DBT Distress Tolerance Skill: ACCEPTS

Have you ever been in a situation where you are so consumed with an emotion that you aren’t able to think clearly? In DBT, we teach distress tolerance skills that can be used to create short-term relief from painful situations and minimize the risk of impulsive behaviors. No, we don’t mean push away and avoid your emotions forever (because they will resurface). The intention is to tolerate them temporarily so you don’t make the problem worse or to survive a crisis. They can help you feel more relaxed and in control of your behaviors. 

Distress tolerance skills are especially useful for:

•Intense emotional and/or physical pain

•Emotional pain that is so strong that it feels overwhelming

•Strong urges to engage in unhelpful behaviors

•When you have something to do but are too consumed with an emotion 

The ACCEPTS skill is an acronym - because we just can’t get enough of them in DBT (see what I mean!). ACCEPTS stands for activity, contributing, comparisons, emotions, pushing away, thoughts, and sensations. However, when we work with young children, we often shorten this acronym to ACTS (activity, contributing, thoughts, and sensations) for accessibility. This one is particularly useful when we need something to distract us from a challenging situation or difficult emotions that we can’t do anything about. 

Activities: Engage in an activity. Read a book, bake some brownies, go for a walk, call a friend, clean your room, etc. Anything that keeps you busy and gets your mind off of the negative emotion. Make a list to use for the next time you’re in distress!

Contributing: Do something kind for another person. Helping others can relieve emotional distress. This activity will also get your mind off of the problem at hand. Help with dinner, check in with a friend, give someone a compliment, buy or make a gift, etc. We feel good about ourselves when we help others too! Mind Chicago often participates in making cards for hospitalized kids.

Comparisons: (We know, this one may not be for everyone. And remember, DBT invites you to use what resonates with you.) Think about a time when you’ve faced a more difficult challenge than the one you’re facing right now. Or, consider thinking about other humans that may be experiencing a more intense hardship like a natural disaster or food shortage. The purpose of this exercise is not to add more distress or emotional pain, rather, this skill is meant to add a different perspective to your experience and get you unstuck from extreme thinking. (If this is the most intense situation you have ever experienced, you may want to try the TIP skill.)

 Emotions: Distract from your current emotion by creating another one. Watch an emotional movie, listen to emotional music, read an enticing book, watch a hilarious TikTok, etc. We suggest doing something that will evoke an emotion opposite to the one you’re feeling. So if you’re feeling sad, watch a comedy, listen to happy music, or dance. Try having a list of your favorite playlists, shows, books, or movies for times like these!  

 Pushing Away: This skill is great for when you have a problem you can’t immediately solve. It involves blocking a situation from your mind and whenever it creeps back into your mind, you tell it to go away or put another thought in its place. You can push away a thought by distracting yourself with activities, thoughts, or mindfulness. (This, of course, does not solve the painful situation by any means, but sometimes emotions have to be put away for a while so that you have a chance to calm down, get through a moment, and find a time to connect to your emotions in a more meaningful way.)

Thoughts: The thing about thoughts is that you can only focus on one thought at a time. Push pause on negative or anxious thoughts with an activity that busies the mind, such as a puzzle, playing an engrossing game, or going through old photos. Try to give the task 100% of your attention.

Sensations: A strong physical stimulus can distract you from the emotional pain you’re having. You might try holding an ice cube in your hand, listening to loud music, taking a hot or cold shower, swimming, etc.! After doing a sensation skill, you may want to try another letter of ACCEPTS.

For more guidance on working through distress with the ACCEPTS skill and using other DBT skills, reach out to us at hello@mindchicago.com. 

Authored by Mind Chicago therapist Fatima Sakrani, LSW