.

So there's actually even a D B T House of Treatment, and I'll put a link in the show notes so you can have the visual.

If you're watching this on Instagram, and this is a clip that ends up there, you'll see the house, but basically the bottom house is on fire. As we talked about. We are a hot mess at this point. When Marshall Lenahan developed D B T, her guiding principle and mission in life was to. Helped get people out of hell was how she described it.

She struggled immensely with her mental health as a young adult. So once she pulled herself out of hell, her goal in life was to go back and help other people pull themselves out of there too. And that's why she made D B T. We love Marsha. So when we look at this D B T house, sometimes people will call the first stage living in hell because that's what the experience is for a lot of people.

It's overwhelmed, [00:07:00] it's distressed, it's constantly being unhappy and ineffective. And so when you see the D B T House, the first floor is actually on fire. And so this is the stage one of addressing severe behavioral dysfunction. This is also called. Addressing life threatening behaviors

, So when we're in stage one, we're getting in control. So we are addressing life-threatening behaviors. We are talking about threats to treatment or major threats to quality of life. And this means committing to using skills and having contingency plans if maladaptive coping mechanisms are engaged in.

So the goal here is to control behavior by increasing motivation, having a goal to get better, and committing to D P T and committing to using your skills.

And so within this life-threatening behavior, it's things like self-harm, suicidal ideation, anything that increases those urges, those thought patterns, et cetera. What's interesting about D B T is that things like substance use, binge eating, not taking prescribed medication, if you get in trouble with the [00:08:00] law, like none of those are considered life threatened behaviors. Those are considered quality of life interfering behaviors. So again, when we are in stage one, we are only focusing on life-threatening behaviors.

And within that does include self-harm. And so when we have this idea of life-threatening behaviors, that is including not only the actions you're taking, the behaviors you're engaging in current and future experiences, but also the urges that are coming up and past experiences with those maladaptive coping mechanisms.

So that is the baseline, that's the floor of the house. We're on fire, we're overwhelmed, we're distressed. That is stage one. That is what you are addressing when you're going into D P T treatment. So within stage one, we also address therapy interfering behaviors because.

Sure, it's great if you've agreed to use the skills, but if you're not even showing up to therapy, none of that's going to matter. So our therapy interfering behaviors include things like not going to sessions, missing them, being late, not doing your diary card, which in D B T, how you're tracking these life-threatening behaviors.

Knee. You are not using your [00:09:00] phone coaching correctly or any interpersonal dynamics between you and the therapist. So that's also addressed in stage one, but not as applicable to this episode. So we're skating over it now. We're on the second floor of the house. This is stage two this is called quiet desperation, and this stage you are getting in touch.

So stage one, we are getting in control here, we're getting in touch and we are working on emotional experiencing and we're doing both exposure therapy and also doing some cognitive restructuring to work to reduce your overall suffering. And within this encapsulates your quality of life interfering behavior.

So things like drug use, binge eating, not taking prescribed medication, legal problems, relationship issues, high-risk sexual behavior, job loss, and financial issues. Those are all quality of life interfering behaviors. They're not life-threatening, but they are impacting your quality of life, and those are addressed in stage two.

And then stage three is problems in living. So we've got in control, we've gotten in touch. Now we're getting a life. So we are identifying, working towards our life goals, we're [00:10:00] increasing our self-respect, and we're both increasing happiness. And decreasing unhappiness, but it's in a more normal scale, so it's called ordinary happiness and unhappiness.

So we're not in stage one. The house is on fire. We're constantly overwhelmed. It's like a normal wave of emotions. And then the final stage, the roof of the house is incompleteness. Because we know that the journey's never over. You're not like, okay, I got to the top of the house. I've gone through D B T.

My life is perfect. You're gonna continue to implement those skills to the rest of your life. So it's that radical acceptance of like, okay, I've done the work. I've given myself the skills to be able to navigate the challenges that life throws at me. And this is not the ending point. Life continues, life goes on, and I will be okay.

So within this stage we talk spiritual fulfillment. This is where like the mindfulness part of D B T comes in, expanded awareness of your experience and then having a capacity for sustained joy.

So that's the D B T house. And while it depends on what therapist you're working with and what modality of therapy you're doing, in most [00:11:00] cases, they're going to do that order of operations of what is life threatening, what is therapy interfering? Then what is quality of life interfering? So the goal of this episode is to intervenous into the life-threatening behavior chunk.

The goal is to take that off the table and to just sit above floor one. we're not on fire, but we're also a little bit in quiet desperation. So we're not making things worse. We're not working on climbing up the house and getting to our spiritual fulfillment yet, but we're just not going further down the floors.

So there are a couple of different things at play here, and one of them is the idea of accountability. Especially in therapy, you are the only one that's going to be accountable for the coping skills you choose to engage in and the way that you handle your emotional distress. So if you are choosing to engage with a maladaptive coping mechanism, you are the one that's going to have to take accountability for that.

You are the one that's going to have to deal with the repercussions, whether that's trust in your relationships, trust with your therapist. What you're able to address in sessions and firsthand that looks [00:12:00] like if you're engaging in these negative behaviors. In D B T, there's this almost like, again, there's this contingency, which I mentioned a little bit earlier, where when you engage in these behaviors, you don't get phone coaching for 24 hours and it might be different

in each D B T program. But the idea is that you didn't ask for support. You didn't ask for help. In the moment of crisis, you chose to engage in a maladaptive coping mechanism. And of course, lots of intent emotions arise after engaging in a maladaptive coping mechanism. And your therapist is not going to be able to be there and talk you through that over the phone.

Like that's something that would be reserved for in a session. But also in the crisis moment, you chose not to use that resource. So you're also not gonna be able to use it in the aftermath. And so that's a very specific example, but it's true across the board and that when you engage in these maladaptive coping mechanisms, there are repercussions and you are the one that's going to take accountability.

And so if we can focus on not even making things better, because that is an overwhelming and distressing [00:13:00] prospect at the moment, but just not making things worse, you can save yourself. A lot of challenges and a lot of problems down the road. So to paint you a picture, if you're like, my mental health is struggling, I think I need to go to therapy, I think I need to get support. When you think about why your mental health is struggling, it's probably those quality of life interfering behaviors.

So maybe it's your relationships, maybe it's your routine, maybe it's. A core belief you hold about yourself. You're never gonna be able to address any of those or work on any of those things until you spend the weeks, months, et cetera, working through

analyzing. And addressing these maladaptive coping mechanisms that you've chosen to engage in. And the thing with coping skills is that we can almost think about it as like a neural pathway. So if we're choosing to engage in something like restricting or overeating, or self harm, or suicidal ideation, whatever it is, every time we engage with.

Fat coping skill rather than deep breathing or distraction or whatever it is. You are strengthening the neural pathway between emotional distress and the mal act of coping [00:14:00] mechanism. So it's going to become more challenging to choose the effective option because you are strengthening the relationship between the Q, which is the emotional distress, and the response, which is the maladaptive coping mechanism.

So it's also gonna be more challenging long term to use your coping skills if you solidify that pathway and that habit and that strategy.

And if you're listening to this episode, I wanna add this caveat here, and you're like, I have already engaged in a lot of coping skills that maybe weren't the most effective. You can integrate this like net neutral plan. Approach at any point. Because if you can cut off the negative trajectory and just stay where you're at, you are saving yourself so much suffering, so much challenge, so much distress, and then you can eventually work on your positive trajectory Jury.

So with all of that context of what happens when you get engaged in a negative coping skill, what happens when that becomes one of the symptoms that you're presenting with What happens when that becomes a solidified neuro pathway?

So with all of that context of solidifying neural pathways, making it more [00:15:00] challenging to engage in coping skills long term with knowing that you always have a decision with knowing what it looks like when you then go to treatment, and you do have these maladaptive coping mechanisms.

From my experience, having engaged in ineffective coping mechanisms for years, you will save yourself so much challenge, so much suffering, so much distress if you can just stay neutral again. We don't have to focus on getting better. We don't have to focus on trying to completely turn our life around, just focus on not making it worse.

So now getting into the more skills based part of this episode, we're gonna talk about skills that you can use in the moment and long term to keep things at net neutral. And when we talked about solidifying neural pathways with negative coping skills, the same thing works with positive ones. Average time you choose to engage in an effective coping mechanism, you're solidifying that pathway, that relationship, that strategy.

So as you use these skills, you kind of are improving, but we're not even focused on that right now. We're just focused on not making things worse. So I think it's important to first address what we're gonna do in crisis mode, [00:16:00] because yes, we will talk about long-term, what you can do to improve your mood and keep things constant.

And when you're not in crisis, keep things at a neutral place. But when it comes down to it, when you're in crisis mode, if you're engaging in those behaviors, none of those long-term things are really gonna matter because you, again, are making things worse for yourself.

So let's talk crisis mode. Whenever you are experiencing a really intense emotion, we're talking like an eight to a 10 out of your emotional intensity. And this could be a thought, it could be an urge, it could be an emotion. The first thing that I want you to do is use the Stop Scale.

This is an acronym that stands for Stop. Take a step back, observe and proceed mindfully.

And I'm gonna go over these skills pretty quickly so that we can get through a bunch of them. But there are tons of episodes explaining these in more depth. Or you can always Google the name of the skill D b T worksheet. You can see the exact worksheets that they teach in D B T for that skill. So with the stop scale, again, stop.

Take a step back, observe, proceed mindfully. So we're physically and mentally stopping. We're either stopping, engaging in the urge we are stopping, engaging in the physical situation that's causing [00:17:00] distress. If it's an argument you're physically stopping, then we're gonna take a step back. That is both mentally, emotionally, and physically.

So again, if it's an argument, you're leaving the room. If it's an urge, you're gonna be like, okay, I'm having a urge. Let's take a step back. Let's observe what's going on here. How did I get to this point, et cetera. And that's leading right into observation. So once you've taken a step back from the emotional state, the thought you're having, the physical situation you're in, you're observing, how did I get to this point?

What are the thoughts, emotions, urges that are currently happening? What is the effective way to maybe cope with this? What would be the ineffective way to coping with this? Because we always have that choice. And then how can I proceed mindfully and effectively? And this is when you would choose to do, let's not even focus on like making things totally better and doing this really comprehensive, overwhelming coping skill plan and let's just focus on not making things worse.

And so that would be the proceed mindfully. Now, when we're proceeding mindfully, there are three skills that I'm going to give you. And then one caveat that I wanna give there's another D B T scale called mindfulness of current emotion. You can also apply this to your thoughts and your [00:18:00] urges.

So in DBT mindfulness, there's two acronyms. Neo, n e, o, and pod, p o d. And that is what you're doing when you're. Being mindful and how you're doing it. So what you're doing is you're participating, you're observing, and you're describing, and how you're doing it is non-judgmentally effectively, and one mindfully.

So when you're in that observed part of the stop scale, when you're observing your thoughts, the emotions that are coming up for you, the interaction that just occurred, You're gonna do that by being fully present in the moment, fully participating, not going on a thoughts spiral of like, oh my God, this was so ineffective.

This was not the goal, blah, blah, blah, blah, blah. We're just fully participating in the observation part of it. When we are observing, we are going to be. Paying attention to the emotions that have come up. The physical sensations, the thoughts, the urges, the interactions that have taken place.

And then we're going to describe it. And when we're describing this is where the, how skills come in. So we're being non-judgmental. We are literally just objectively stating what happened. I said this thing, this emotion came up, this urge is going through my [00:19:00] head. when we're doing it one mindfully, again, we're not second guessing and doing the thoughts spiral about like, how did I get into this?

What am I gonna do to get myself out of this situation? We're just focusing on observing. And then the effective part of it, I skipped over again. This is where we're choosing to not make things worse for ourselves. We're doing what is the most effective way to navigate the situation, what will make the most sense?

So adding that little caveat for the stop scale, the next skill that I wanna give you for crisis mode is the tip scale. I talk about this all the time because it's a game changer. I wish everyone had the skill in their toolkit because it's a skill that works 100% of the time. It's not often that you can say This will work for 100% of your mental health challenges when it comes to like intense emotions.

So whether you're angry, you're anxious, you're depressed, this skill will work. So when you're at an eight, outta 10, you're in crisis mode. You can't think straight. A lot of the times there are physiological symptoms that go with that, whether it's increased heart rate, increased breathing rate.

Are you having a panic attack? What's going on? There's probably some physical that is also tied to [00:20:00] that emotional stress, and a lot of the times that becomes the predominant focus of your attention. You can't even. Think about like, okay, let me analyze this situation and figure out how to proceed mindfully, because you're so overwhelmed with the fact that you can't breathe.

And so that's where the tips go comes in. So it's an acronym that stands for temperature intense exercise, pace breathing, impaired muscle relaxation. You've probably seen the temperature part of it on TikTok. Basically what you do is you take a bowl of ice water and you submerge your face in it for. 10 to 15 seconds between breaths, take a deep breath and then keep doing it until your heart rate and your breathing rate decrease.

It will work 100% of the time because it stimulates your vagus nerve and mammalian diving reflex, and so your body thinks you're jumping into cold water and your body's like, I'm gonna be underwater. Like, I need to stop producing carbon dioxide because I don't know when I'm gonna get my next breath. So your body lowers your heart rate, it lowers your breathing rate.

And as it's doing that, it's also lowering it past that threshold that it was elevated to because of the emotional [00:21:00] distress. Intense exercise works in a similar fashion. It's also great for distress tolerance, but you're gonna do something like burpees, sprints, something that really gets your heart rate going.

And what you're doing is you're raising your heart rate past the threshold that it was at when you were emotionally overwhelmed. And then as your body does its natural system of lowering your heart rate after exercise, it lowers it past the threshold it was at from the emotional distress. It's also really effective when you're overwhelmed to do something that physical, you're like, okay, that felt good.

Like, I need to put this energy somewhere. My thoughts are going insane. Doing that exercise feels really good emotionally. In addition to helping the physical distress and then pace breathing, impaired muscle relaxation, we'll talk about together. You are doing pace breathing, so you're doing your exhale longer than your inhale.

I like to do two counts. Inhale, pause three counts for an exhale. And you are again lowering your breathing rate past what it was at because of the emotional distress with paired muscle relaxation. We know that we carry a lot of tension when we're mostly distressed. So like if you're super angry, your fists are [00:22:00] cleansed, your shoulders are tight, so as you're inhaling, you're clenching your muscles, and as you're exhaling, you're releasing that tension and you're releasing it past what it was at when you were emotionally distressed.

So that's like the quickest rundown ever of the tip scale. Amazing. When I say use the stop skill and proceed mindfully, My recommendation if you're super distressed would be like the proceed mindfully is just tip. We know that that's our next step. That's what we dive into, and then I'll figure out what to do next.

So the third skill that I wanna give you for crisis mode is the distraction skill. Distraction is a really effective skill when we're in crisis mode because it will distract us from the emotions, the thoughts, whatever it is that we're currently having, so that we can calm down enough to be able to cope with the emotions effectively.

But the issue with distraction is that if we're constantly avoiding our emotions, we'll just come back in a bigger way. We know this for anxiety avoidance amplifies the anxiety, and this is true across the board with your emotions. If you avoid a thought, it's like all you can think about in your head.

If you avoid an urge, it just keeps coming back more strongly. So we're using distraction, but we're using it in a short [00:23:00] term way. So with distraction, there's two acronyms in D B T.

But I'm gonna go over these super quickly because you know how to distract yourself. , you're watching a show, you're listening to loud of music, you're talking to someone, et cetera. So the way the D B T breaks down distraction is that with the accept skill you're doing activities, contributing comparisons, emotional opposites, pushing away thoughts and sensations.

And with improve, you are doing imagery, meaning prayer, relaxation, one thing at a time, vacation and encouragement. So distraction , short term resource, long term, not effective because again, it loses its effectiveness. And I always give, the example is I love the office. Whenever I'm like overwhelmed or stressed, I'll turn on the office.

But if I watch the office 24 hours a day, it would not be effective in a time of crisis. Cause I'm like, this is just background noise. I, I'm used to this. The last skill that I'm going to give you for crisis mode is something called riding the wave. This is one of my favorite skills, and I use this now actually for migraines, which sounds kind of odd, but it's super effective, and the idea that nothing in [00:24:00] life is impermanent.

This is a quote that was actually set on. She persisted, and I'm obsessed with it. I say it all the time. I mentally say it to myself constantly. Life is impermanent and that impermanence will be on your side. No emotion, no thought, no urge, no physiological distress will last forever. That's just not how life works.

Our body's incapable of it. Our mind is incapable of it. Our distress will decrease At some points, something has to give. Something has to shift, and so when you're in crisis mode and you're really overwhelmed with an urge, you're like, I just think that I'm gonna engage in this behavior. I can't stop having this urge circle in my head.

What you're gonna do is pay 100% attention to those thoughts you're having, and you're gonna notice that the intensity of the urge comes in a wave. Certain promise is true. It's like physics or something, but I promise this works. So you're like, wow, this urge is really strong. Like I don't even know if I'm gonna be able to resist it.

And then it gets a little bit lesser and then it lessens, and then it's gonna be more intense again. And then it lessens. Same thing for anger or anxiety. You're like, oh my God, I can't breathe. Okay, my [00:25:00] mind is a little bit quieter now, but then it's intense again, and then it's lesser. It works in a wave.

And so what you're doing, rather than trying to. Avoid the emotion or force it to go away. You're just sitting with the emotion and you're riding the wave and you're really leaning into those moments where it lessens and intensity and being like, see, it's getting less intense and this too will pass. And so when I use this for migraines, if you've ever had a headache, you're like, this is parable.

And what I try to do is sleep them off. So like a lot of the times I get a headache at the end of the day and I'm like, I've, I've tried shower, I've tried drinking a lot of water, I've taken Advil. Nothing is working. I just need to fall asleep. And I can't fall asleep because my head hurts so bad. So rather than having thoughts going crazy in my mind and also having this like throbbing going on in my head, I focus all of my energy on the pain itself.

And you notice that it's more intense. You're like, oh, this is terrible. And then it lessens. You're like, oh my gosh. There's that sense of relief. And so as you really lean into those moments of relief, you're like, okay, I got this. I can do this. I can push through. [00:26:00] And then it's also really effective to be mindful, and then I just go to sleep.

It's great. So that's the ride the wave scale. I'm gonna give you three more skills that you can use, not in crisis mode that will help you keep things at a net neutral point. We're not making things worse. We're not necessarily focusing on re-shifting our entire life, but we're just gonna focus on coping with the right now, not adding more things to our plate. So the first one that I'm gonna tell you about is radical acceptance. We talked about how in D B T accepting alone wasn't effective and changing alone wasn't effective because it doesn't satisfy all the emotional needs and it leads to more distress.

So the idea with radical acceptance is that you are accepting life on life's terms, and if you can do this, keeping things net neutral, choosing not to engage in those maladaptive coping skills, in my experience, is a bit easier. So reading straight from the D B T worksheet here. What is radical acceptance?

It's when you cannot keep events and emotions from coming your way. You're still gonna have the urges, you're still gonna have the stressors you're experiencing, [00:27:00] but you can do some radical acceptance. So what does that mean? It means radically accepting all the way. Completely. Totally. You're accepting with your mind, your heart, and your body, and.

When you stop fighting reality, when you stop resisting, when you stop throwing a tantrum, when things are not the way you want it, and let go of bitterness, that is radical acceptance. And so there are a couple of things that need to be accepted and you can use radical acceptance for any situation.

Whenever I get news that I'm not excited about or I wish things were different, automatically accepting. But in D B T, we are radically accepting these four pillars across the board just to accept that this is how life works and that we can't prevent painful things from happening. So we're accepting that reality is as it is, so the facts about the past, the facts about the present, and even if you don't like the situation, the cards you've been dealt, those are the facts of life.

The second one is that there are limitations on the future for everyone, but only realistic limitations need to be accepted So one example of this is when I was [00:28:00] starting treatment, I had this core belief that I would never be capable of recovering that didn't need to be radically accepted because it wasn't a realistic limitation.

I was capable of getting support and shifting my behaviors and asking for help. And so that's the example of like, what are we radically accepting? What are we not radically accepting? Third is that everything has a cause, including events and situations that cause you pain and suffering. So this is, again, we're almost addressing this with this net neutral plan where when we're engaging in negative coping skills, the causes us.

We have to take accountability there. And so if we can even avoid that from happening in the first place, it saves us pain and suffering.

And then the last pillar that we're accepting is that life can be worth living even with painful events in it. And this is hard. This is a tough pill to swallow when you are in so much distress. But as your emotional intensity lessons with time, as you regulate your emotions more effectively, the painful events you're experiencing become less intense and life really can be worth living.

So that is what [00:29:00] we're accepting and why we're accepting it is that rejecting reality does not change it. If we are resisting the truth of life, it's not gonna change it.

It just makes things worse for ourselves. Second is that changing reality first requires accepting reality. So again, we are accepting and changing, but to change, we first have to accept . Three, pain can't be avoided. It's nature's way of signaling that something is wrong, telling us that something's not effective. , the way that we're coping with life, the relationships we're engaged in aren't working for us. Something needs to shift.

So pain is a signal. Four, rejecting reality turns pain into suffering. So there's a difference between pain and suffering. And when we reject reality, we suffer more. And I almost sometimes see those. Maladaptive coping mechanisms as a way of rejecting reality and increasing that suffering. So that's why we're nipping it in the bud and trying to avoid that.

Five. Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame, and other painful emotions.

. Six. Acceptance may lead to [00:30:00] sadness, but deep calmness usually follows. Again, nothing is permanent and that impermanence will be on your side. And seven, the path outta hell is through misery. By refusing to accept the misery that is part of climbing out of hell, you fall back into hell again.

We picture a house, the bottom floor is on fire burning and overwhelming. But unless we climb up that and get through that stage one, we can't address anything else.

And so one little mantra that is used for radical acceptance is that everything is as it should be, and everything is as it is. So to just reiterate the points we just talked about in slightly different language on a different D B T worksheet. Freedom from suffering requires acceptance from deep within of what is.

Let yourself go completely with what is and let go of fighting reality. Acceptance is the only way out of hell. Pain creates suffering. Only when you refuse to accept the pain, deciding to tolerate and endure. The moment is acceptance. Acceptance is acknowledging what is. To accept something is not the same as judging it as good or approving of it.

You're just saying this is. The cards I'm being dealt even if I [00:31:00] don't like them. And lastly, acceptance is turning suffering into pain that I can endure. So that's radical acceptance. We love radical acceptance. I wanna do like a whole episode on that at some point because it's such freaking good scale.

It's hard, but it's amazing. It's like mind altering, paradigm shifting. And then the second Alaska was cope ahead. We wanna set ourselves up for success and if we know that we are emotionally vulnerable to experiencing urges, to wanting to engage in a maladaptive coping mechanism, we wanna set ourselves up for success.

And that is when we're using the COPA head scale. So we're mentally walking through like, what's the situation like? I know that when I'm sitting in bed at night and just laying there and I'm alone with my thoughts, I am more likely to have like a negative urge pop into my head, or I know that when I. Am alone for a really long time.

Those negative thoughts pop up. Or when I have less of a routine, I'm more likely to engage in this behavior because I feel really hopeless. Whatever it is, be aware of what those triggers are, what those vulnerabilities are, and then we're gonna set up a plan for how you're gonna deal with the urges when they arise in that situation.[00:32:00]

So again, we're gonna pull from those crisis skills we just talked about. I'm gonna use this. Stop scale first, then I'm going right into tip, then we're doing some distraction. And then once I loop back to the original thought, we're gonna ride the wave and we're gonna work through it and we're gonna accept it.

So give yourself a plan. What thoughts are gonna come up? What urge is gonna come up? What skill I'm gonna use and how am I going to deal with it? Write it out, make it super detailed and give yourself a plan to follow. The last skill I'm gonna teach you is accumulating positives. This one simple and it's one of my favorite skills of D P T cause you're doing things that you like.

And the idea here is that. When you're accumulating positive, you're not only increasing joy in making your life more worth living, but you're improving your baseline of functioning. So when we look at like a chart and we're like, okay, sometimes my, my mood is really high, sometimes it's really low, and there's a big gap between that emotional high and that emotional low. We're sprinkling and accumulating positives throughout our day, throughout our routine, throughout our life, we become more neutral in the emotions we're experiencing.

So again, Having pain in life can be worth living and it's more worth living when [00:33:00] the emotions are less intense. And there is not that whiplash. I'm like, oh my God, I just had a great day. And then I'm like at an absolute low. So sprinkle in the accumulating positives. And the key here is that you have to plan them.

They have to be intentional. So plan your cup of coffee, plan the book you're gonna read, plan the TV show. You're gonna watch the friend, you're gonna see whatever it is that brings you joy. Plan those moments and accumulate them throughout your day. So, we're reducing suffering. We're not rejecting reality. We are staying neutral. We're not overwhelming ourselves to try and make things better. We're just not making things worse. We're taking accountability over the fact that we have a choice when we engage in maladaptive coping mechanisms, and then we have a really comprehensive plan of how to deal with those.

So that's today's episode. I really hope you enjoy this. If you do share with a friend or family member, if you share on social media, tag me at She Persisted podcast. I always repost and give you a little shout out. And thank you for listening, and I'll see you next week.

Sadie: Thank you so much for listening to this week's episode of she persisted. If you enjoyed, make sure to share with a friend or family member, it really helps out the podcast. And if [00:34:00] you haven't already leave a review on apple podcasts or Spotify, you can also make sure to follow along at actually persisted podcast on both Instagram and Tik TOK, and check out all the bonus resources, content and information on my website.

She persisted podcast.com. Thanks for supporting. Keep persisting and I'll see you next week.

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