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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). distress tolerance Handout 11   (Distress Tolerance Worksheets 8–9a)
radical a cceptance
(When you cannot keep painful events and emotions from coming your way.)
Wha T iS r aDical a ccep Tance?
1. Radical means all the way , complete and total.
2. It is accepting in your mind, your heart, and your body.
3. It’s when you stop fighting reality, stop throwing tantrums because reality is not 
the way you want it, and let go of bitterness.
Wha T haS To Be a ccep TeD?
1. Reality is as it is (the facts about the past and the present are the facts, even if you don’t like them).
2. There are limitations on the future for everyone (but only realistic limitations need to be accepted).
3. Everything has a cause (including events and situations that cause you pain and suffering).
4. Life can be worth living even with painful events in it.
Why a ccep T reali Ty?
1. Rejecting reality does not change reality.
2. Changing reality requires first accepting reality.
3. Pain can’t be avoided; it is nature’s way of signaling that something is wrong.
4. Rejecting reality turns pain into suffering.
5. Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, 
sadness, shame, or other painful emotions.
6. Acceptance may lead to sadness, but deep calmness usually follows.