Welcome to Distress Tolerance! Let’s recap the goals of Distress Tolerance skills from DBT Series 1 post: The goal of Distress Tolerance is crisis survival. The Distress Tolerance skills help to “get through a crisis without making things worse” (1).
I like to encourage my clients to consider the Distress Tolerance skills when they are feeling the intensity of certain emotions between 6 out of 10 to a 10 out of 10.
The first Distress Tolerance skill we will visit is ACCEPTS. The ACCEPTS skill is considered the distraction-based skill. You don’t have to do every aspect of the skill to feel its benefits and you can use any part of it that feels effective in the moment. A quick friendly reminder: we do not want to utilize this skill to remain distracted from what is bothering us, to avoid things, and to never address it.
Let’s break this skill down. You might already do certain aspects of this skill!
ACCEPTS is an acronym that stands for:
- Putting Away
A - Activities are pretty self-explanatory. This part of the skill refers to activities you can engage in to pull your mind away from what is occurring in the moment. This may include reading, organizing, moving your body in a way that feels effective (see what I did there? Hint hint: Mindfulness How skill Effectively), cleaning, anything.
C - Contributing refers to “pouring into someone else’s cup” so to speak. This can look like calling a close friend and asking how their day is going. This can look like volunteering at an animal shelter or soup kitchen. Anything else to refocus your attention away from the crisis at hand.
C - Comparisons can feel like a tricky part of this skill. Comparisons may include looking back on times where you were in a similar situation and may have been coping differently or not as well. Some may not be a fan of this part of the skill because it may come across as judgmental. However, this is a great opportunity to sprinkle in some Mindfulness How skills (hint hint: Non-judgmentally).
E - Emotions refers to engaging in an activity that elicits a competing emotion to the emotion you are experiencing. For example, if you are feeling sad, you may elicit fear by watching a scary movie. You may be feeling anxious so maybe you go for a walk to elicit calm.
P - Pushing Away is imagery-based in your mind. You imagine your crisis/current problem being placed in a box. You place that box on a shelf and come back to it when you feel ready. Remember though… this isn’t a box that you get to throw things into and never address again. Be sure to come back to this box when you feel ready. Sometimes, I even encourage my clients to think of this aspect of the skill as “Putting Away.”
T - Thoughts include the mental activities to distract your mind. For example, try counting backwards from a number that you normally wouldn’t, such as by 7. Maybe this is counting the number of trees you can see from your window. One of my favorites includes choosing a category (i.e., foods and drinks), moving slowly through the alphabet, and seeing how many items I can list with that particular letter.
S - Sensations refers to creating safe physical sensations that can be distracting. This may include biting into a lemon (you just salivated a little bit from reading this, didn’t you?), taking a warm or cold shower, or tickling your arm with a feather.
Want to hear more about the DBT ACCEPTS skills? Check out this free video from DBT-RU to hear more! (2)
(1) Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed., p. 420). The Guilford Press.
(2) [@DBTRU]. (2020, December 8). Distract with Accepts [Video]. YouTube. https://www.youtube.com/watch?v=bl1Sy7xR92g
Reminder: these blog posts are meant to be purely educational and/or entertainment tools and do NOT replace psychotherapy and/or other medically necessary treatments.