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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 11b   (Distress Tolerance Worksheets 9, 9a)
practicing r adical a cceptance Step by Step
Observe that you are questioning or fighting reality (“It shouldn’t be this way”).
Remind yourself that the unpleasant reality is just as it is and cannot be changed (“This is what 
happened”).
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 given these causal factors and how history led up to this moment, this reality had to occur just this way (“This is how things happened”).
Practice accepting with the whole self (mind, body, and spirit). Be creative in finding ways to involve your whole self. Use accepting self-talk—but also consider using relaxation; mindfulness of your breath; half-  smiling and willing hands while thinking about what feels 
unacceptable; prayer; going to a place that helps bring you to acceptance; or imagery.
Practice opposite action. List all the behaviors you would do if you did accept the facts. Then 
act as if you have already accepted the facts. Engage in the behaviors that you would do if you 
really had accepted.