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This week’s installment of DBT was about accepting reality as part of distress tolerance. Reviewing last week’s homework, I shared that I’d done the counting breaths exercise while in the oral surgeon’s chair waiting for the local anesthetic to kick in. I was totally freaking out as each application of anesthetic made my heart rate spike and induced very mild shock symptoms like vertigo and sweating. The valium hadn’t quite kicked in yet either, and the breathing helped me get through until I was calmer.

When it came to the half-smile, though, I said it was one of the weirdest and least useful things I’d attempted. I can do it, but I don’t see any benefit. It would probably help if I’d done it during moments of distress rather than when driving, which was the only time I remembered to try it. As with last week (I’m seeing a pattern here) the more experienced members of the group talked about how they found it useful, almost as though trying to convince me to keep at it. That’s really why this DBT thing is supposed to take at least a year, twice through the modules, so you have time to really learn and practice it.

Then we moved on to new acceptance skills, starting with awareness exercises. I said I’d try to do awareness while making coffee (espresso!) and I already have quite a bit of practice with awareness of positions of the body. I might also try the awareness while hand-washing laundry exercise. What’s that have to do with acceptance? My guess is that mindfulness is a component of acceptance, so these exercises promote practicing mindfulness in the context of distress tolerance.

Then came more basic principles of accepting reality. The first is radical acceptance, which is actually quite Buddhist – suffering is caused by resisting reality, and refusing to accept pain makes it worse. Yes, I fully agree, desire is the primary cause of suffering. Wanting things to be different is completely normal, but sometimes that’s just not going to happen. Radical acceptance just points that out and acknowledges that accepting something doesn’t mean that it’s a good thing.

More DBT doodles. Real women have hips; I draw legs better than arms; putting on a half-smile doesn’t mean the situation isn’t shitty.

The co-leader asked if we all had instances of difficult situations we had to accept. Eyes down, nodding heads. No one spoke. She tried to get us to say more about it, but I couldn’t speak up. One of the examples – accepting your diagnosis – hit way too close to home. I struggle with this. I have so much empirical evidence that I’m bipolar, but it’s still hard to accept that there has been no error, that it’s for the rest of my life, and that I’m always going to have to work extra hard to manage my health. When my diagnosis was depression, there was always the possibility that it might go away entirely, forever. Not so likely with the bipolar dx.

Following radical acceptance is turning the mind – making a choice to face reality, commit to acceptance, and commit to it over and over again because just making the commitment does not itself create acceptance. Part of the way I commit to acceptance of my diagnosis is by revisiting my mood charts whenever I start getting it into my head that this is all fraudulent misinterpretation. I always come to the same conclusion. It always makes me sad, but also helps me acknowledge that this is what it is, whether I like it or not.

Still no comments from the group members, so we moved on to willingness and willfulness. Willing responses are doing what is needed, focusing on effectiveness, and allowing yourself to be aware of self and connectedness. Willfulness is the opposite; it’s refusing to make changes, giving up, not doing what’s effective for the situation, trying to fix things that we can’t change, and refusing to tolerate difficult moments. That all makes sense. The point here is learning to consciously recognize when our reactions to distressing situations are willful, and try to change them into willingness.

The discussion of acceptance was sobering. Accepting my diagnosis continues to be difficult, although my behavior to date definitely demonstrates more willingness than willfulness. I’m not giving up, I’m trying to do what I can to improve things, I’m making changes, and I know there’s nothing to do but tolerate it. Rebelling against my diagnosis isn’t going to make me less bipolar, it’s just going to fill me with unnecessary angst. Acceptance isn’t going to make me any less bipolar either, but it helps me focus on opportunities to improve. Acceptance doesn’t happen overnight. I’ll keep working on that one.