168. DBT Crash Course: Key DBT Skills & Dialectics That CHANGED My Life!

Nov 17

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In this week's solo episode, I share some of my favorite DBT skills and dialectics that changed my life! I discuss why DBT is so unique compared to traditional talk therapy, key assumptions to operate under when learning DBT skills, what dialectics are and how to practice a dialectical mindset, my favorite dialectics that completely changed how I think, and how you can learn other life-changing DBT skills including radical acceptance and willingness. If you're looking to learn more about DBT and start practicing DBT skills in your daily life, then this episode is a MUST-LISTEN!

Mentioned In The Episode…

+ DBT Skills TikTok

+ She Persisted Ep. 162 (positive psychology)

+ She Persisted Ep. 158 (car metaphor)

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: 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.

Sadie: 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.

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

Sadie: So no matter what you are navigating, no matter how old you are, no matter what situation is presented to you, you don't have to make things better. You always have the option to stay exactly where you're at and make. And honestly, that was really empowering to me, not empowering to make things worse, but to know that I was choosing to get better and that I was the one that was making that choice and I didn't have to do this.

Sadie: Like, if I was doing this, I was doing it for me because I wanted to.

Sadie: Hello, hello, and welcome back to She Persisted. I'm so excited you're here today. We are doing an episode about grab bag DBT philosophies, and these are some of my favorite things I learned in DBT. They are definitely not, a quick skill that you implement, like, deep breathing, but these almost like mindset shifts, thinking shifts that you can make have a really amazing impact on mental health. So we're going to talk about willingness, thinking mistakes, radical acceptance. We're going to touch on the underlying assumptions of DBT because I think they're really helpful to just understand and be aware of.

Sadie: And also dialectics, of course. So, diving straight into it, when you start DBT, you learn about these assumptions that you operate under during treatment. And I think this is one of the things that makes DBT really unique compared to typical therapy.

Sadie: When you start talk therapy with a therapist, maybe they're like, I'm here to help you. I want to support you. What are your goals? With DBT, you come in and they're really clear, like, we're on the same page, here are the assumptions we're operating under, and that informs all the work you're doing.

Sadie: So, the first assumption is that individuals are doing the best that they can. When you are doing DBT, especially if you're struggling with things like Depression, anxiety, self harm, ideation, probably conflict, like there's all these different areas of your life that you're really struggling in.

Sadie: And we think about the population that DBT was developed for, which is adults that had borderline personality disorder and were also extremely suicidal. There was this misconception when they interacted with a lot of clinicians and individuals, maybe family members, friends, that they weren't trying to get better.

Sadie: They didn't want to get better. They weren't doing the work. They weren't motivated. And I think a lot of that comes from the idea that you are trying so hard to do the bare minimum, waking up. Getting out of bed, going to class, like, whatever these really low level markers are, those take all the effort in the world.

Sadie: And I remember when I was depressed, the way that I would mentally kind of address that is I would just say I was lazy. Like, if someone was like, oh, do you want to do this? , why aren't you doing this? Like, why haven't you gone to the gym? I was like, I'm lazy. Like, it was a personality trait that I embodied.

Sadie: It wasn't like, I don't have the energy and the motivation and I'm so exhausted by just being that I can't even fathom the idea of going and doing that thing. It was like, oh, I'm just lazy. That's just who I am and what I'm doing. That's the reason that's not going to happen. And so in DBT, you kind of shift that false belief that people don't want to get better and they're just kind of twiddling their thumbs and making things worse for themselves and you have this belief that people are doing the best that they can, and it's their best.

Sadie: Maybe it's not your best, maybe it's not some other random person's best, but they are doing the best that they can do at this given time. So the caveats here that they gave at McLean, which I really love, which is that individuals are doing their best, but there may often be very little visible success.

Sadie: and efforts may not be overtly obvious. At times, individuals may report that they are not trying, which is often a learned, socially acceptable explanation for their behavioral failures. If you struggle with, like, really bad depression and anxiety and have been on this hamster wheel of trying and not seeing a difference, I know that resonates because reading that when I started DPT, I was like, that is me.

Sadie: I have said before, I'm not trying. I don't want to try. I don't want to get better. It was so hard for me to do these things that had very little visible success and it wasn't obvious to other people that I was really trying to overcome these thoughts and emotions and urges. And so I love that underlying assumption and even just having your own internal monologue reflect that, that I'm doing the best I can and just understanding that to be true and understanding that to be true for other people, especially in conflict with parents.

Sadie: And family members

Sadie: having that mindset of they are trying their best. They're showing up how they can. They're giving as much as possible to this relationship, this interaction, this therapy session, whatever it is. And they're not just, again, twiddling their thumbs and killing time and not wanting to be here. The second part of that assumption is that individuals want to improve. And again, I'm going to give you the McLean caveat because these are so, so, so good. And also I should have mentioned, if you've never listened to She Persisted before, I did intensive DBT at Three East McLean Hospital, which is a program for adolescents.

Sadie: They have a girls program and a boys program, and it's intensive DBT. Their length of stay when I was there was like four to six weeks. It's probably changed since then. I was there for 14 weeks my freshman year of high school, and it changed my life. It saved my life. We love DBT. It was like the fifth or sixth time I've done DBT, and I mentioned that before.

Sadie: And tangent, I got a comment on TikTok about that, where it was like, I'm going to DBT, I'm going to therapy, and I don't feel like things are getting better. And I, I feel like I don't say that enough, that Things didn't get better immediately when I went to therapy, when I went to DBT. Things got worse before they got better, and a big shift that happened at McLean was, for the first time, choosing to be invested and be engaged and trust others to help me, and also having the mindset shift of going from not believing I was deserving of recovery and happiness to being like, okay, maybe I'm not.

Sadie: feeling great about myself now and my self esteem is at the lowest of low and I don't believe that this is possible, but maybe like 30 years from now I could potentially be a little bit in an improved headspace. That was the amount of self compassion I could garner at that point in life, but having that shift and having enough compassion to want to get better, even if it didn't seem possible, was a game changer when it came to doing DPT and really seeing results.

Sadie: So. I'm going back to this McLean description.

Sadie: Individuals are often so used to hearing that their behavioral failures and difficulties with therapy stem from lack of motivation, and they begin to believe it themselves. Assuming that individuals want to improve, of course, does not mean that we do not look at what factors got in the way of the motivation to improve, if motivation is indeed a factor in therapeutic difficulties.

Sadie: So again, we have this belief that individuals are doing the best and that they want to improve. And this can be a big shift to have mentally yourself and for others to be just inherently believing that about you when You'll feel like you've failed to meet these behavioral metrics of not engaging in urges, or going to school, getting out of bed, changing these thought patterns.

Sadie: And, again, you might have a past where it's tied to, oh, you're not motivated enough, you don't want this enough, you're not trying hard enough. And so, to shift that mindset from, I failed, from a level of motivation and wanting this and not trying my best to, I'm trying my best, I'm doing the best that I can at this point, and I want to get better, and I am motivated can be a really, really big game changer.

Sadie: Okay, so that's one half of these assumptions, and as we'll get into when we go into dialectic, dialectics are like a seesaw. You have two of these opposing things that are true at the same time. And so, with the underlying assumptions, you have individuals are doing the best they can and they want to improve, but they need to do better, try harder, and be more motivated to change.. And so the other side of that dialectic is that individuals still do need to do better and try harder and be more motivated to change. So you might be trying your hardest, you might be motivated, you might be showing up in every way possible, and you can do better.

Sadie: We can always do better, and that can be discouraging, but again, there's that other side of that dialectic that's really reinforcing what you're currently doing, which is you are trying your best. You are doing your best, and down the road, you will also do better. The McLean caveat here is that, seemingly in contradiction to the first two principles of DBT, the fact that individuals are doing the best they can and want to do even better doesn't mean that their efforts and motivations are sufficient to the task. The therapeutic goal in this instance, therefore, is to help the individual analyze factors that inhibit or interfere with the efforts and motivation to facilitate effective change. With this goal in mind, the effort of therapy would then focus on problem solving strategies to help the individual increase his or her efforts and clarify motivation. So this is what I love about DBT.

Sadie: It's like when you identify the problem, we are eventually problem solving. And so we have this understanding that you're trying your best, you want to improve, and there are a lot of things getting in the way that are preventing you from doing better. So what DBT works to do is decrease those obstacles and

Sadie: Increase motivation and figuring out what is getting in the way there. And like I mentioned, when I started dbt and did it at McLean, one of those big obstacles when it's not believing that I deserve to be happy, not believing that I deserve to get better. And so working to problem solve and shift that mindset was part of that process to increase motivation and.

Sadie: improve on those behavioral measures. the next assumption we're going to go over is that individuals may not have caused all their own problems and at the same time they are in the position of having to solve them anyways. I love this one. This was so incredibly validating in my treatment journey to hear that, yes, you are solving problems that it doesn't feel like you've created for yourself.

Sadie: I was in such a headspace of like, Why am I depressed? Why am I anxious? Why is this happening to me? Why are my peers not struggling with all these everyday things like I am? There was all of this misunderstanding about why my life felt so hard and so having this mental clarification Truly is a game changer.

Sadie: So the individual has to change their own behavioral responses and alter their environment For their life to change, unfortunately, improvement will not occur solely through therapeutic insight, taking medication, receiving consistent, nurturing, finding the perfect relationship or resigning oneself to the grace of fate or higher power.

Sadie: Most importantly, it is not in the therapist power to save the individual. Although it may be true that the individual cannot entirely change on their own, the majority of the work will, nonetheless, be done by the individual. So this is, again, the part of DBT that is so empowering, where, yes, you are solving problems that you didn't create yourself, but again, you are solving them.

Sadie: You are making these changes. And it's not just changing the environment. And it's not just having this revelation in therapy or taking meds on a daily basis or improving a relationship. It is changing your environment and changing your behavioral responses that makes that long term shift.

Sadie: And then a couple more caveats that I will add that are helpful to understand the philosophy of DBT and how and why it was developed but maybe are not super applicable to you is that the lives of the individual are often unbearable as they are currently being lived. So when we talk about DBT being developed for adults with borderline personality disorder that were highly suicidal, again, they felt like life was not worth living.

Sadie: It was so challenging. It was so overwhelming. No therapist would take on their case. Nothing was making things better. They were in and out of the hospital, . Like all of these things were too much to bear and handle. And so the reality of their everyday life is that it was unbearable.

Sadie: And I think having that understanding or having people around you understand that when you're doing the work is a game changer. Like, I want you to imagine if you went to therapy or group therapy or were just living in an environment where people were like, Well, she's not really motivated.

Sadie: She's not really problem solving these things. She could definitely try harder. I don't understand why she can't just get out of bed. Blah, blah, blah, blah, blah. Versus having people around you that truly understand and believe to their core that your internal experience is unbearable and it's incredibly painful and you are trying your hardest and you want to get better and you're going to solve these problems yourself even if you didn't create them.

Sadie: Like, think about how much more validating and understanding and supportive those people will be when they truly have the ability to sympathize with what you're going through. And so having that understanding from a therapist's perspective or from the people that are surrounding you can be incredibly helpful.

Sadie: And so, the McLean caveat is that individuals expression of dissatisfaction with their life is valid. They are often living in hell. Given this fact, efforts need to be geared towards helping them change their lives. So, you're at rock bottom, and this was completely true when I started at McLean, which is that the life you are currently living, the way you're coping with things, and the way you are navigating through your environment, is unbearable and extremely ineffective and cannot continue in the long term.

Sadie: So we have to put our efforts towards changing our lives so that it becomes worth living. And then the last three, I'm going to go over really quickly because, again, they're not super applicable here, but helpful to understand, which is that individuals must learn new behaviors in all relative contexts.

Sadie: So that means when you're not distressed, it means when you're having a panic attack, it means when you are in that challenging relationship, it means when you're and when you're at home. And why I love this one is I think it really speaks to some of the shortcomings of the trouble teen industry, and I'm not going to go on this total tangent here, but like, I went to a therapeutic boarding school after McLean, and I was living five minutes south of the Canadian border, visiting my family every couple of months, minimal to no contact.

Sadie: And if you don't learn skills in the environment you're going to be using them in after you graduate treatment, I'm You're not going to be able to implement the skills and the same thing is true. Like if you go to a therapy session and you're like, okay, let me rewire this anxiety thought pattern.

Sadie: You'll leave the therapist's office and never do it again. You're not able to truly learn that skill and it's not helpful to you because you've never practiced it outside of the therapy office. And when you need it is when you're not in the therapy office.

Sadie: And. The last two is that individuals cannot fail therapy. When individuals drop out of therapy, fail to progress, do not feel motivated, or actually get worse in TBT, is the therapist, the therapy, or both that have failed, not the individual. And again, If you feel like you have been fighting this one woman battle for months and years at this point and you are overwhelmed and struggling and you feel like you are the only one in your corner, hearing that if things aren't working in DBT, it's not a reflection of you can be really a game changer.

Sadie: And then the last one is that therapists need support. DBT is structured to have therapists work on a board together and consult on cases and have it be very collaborative. Therapists are not superhuman and so they need Support and collaboration when working on these really challenging cases. now we're going to talk about dialectics. So those were some examples of dialectics when it comes to DBT, but to Back up. Dialectics is the idea that two seemingly opposing ideas and viewpoints and things can be true at the same time. So dialectics teach us that there's always more than one way to see a situation, there's always more than one way to solve a problem, all people have unique qualities and different points of view, change is the only constant, two things that seem like are opposites can both be true at the same time, and we honor the truth of.

Sadie: both sides of a conflict. That does not mean giving up your value or selling out, but it means avoiding seeing the world as black and white or all or nothing. So one of the biggest dialectics at the core of DBT, probably the biggest, is acceptance and change. So we're accepting where we're at. We are accepting what our currently reality is.

Sadie: And we are working to change that.

Sadie: And so when we truly adapt a dialectical mindset, there are a couple of things that that can help us do. And the list is truly endless, but some that are really applicable to DBT is that it helps you expand your thoughts and ways of considering life situations. It helps you become unstuck in standoffs, conflicts, arguments, and it helps you be more flexible and approachable and also avoid assumptions and blaming.

Sadie: So how do we think and act? Dialectically. I'm going to give you a couple of steps if you've never done this before that you can go through. You can apply this to any situation. You can write it out. You can just mentally go through it. But it's helpful to kind of have clear steps. This is what we love in DBT.

Sadie: There's always a roadmap. There's always a plan. So. The first is that there is always more than one side to anything that exists. So you are going to look for both sides of the situation. So ask yourself, what are you missing? Let go of extremes like, this always happens, this never happens black and white thinking.

Sadie: You're going to balance the opposite. So validate both sides, accept reality, and then work to change. You're going to make lemonade out of lemons, embrace confusion. Play devil's advocate and use metaphors and storytelling to help kind of unstick those thought patterns that you get stuck in. The second step is to be aware that you are connected.

Sadie: So, we operate in the context of relationships, in the context of a community, and it's a really big part to our functioning and our success in life. So treat others the way that you want them to treat you, look for similarities among people instead of differences,

Sadie: and notice those physical connections, among all things. The third is to embrace change. So throw yourself into change, allow it, embrace it, practice radical acceptance of change when rules, circumstances, people, and relationships change in ways that you don't like, and we will go over radical acceptance, don't worry, and practice getting used to change.

Sadie: We mentioned earlier that change is the only constant, so really embracing that will alleviate a lot of suffering. And Lastly, change is transactional. Remember that you affect your environment, and your environment affects you. Treatment doesn't happen in a vacuum. Mental health challenges don't happen in a vacuum.

Sadie: We have to be aware of how these things are impacting not only us, but those and the things around us. So pay attention to your effect on others. Practice letting go of blame and remember that all things, including behaviors, are caused.

Sadie: I did a carousel on TikTok last week where I talked about DBT things I learned that changed my life, and a lot of them were pulled from this list, and so I wanted to share some of them. And There are examples of opposite sides that can both be true at the same time that have really carried with me since learning this in DBT back in 2018.

Sadie: So skipping the ones that we went over at the beginning, here are some that I really, really love. You can be independent and you can also want help. And you can also allow someone to be independent and give them help.

Sadie: You can want to be alone and also be connected to others. You can be with others and also still feel lonely. You can accept yourself the way you are and still want to change. And inversely, you can accept others as they are but also still want them to change. At times, you need to both control and tolerate your emotions.

Sadie: You may have a valid reason for believing what you believe, but you also may be wrong and incorrect.

Sadie: Someone may have valid reasons for wanting something from you, and you may have valid reasons for saying no.

Sadie: now we're going to talk about radical acceptance This is a skill in the distress tolerance module, but it honestly is so integral to DBT that when I was trying to find this worksheet just now, I literally was looking in all of the modules. I was like, think this is key DBT, but it also could be emotion regulation.

Sadie: It applies to interpersonal effectiveness and of course, distress tolerance. So. Love this skill. Incredibly important. We've talked about it on the podcast before, but it's been a while and we haven't gone into a ton of depth. So, when we talk about radical acceptance skills, the skills that are underneath that umbrella are radical acceptance, turning the mind, willingness, half smiling willing hands, and allowing the mind to be mindful of current thoughts.

Sadie: We are going to touch on radical acceptance and willingness because those two I feel like are applicable to what we're talking about today. We've covered the other ones on the podcast before, but if you guys are interested, we can also talk about those in the future. So when we are faced with a situation, whether it's a big problem, like you just got news that you're really unhappy about, like what comes to mind for things I had to radically accept going to treatment, not being able to leave treatment at certain times.

Sadie: Those were two of, the biggest things that I had to radically accept and had trouble radically accepting, but it can be small things. Like, I didn't get a job opportunity. I didn't get the grade I wanted on a test. All of those things you can do radical acceptance around. So when we are presented with a situation, we have five options on how we can respond.

Sadie: We can figure out how to solve the problem. We can change how we feel about it. We can accept it, we can stay miserable, or we can make things worse. This way of looking at life truly changed my life. I think a lot of the times,

Sadie: I don't love being backed into a corner when I feel like I have to do something like I remember when I was navigating TBT and it was like, I have to go to residential, I have to do this therapy, did not like that. And I remember when I got into my intake meeting and they said everyone here is willing and they are They are motivated, and they are active participants in the work, and you have a choice.

Sadie: You can choose to be here, you can choose to go to another program. My mind was blown. The fact that I had an active role in my own treatment was a newer concept. Because again, I was 14 at this point, a lot of decisions were being made for me, especially because I was struggling so much.

Sadie: And to realize that any situation I was presented with, even if it didn't feel like I had autonomy and there was a lot of these, , things in place in my environment, like, you have to go to school, you have to go to your classes, maybe you have to go to therapy . I still had the power and these choice points with any situation that was presented to me.

Sadie: So no matter what you are navigating, no matter how old you are, no matter what situation is presented to you, you have these five options and you don't have to make things better. You always have the option to stay exactly where you're at and make. And honestly, that was really empowering to me, not empowering to make things worse, but to know that I was choosing to get better and that I was the one that was making that choice and I didn't have to do this.

Sadie: Like, if I was doing this, I was doing it for me because I wanted to. And again, it wasn't like you have to do this, you're backed into a corner, this is the only way forward. Again. you were the one that was making that decision. So we have those five options, but when you can't solve the problem or change your emotions about the problem, acceptance can be a really effective way to reduce your suffering.

Sadie: the treatment example works really well here, because I couldn't be like, No, I'm not going to treatment. Like, that was happening, and it was the only option forward, and it was really unlikely at that point and challenging for me to change my emotions around that. Looking back, I would be appalled if I somehow had a mindset shift where I was like, I cannot wait to live in a mental hospital on the other side of the country.

Sadie: I cannot wait to be in treatment for an undetermined amount of time, focusing on all these challenges and doing therapy day in and day out, especially when there is so much unknown ahead of me because I'd never visited the program. I've never been there before. I'd never been to intensive treatment. So, changing the situation and changing my emotions were pretty unlikely.

Sadie: The way forward to reduce that suffering is acceptance. And so you might be asking, why would I do that? Like, what is the point? What is the benefits there? And DBT offers a couple of reasons. The first is that rejecting reality doesn't change reality. So if you choose not to accept things, if I was like, I don't want to go to treatment, I'm not going to go, I still would have gone.

Sadie: I still would have put me on that plane. I still would have ended up on the other side of the country. The second is that changing reality first requires accepting reality. So if I, for whatever reason, was like, I'm gonna convince my parents to not make me do this, which wouldn't have worked because we tried everything locally and I was on the circle bus and this was what was being recommended professionally.

Sadie: But if I was like, I'm gonna pitch them an alternative idea and tell them I'm really motivated to Do this other therapy option that I've thoroughly researched or whatever it came about it from a logical point of view To try and change the outcome of me going to treatment I would first have to accept that that was what was going to happen And by staying in that mental state of delusion where I was like, I'm not going to treatment, like, that's not really going to happen, I can't change the problem.

Sadie: The third thing is that rejecting reality turns pain into suffering. So pain is unavoidable, but suffering is preventable. And so when we don't accept reality and when we reject what is happening in front of us, like, we're like, I don't want to feel that way. I don't want to think this. I wish this wasn't happening.

Sadie: All of those different things, the pain becomes amplified, it becomes more intense, and it continues on that path from going from pain to suffering. And the last thing is that refusing to accept reality can keep you stuck in unhappiness, anger, shame, sadness, bitterness, and other painful emotions.

Sadie: So if you were like, I, I don't like this situation. I really don't want to accept it, but the emotions that are associated with it are really painful and uncomfortable. The path forward to alleviating that distress is accepting. So what is radical acceptance? How do we do it? So radical acceptance is the skill of accepting the things you can't change.

Sadie: We have the term radical because you are completely and totally accepting in your mind, heart and body. And the acceptance part of it is that you are seeing reality for what it is. Even if you don't like it, and this is the best part of radical acceptance, is that you don't have to like the situation.

Sadie: You don't have to agree with it. You don't have to condone it. You just are saying, okay, these are the cards that I've been dealt. And so, I didn't like that I was going to treatment. I didn't want to go to treatment. I was not excited about it. There were not positive emotions there, but accepting reality then allowed me to not experience all those painful emotions like anger at my parents, a lot of unhappiness for what was happening, shame because I needed that level of treatment, sadness because I was leaving home, bitterness that people are making me do this, like accepting the situation allowed those things to kind of lessen in their intensity.

Sadie: And so acceptance can mean acknowledging, recognizing, enduring, not giving up and not giving in. And it's when you stop fighting reality, you stop throwing tantrums about reality, you let go of bitterness, and it's the inverse of, why me? And instead, you're saying , things are as they are.

Sadie: So it's kind of, we hear a lot in the mental health space and the self help space about victim mindset and are you playing the victim and blah, blah, blah, blah, blah. It's not really a huge thing in DBT, but we do see these elements of it in these situations, like shifting your thoughts. process and your thought pattern of why me, and things are as they are.

Sadie: And to pull in some positive psychology that we talked about on a recent episode, the way that we attribute things that happen to us has a really big impact on our mental health. People that on average tend to be more unhappy and have lower subjective well being tend to attribute a lot of things to themselves.

Sadie: So to give you an example of this internal versus external attribution, when we think about relationships or things that happen in our environment, there are two examples that come to mind.

Sadie: One is the idea of running late. When we are running late, there are two ways that we can approach it. One is that mentally we can say, I'm procrastinated, I was lazy, I didn't get up when I needed to, I am not capable of organizing myself, I can't stay on a schedule, I am chronically late and disorganized, and like, Again, it's me.

Sadie: I am internally this. It's not like I was late. I showed up late. It's, I'm a late person. I'm unorganized. I failed to do this thing. You're embracing it as like a personality trait. You are seeing it as a part of yourself and the healthier way to mentally approach that situation when you see people with higher subjective well being What they do is they say, I was late.

Sadie: My alarm didn't go off. There was traffic. You are attributing it to your environment or the choices you've made. It's not part of you. It's things you did. And the same thing can be really true for... For mental health. And this is a conversation you see people having all the time where When you are depressed for a long period of time when you are anxious for a long period of time You embrace these things as almost like a personality trait.

Sadie: It's part of you. I'm depressed. I'm anxious And I saw Jaz Thorne talk about this on our podcast and I loved how she explained it where you don't say I am diabetes, I am cancer. Like, the way that we approach these physical health complications, we don't embrace it as part of our personality. We say, I have diabetes, I have cancer, I have health problems.

Sadie: We don't say, I have bad mental health. Like, the way that we attribute it has a really big impact on how we view ourselves and how malleable we view the situation. So that was a little bit of a tangent. But if you want a mindset shift to make that can be helpful with mental health, stop labeling these things as a reflection of you and start externalizing them to the environment.

Sadie: And that doesn't mean that you don't take accountability. It doesn't mean that you're not responsible for these things. I didn't wake up on my alarm. I didn't get out of bed when I could have. I chose to get a coffee even though it was going to make me late. That is still a reflection of you, but you... are not chronically late and disorganized and a bad person because of those things that happened.

Sadie: And then the last thing on this list with regard to radical acceptance after that tangent is that life can be worth living even with painful events in it.

Sadie: So I want to give you a couple of things that we can accept, that everyone can accept regardless of what situation you're in. These are things that we just radically accept as part of the human experience. So , the first thing we accept is reality as it is. The facts about the past and the present are facts, even if you don't like them. Saying that that didn't happen, that's not true, avoiding it, not acknowledging it, doesn't change the situation because those are facts, they have already happened, they are a situation, we have to accept them.

Sadie: The second is that there are limitations on the future for everyone, but only realistic limitations need to be accepted. The third is that everything has a cause, including events and situations that cause you pain and suffering. And again, we talk about, , this attribution thing. This is a huge part of DBT, is attributing these things to cause and effect, rather than a failure of you and your skills usage.

Sadie: So, I am feeling sad because this interaction happened. You're not like, I am sad. I'm a sad person all the time. So, I also want to cover factors that interfere with radical acceptance. Because you're like, this sounds great. Can't wait to implement. But, like, what's the step forward? Here is what can get in the way. So the first thing that we need to... debunk, and we talked a little bit about this, but radical acceptance is not approval, it's not compassion, it's not love, it's not passivity, and it's not working against change.

Sadie: Those are not synonymous with radical acceptance. So again, we don't have to approve the situation we don't need to love the situation. It doesn't mean that we have to be passive in these things happening to us. And it doesn't mean that we don't want to change our life.

Sadie: And so the factors that tend to interfere is, first, that you don't have the skills for acceptance. You don't know how to accept really painful events and facts. And this can be really common in really traumatic situations, if acceptance is like the opposite of a belief that you've held for a really long time.

Sadie: So one of those for me was that I believed I wasn't deserving of love. And so now I believe as a fact that everyone is born deserving of love and they are lovable because as humans we deserve love and are just lovable individuals. That's how life works. And so I really didn't have the skills or the self compassion or the ability to shift that belief at that point.

Sadie: The second is that you believe that if you accept a painful event, you're making light of it or proving of the facts and that nothing will be done to change or prevent future painful events. So again, when we think about radical acceptance, it's kind of like, okay, this is where I'm at. And then you have all of the choice plans.

Sadie: Do I make things better? Do I make things worse? Do I just stay where I'm at? And so when you. If you focus too much on what happens after radical acceptance, that can be a barrier. So you worry, if I accept that this happened to me, if I accept that this person treated me this way, if I accept that this is what my life looks like, does that mean that I am saying that's okay and that I like it and that I want it to stay this way, if that makes sense?

Sadie: And again, when we accept something, we don't condone it. We just are no longer rejecting reality.

Sadie: And the last thing that can interfere with acceptance is that emotions get in the way. So maybe it's unbearable sadness. Maybe it's anger at the person, the group that caused the painful event. Rage at the injustice of the world. Overwhelming shame about who you are and guilt about your own behavior.

Sadie: And if we're thinking about things that you don't really want to accept, you don't want to feel okay about, you don't want to see as facts, I'm sure some of those apply. Whether it is guilt about your role in it, maybe you feel shame, maybe it feels like things aren't fair in the world. Like, those are really common things that I'm sure you've mentally processed through before.

Sadie: So, some steps for you to practice radical acceptance, and then we are going to talk about willingness. , the first thing you're going to do is you're going to observe that you are questioning or fighting reality. So, thoughts like, it shouldn't be this way, this isn't fair that shouldn't have happened, blah, blah, blah, blah, blah.

Sadie: The next thing you're going to do is remind yourself of the unpleasant reality. It's just as it is and it cannot be changed. So, really embracing that thought pattern in that script of this is what happened, not that shouldn't have happened, that's not okay. Why did this happen? It's like, this has happened, and now we must move forward.

Sadie: Third, remind yourself that there are causes for the reality. Acknowledge that some sort of history led up to this very moment. Consider how people's lives have been shaped by a series of factors. Notice that these causal factors and how history led up to this moment, this reality had to occur in this way.

Sadie: So the thought there is this is how things happened. And so when we think about This example of going to treatment, it wasn't like my parents and my treatment providers woke up and were like, residential, , this is what's happening. It was a long history of not seeing a shift with outpatient DVT, hospitalizations, intensive outpatient programs, trying different medications, and not seeing shifts, and that history,

Sadie: Next, you are going to practice accepting with your whole self. Be creative in finding ways to involve your whole self you can use accepting self talk, but also consider using relaxation, mindfulness of breath, half smiling willing hands while thinking about what feels unacceptable, prayer, going to a place that helps you bring acceptance or imagery.

Sadie: Next, we do some opposite action. So we list all the behaviors that you would do if you did accept the facts. Then you act as if you've already accepted the facts. So mentally, you're like, not there yet. You're not like, I am going to treatment, but what would you do if you accepted that you were going to treatment?

Sadie: Would you start packing? Would you start looking at the website? Would you start thinking about what your goals are going to be? And so you kind of bypass that step of acceptance and Do the opposite action to move yourself in that direction. Again, we go back to that metaphor that we heard in Leandra's episode, which love so much is that your mind is a car and you can steer the front wheels of the car, which are your thoughts and your behaviors your emotions and your physiological sensations will follow.

Sadie: So maybe you can't control the thoughts yet. Maybe the emotions haven't followed, but we start to shift the behavior and those follow behind.

Sadie: And then we are going to cope ahead with events that seem unacceptable. So imagine believing what you don't want to accept. Rehearse in your mind what you would do if you accepted what seems unacceptable. So I think a good example of this is like a interaction or relationship, you know, like there is no way that person treated me that way, there is no way they acted that way. There's no way they think that's okay. Like, again, that rejecting reality mindset. And then you cope ahead and you say, okay, if I were to accept this, I need to do some self soothing to realize that some people act this way and some people treat people this way and They choose to do these things that really have negative implications for their loved ones, or friends, or family, or whoever it is.

Sadie: And you're like, okay, I'm going to do some deep breathing, or I'm going to take a walk, or I'm going to remind myself what my values are, and remind myself that what they do doesn't necessarily have to change how I treat people, type of thing. Then, you are going to attend to bodily sensations as you think about what you need to accept.

Sadie: Allow disappointment, sadness, and grief to arise within you. Acknowledge that life can be worth living, even when there is pain. And do it pros and cons if you find yourself resisting practicing acceptance. So decide, like, what are the pros of accepting reality, what are the cons of accepting reality, and then because it's DPT we do the opposite, so what are the pros of not accepting reality, what are the cons of not accepting reality?

Sadie: Oh my god, you guys. So I'm like going through my workbook from a client. And there is a worksheet about figuring out what you need to radically accept. And this, this speaks to my mental state at this point. I needed to accept that I'm not okay, and that other people care about me. It was how sad I was at this point.

Sadie: I didn't, I didn't want to accept that people cared about me. so much self hatred and such a lack of self compassion. I felt so unlovable that I was mentally avoiding the thought and not believing that others cared about me. So two less important things that I had to accept was that I am not going to be home for my birthday and that I will be in residential for more than four weeks.

Sadie: Life has changed, folks. . At least this is a sign of growth, that I think it's funny that I was accepting of other people cared about me. Pat on the back. There we go. We love growth. So, the last thing we're going to touch on in this episode is willingness. This is a skill within the radical acceptance umbrella, but It kind of takes a life of its own or at least it did in my treatment, because a lot of the times when you see yourself resisting using your skills, we label that as willfulness. It's the inverse of willingness. Maybe there is avoidance or anger and these emotions are getting in the way and we can kind of describe that as willfulness.

Sadie: And how we combat that is using willingness as a skill and as a mindset shift. So, willingness is doing just what is needed in each situation, wholeheartedly, without dragging your feet. And if you are someone prone to avoidance like me, you recognize that you probably are not doing that in a lot of situations that you're not happy about.

Sadie: So, willingness is listening carefully to your wise mind, and then acting from your wise mind. So, If you're not familiar with Wise Mind, I'm gonna like very quickly give you the most Cliff Notes version. It's this idea in DBT that we balance our emotion mind, so how we're feeling our physiological sensations, our emotional urges, and our rational mind, which is facts And the perfect blend of the two is your wise mind.

Sadie: So it's taking into account how you feel and the facts of the situation and coming up with an effective path forward. So, willingness, you are listening to what your wise mind is saying and then acting. based on that decision. And willingness is also acting with awareness that you are connected to the universe.

Sadie: And so again, it's this idea that there is a cause and effect all around us and that our decisions, our choices, impact those around us. So

Sadie: I mentioned willfulness. I'm going to give you some examples in case you're still like, I'm not totally sure what you mean by that. Willfulness In the refusing to tolerate the moment, refusing to make changes that are needed, giving up, the opposite of doing what works, trying to fix every situation, insisting on being in control, and attachment to me, me, me, and what I want right now.

Sadie: I was a very willful teen. I can tell you that much. But especially if you are avoiding these uncomfortable and intense emotions and thoughts willfulness can really, really be a play. So, how do we practice willingness? We observe the willfulness, we label it, and we experience.

Sadie: Even just accepting and acknowledging, I am being willful right now, I am not being willing, I don't want to do this, and I am giving up, I am trying to fix this situation, I want to be in control, I don't want to tolerate what's going on, can be hugely helpful. Then we radically accept the moment in that you are acting willfully.

Sadie: or feeling willful. And we accept that we cannot fight willfulness with, willfulness. It doesn't work that way. We have to use some willingness. We can't just keep avoiding and problem solving and wanting to be in control. Then we turn our mind towards acceptance and willingness.

Sadie: So again, we talked about that choice point where you always have the option to make things worse. You can stay the same. You can make things better. And so when you make that intentional mental shift to make things better, accept the situation and move forward, that is turning the mind. And then if you find that willfulness is immovable, ask yourself, what is the threat?

Sadie: And maybe it is, I don't know if I can handle this emotion, I'm worried how this will impact my relationship, I don't know what the future holds, I'm really overwhelmed, I'm scared, I feel ashamed, I feel guilty. And then you can kind of, again, accept that situation, work through the emotion, cope with it, and find a path forward.

Sadie: I just threw a lot of DBT at you, but it's a lot of DBT philosophies that I think are really helpful and incredible, and I hope you found this episode to be valuable. Hopefully you learned some new things. Hopefully I explained everything okay, but that is our episode on all things DBT philosophies, dialectics, radical acceptance, and willingness, and mindset shifts that Really, I truly do believe, help you build your life worth living.

Sadie: So, with that, if you enjoyed this episode, leave a review, share with a friend or family member, share on social media, all of the things. I really appreciate it. Helps out the podcast and I will talk to you guys next week for a really fun interview.

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 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.

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

Sadie:

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