“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”

Regardless of your faith, the serenity prayer speaks to what many of us believe to be true; that personal contentment and peace are derived from a balance of the acceptance and change of life’s challenges. This philosophy is at the core of a psychological treatment modality called Dialectical Behavioral Therapy (DBT), developed by psychologist, Dr. Marsha Linehan at the University of Washington.

The New York Time’s wrote a piece on Linehan and her path to her own self-discovery when she was hospitalized throughout her teen and young adult years for suicidal behavior. Through this experience, Linehan developed what is now thought to be the most effective treatment modality for suicidal and self-harming people, harnessing a dialectic approach that embraces the philosophy of radical acceptance and the belief that change is possible and necessary.


The first piece of the dialectic is acceptance, which is crucial in breaking through to suicidal ideation and behaviors. It is important to understand that people with suicidal thoughts and self-harming behavior don’t want to die; they simply want their pain to end and haven’t discovered a viable solution. Thus, the idea of self-injury or death becomes soothing to a person who is suffering, developing into a coping strategy which provides brief relief. Radical acceptance from a therapeutic standpoint doesn’t mean accepting suicide as an option, but instead refers to accepting the person’s suicidal thoughts and behaviors as a logical response to their pain and suffering and providing validation, i.e. “You’re not crazy, given your pain and suffering, these thoughts and behaviors make sense”.


In conjunction with acceptance is change, which revolves around the idea that change needs to happen and real change is photo-1427805371062-cacdd21273f1possible. In DBT, change comes in the form of a commitment to learn new coping behaviors. There are many skills taught in DBT, but at the core is mindfulness, a Zen practice which helps people to focus on the present moment. Suicidal thoughts and behaviors are a coping strategy for emotional dysregulation. Emotional dysregulation can occur when we ruminate over the past and worry about the future. Mindfulness is about being in the here and now. It is the belief that feelings and thoughts will come and go, and we should notice them, but not allow them to dictate our behavior or mood. For most of us, there is rarely real suffering in any given moment. It is the obsessive revolving door of negative thoughts of the past and future that cause us pain.

DBT has exploded in popularity based on research evidence showing it’s remarkable effectiveness. NIMH studies show that DBT decreases suicide rates by 50% for clients with borderline personality disorder when compared to clients receiving traditional therapy. Researchers out of the University of Washington found that borderline patients receiving DBT made far less suicide attempts, had fewer hospitalizations and were more likely to stay in treatment. Beyond borderline patients, research indicates DBT is also effective with mood disorders, trauma and substance abuse issues.

For more information on Dr. Marsha Linehan and DBT, click here.