Radical acceptance: what it is and how to practise it

What is radical acceptance?

“Radical acceptance teaches us to accept everything radically, without judging the situation, the people who may be part of it, or ourselves.”

“Everything” here means the facts. Linehan is clear that while everyone’s future has limits, only realistic limits need to be accepted^[1].

Where does radical acceptance come from?

Marsha Linehan developed DBT at the University of Washington, first for people who were highly suicidal and later for borderline personality disorder^[5]. The first randomised trial was published in 1991^[3], and her treatment and skills manuals in 1993, with a second edition of the skills manual in 2014–2015^[4]. DBT combines acceptance with change. Linehan has said that “learning acceptance myself so I could teach it to clients” led her to almost 30 years of Zen training^[6]. NIMH describes DBT as a treatment developed specifically for borderline personality disorder that uses mindfulness and teaches skills to manage intense emotions^[7].

The phrase is also the title of a 2003 book by psychologist and Buddhist meditation teacher Tara Brach, about self-compassion and the feeling of not being good enough^[8][9]. Both draw on Buddhist ideas, but they are different traditions:

What do you have to accept, and why?

Linehan lists four things to accept^[1]:

• The facts about the past and present are the facts, even if you do not like them.
• Everyone’s future has limits, but only realistic limits need accepting.
• Everything has a cause, including the events that hurt you.
• Life can be worth living even with painful events in it.

Her central point is that pain cannot be avoided, but rejecting reality turns pain into suffering^[1]. An NHS mindfulness handout puts it as: suffering is pain plus non-acceptance of pain^[2].

“Pain is an unavoidable part of life. Suffering comes from trying to deny the pain, by fixating on questions like 'why did this happen to me?' or 'why does it have to be me?'”

What radical acceptance is not

In Linehan’s words, radical acceptance is not “approval, compassion, love, passivity, or against change”^[1]. Accepting that something happened does not mean you think it was fine. In fact, Linehan writes that changing reality first requires accepting it^[1].

“By accepting a situation radically, we can truly understand our position and do something to change it.”

It never means accepting harm

Radical acceptance is about accepting facts, not putting up with abuse. You can fully accept that someone has hurt you, or that a situation is unsafe, and still set limits, leave or get help. Tara Brach writes that radical acceptance “doesn’t mean we allow others to harm us”^[9]. If you are not safe at home, the US National Domestic Violence Hotline is free, confidential and open 24/7 on 1-800-799-7233^[10]; in the UK, call 999 in an emergency.

How to practise radical acceptance, step by step

These are Linehan’s practice steps, in our own words^[1]:

Turning the mind

Linehan compares acceptance to a fork in the road: you turn your mind towards accepting, and away from rejecting reality. Choosing to accept is not the same as accepting; it just puts you on the path, so you do it again, over and over^[1].

Willingness instead of willfulness

Linehan contrasts willingness, being ready to take part fully in life and doing just what each situation needs, with willfulness: refusing to tolerate the moment, refusing needed change, trying to control everything, or giving up^[1]. That last one matters: in this view, giving up is the opposite of radical acceptance, not the same thing.

Radical acceptance examples

Losing your job

“Suppose we've been fired from work. This is undoubtedly a difficult situation. Radical acceptance tells us to accept the situation for what it is — regardless of the reasons or people involved.”

Accepting the fact that you lost your job does not mean ignoring why it happened, and it does not stop you challenging a dismissal you believe was unfair. It stops you spending all your energy on “this shouldn’t have happened”, so you have energy for what comes next.

Grief

You cannot change that someone has died. Acceptance here is letting the grief come instead of fighting it. See our page on grief counselling and therapy for grief.

A parent who will not change

Anger at the person who hurt you is one of the things Linehan lists as getting in the way of acceptance^[1]. Accepting that a parent is who they are does not mean agreeing with them, and it can free you to decide how close you want to be.

Life abroad

Moving abroad brings facts that are hard to accept: not being there for an ageing parent, a qualification that does not count in the new country, visa limits, or a place that does not feel like home yet. Radical acceptance helps you separate the realistic limits you need to accept from the things you can still work on. See our page on therapy for expats.

A radical acceptance worksheet

Linehan’s official worksheets are in her DBT skills handbook^[1]. This is our own simpler version, inspired by her ideas. Copy it into a notebook:

Does radical acceptance work? What the research says

DBT as a full programme, which combines individual therapy, a skills group, phone coaching and a team of therapists^[5], is the most-studied therapy for borderline personality disorder. A Cochrane review found it reduced the severity of the condition and self-harm compared with usual care, but rated the evidence as low quality^[11]. For adults who self-harm, it is uncertain whether DBT reduces repeat self-harm, though it may reduce how often it happens^[12]. In one trial, versions of DBT that included skills training reduced self-injury and depression more than DBT without it^[13], but evidence for the skills on their own is still limited^[14].

Research on radical acceptance as a single skill is early. In small studies, mostly with healthy volunteers from one research group, practising it helped people regulate emotions^[15], and after one session, distress from a personal memory returned to normal in people who used radical acceptance but not in those who used another skill^[16]. In a trial with women whose relatives were deployed in a war, radical acceptance practice reduced stress and depression over the following weeks^[17]. A broader review of acceptance strategies found they helped people tolerate pain, but did not reduce negative feelings more than other strategies^[19]. In other words: promising, not proven.

When radical acceptance is not the right tool

• If the situation can be changed, work on changing it: acceptance is for the parts you cannot change.
• If you are not safe, get safe first.
• If you are in crisis, DBT has a separate set of crisis survival skills^[1], and you should contact crisis support now.

How therapy can help

Radical acceptance is simple to describe and hard to do, especially when sadness, anger or shame get in the way, which Linehan lists among the things that interfere^[1]. A therapist can help you practise it on the situations that matter to you. In a small study of women in DBT for PTSD, shame, guilt and fear fell during treatment while radical acceptance rose^[18].

On Bliss Therapy you choose a therapist who speaks your language, by video, with no waitlist, so you can work on acceptance in the language you feel it in. 7 therapists list DBT, with sessions from €40 (about £33).

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers or covered by US health insurance. Ask any therapist about their training and their registration in the country where they practise.