“It is what it is” or how to practice radical acceptance

It’s a saying that annoys some; others find it helpful to move on from a situation that can’t be changed. It has been used in sports and politics, to name a few.

I first heard it (or really heard it) during my placement with a DBT (dialectical behavioural therapy) service. DBT was described by the psychotherapist Marsha Lineman and is mainly used for treating people with a borderline personality disorder.

Why do I find it so helpful?

Although it sounds simplistic and maybe dismissive, it’s something I tell myself when I face situations that can’t be changed. During the pandemic, we all have cancelled plans and last-minute disappointments. Also, life as a mother brings other last-minute changes of plans, and unexpected things get in the way.

I can choose to be disappointed and ruin my day or have a few slow breaths, re-evaluate, remind myself that “it is what it is”, and try to make the best of the situation.

For example, we planned to visit family back in my home country last Christmas, and we were supposed to have Christmas dinner with my parents and sister, whom I haven’t seen for more than two years. As Covid tests were required, we were unlucky enough to have a “non-conclusive” test. We couldn’t travel, so we were stuck at home with an empty fridge and the shops closed. Of course, I was disappointed, but after the initial venting and moaning, it was a matter of choice if Christmas was going to be ruined or if we would still have a good time. I moaned on Facebook, and a local acquaintance shared their home-cooked Christmas meal with us. I felt appreciated and grateful for the dinner and everything we had. We still had a good family Christmas instead of remaining grumpy and disappointed.

You may say these are insignificant events in the grand scheme of things, but the same principle applies to everything.

Another example, I managed to launch my blog after it stayed dormant for a month as I got an infection and have been in bed for a few days. Not fun or pleasant to be ill, but it’s not something I can change now. I accept that I need to rest and do what I still can.

“It is what it is” for serious life problems.

It is a recurrent theme for patients in a DBT programme to feel strongly against radical acceptance. How can one accept that they were abused as children, maltreated, and traumatised by people who were supposed to look after them? Radical acceptance doesn’t mean we assume that any of these things were “right” or that the victim was at fault. It doesn’t mean we have to forgive, although some people can feel liberated by practising forgiveness. It is not about accepting horrible things to happen to us; it’s more like an acknowledgement that they did happen. Whatever we do, regardless of how much we want for anything horrible not to have occurred, we can’t change it. Fighting against reality intensifies suffering. We then have the pain caused by the horrific event and the suffering on top. All the “why me”, “it’s my fault..”, “Wish I didn’t..”, and “I deserve it” it’s the suffering we add to the scar.

Exercises for radical acceptance

• First, try to distinguish if the situation requires acceptance or problem-solving. Is the outcome final, or is it anything you can do to change things?
• Observe reality as it is while practising slow breathing; focus on your body and breathing movements. Put a hand on your tummy and make sure that your breathing makes your belly go up and down (which means that you are not breathing superficially)
• After a few slow deep breaths, take notice of the situation; what happened and what led to what. Notice your feelings about it, being disappointment, anger, upset…
• Summarise the situation: notice the facts, how the situation evolved and how things are now, without judgement or putting you down.
• Let everything sink in, allow your feelings and take notice of them.
• In some tragic situations like losing someone, it is perfectly normal to be grieving over a long period. Crying and remembering the loved one helps you and their memory. Blaming yourself or refusing to accept reality adds suffering to a challenging life experience.

Some additional exercises you can try if the above is not enough

• Try to see the situation in perspective. Looking at all the aspects of your life, how serious is this situation relative to everything else?
• Zoom out from the current moment and try to imagine yourself as an older version at the end of your life. Looking back at this moment, how important do you think it will be?
• Practice gratitude. Be grateful for what you have and the people you care about in your life.
• Practice a “half-smile”; this is from DBT as well. It means what it sounds like, make sure that you have a half-smile, bring the corners of your mouth half up. It sounds silly, but it sends messages to your brain that things are better, which leads to feeling a bit better.
• Practice “willing hands”; this is again from DBT. It means sitting down in a relaxed body posture, with the palms resting on our legs upwards. Again, it’s about tricking our brains that things are better than they are. Experiment when very angry. It’s very hard to be angry and have an argument if you do “willing hands” simultaneously.

If none of the above help

• If you have tried everything and it’s just too tricky, it may be a matter of time; the listed practices can be repeated repeatedly, especially if the situation to be accepted is very difficult.
• Psychotherapy or counselling can be the best option in more challenging situations, especially if it’s about early life trauma.
• Sometimes we can be so consumed by the current reality that it’s hard to get past that. We can try distracting our attention to help us notice other things. Try to get involved in activities that interest you usually, although you may not feel like it now. It helps your brain get a break from the upsetting situation.
• Try to get good quality sleep, as in our sleep, the memories get organised, and it’s like having therapy while we sleep; the sleep takes the edge of extreme emotions and organises the events in memories.

Radical acceptance of physical health

I have seen countless patients suffering from a physical illness with their health deteriorating further than the disease explained.

The diagnosis brought disappointment and giving up on life, with health going downhill, leading to depression in many cases. Depression by itself makes all physical illnesses harder to recover from.

Some CBT strategies to help us cope with a recent diagnosis

Thought challenge

• Whatever our thoughts about the diagnosis and the prognosis, try to do a reality check. What is the real impact on life, and what is the likely outcome?
• Is there anything you can do to improve the outcome?
• What do other people with a similar diagnosis do to help themselves?
• Apart from medical treatment, is there anything else that can help? (diet, exercise, mindfulness, physiotherapy, support groups…)

Behavioural activation

• It makes sense, especially if you feel like giving up and withdrawing in bed. Hospital stays don’t help in this respect, as the opportunities to move are reduced. An extended hospital stay and lying in bed can make it hard to get going again. you may feel weak and out of shape, and partly it may be due to prolonged immobilisation
• Depending on the physical condition, take steps to move more each day, as much as you can tolerate. Movement improves both physical and mental health and stops us from going into a vicious cycle of ill health – low mood – further deterioration in health.
• If you are completely immobile, is there anything you enjoy hearing or watching?
• Physical illness can come with a severe impact on our abilities to pursue hobbies and interests. We may need to brainstorm to discover other interests or things we can still do.

Take away

•  Acceptance is the first step towards moving forward when we face difficulties.
  
•  Acceptance is not easy but is necessary at times. It is important to distinguish when we need to practice acceptance versus problem-solving.
  
•  Hopefully, I included some exercises to help the process, but the most crucial step is being aware when acceptance is needed.