Balance Your Efforts to Accept and Change Your Problems

In DBT, balance is incredibly important. In fact, balance is central to the theory that drives this treatment: dialectical theory. Dialectics basically means tension between opposing forces, sort of like good versus bad, negative versus positive charges, thesis versus antithesis, right versus wrong, cold versus hot.

In DBT, the opposing forces are acceptance and change (Linehan 1993a). Acceptance means to allow your emotions, thoughts, and circumstances to simply be what they are, just for now, without struggling to change, modify, escape, or get rid of them. To change, in contrast, means to alter your emotions, thoughts, and circumstances.

DBT is dialectical, because in DBT we are always trying to strike an effective balance between acceptance and change (ibid.). We believe that, in order to deal effectively with emotional difficulties, you need to balance acceptance and change. If you focus too much on changing your emotions, thoughts, and situations, you can experience problems.

Dialectics, then, has to do with the idea that in any situation, you could choose to accept what’s happening, to change what’s happening, or some combination of both. The challenge is in figuring out what you need to accept and what would be best to change. This is a lot like the Serenity Prayer (by Reinhold Niebuhr) used in Alcoholics Anonymous: you need the wisdom to know the difference between what you can change and what you can’t, when to accept, and when to change.

In DBT, maybe even more so than in other treatments, we spend a lot of time helping people find ways to balance acceptance and change and find some kind of synthesis or combination of the two that works best.

Let’s say that you are depressed. You have been spending a lot of time in bed, avoid phone calls, feel empty and sad much of the time, have difficulty concentrating, and have a lot of negative thoughts about yourself. A synthesis or combination of acceptance and change might include:

· Accepting that you are depressed, that you feel sad and empty much of the time, and that you have been and are currently inactive.

· Deciding to slowly get up and drag yourself (with help, hopefully) out of depression by getting active, solving some of the problems that keep you depressed, and making important changes in your life.

Here are a few other examples of this combination, synthesis, or balance of acceptance and change:

· When a relationship has suffered, you often have to acknowledge and accept the fact (accept) that you have hurt someone and feel guilty before you can effectively repair the relationship (change).

· To deal with OCD, you have to both accept that you have obsessive thoughts and work to change your repetitive compulsive behaviors (checking, engaging in rituals, hand washing, and so forth).

· The best way to change panic symptoms is often to accept, sit with, and experience (accept) your panic symptoms, rather than try actively to escape or change them.

· Sometimes the best way to accept and deal with the overwhelming stress of having too many things to do is to change things by breaking your tasks into smaller, more manageable steps (change the tasks).

· If you’re afraid of public speaking, sometimes the best way to get through it is to accept the anxiety and fear you experience, then change the focus of your attention so that you’re paying more attention to your audience than to your own bodily symptoms (possibly the last thing you’d want to do!).

· Sometimes the best way to deal with worry (for example, about financial, relationship, or health problems) is to accept that you’re worrying that something bad might happen, improve your skills at estimating whether something bad will happen, and change or prevent what you can.

· If you deal with obsessive religious thoughts, such as that you might offend God if you wore a particular type of shirt, sometimes the best way to break free of such thoughts is to acknowledge that you really don’t know what might happen, and then wear the shirt anyway, on purpose.

Figure 2.1 How to Balance Your Efforts to Accept and Change Your Problems