Module 2. Distress Tolerance: (Discussion #2) ACCEPTS

DBTuesday is a series of posts where we explore skills and concepts from dialectical behavior therapy (DBT).

This is one of several posts focusing on distress tolerance, which is the second module of DBT skills training. See this post for general info about DBT and this post for more info about distress tolerance.

What is ACCEPTS

ACCEPTS is a set of seven different skills for distracting from difficult feelings.

• Activities: do any healthy activity
• Contributing: help someone else
• Comparisons: compare this to another worse experience
• Emotions: activate an opposite emotion
• Push Away: mentally distance yourself from the situation
• Thoughts: focus on unrelated or neutral thoughts
• Sensations: distract yourself with physical sensations

Sometimes just redirecting your attention from painful feelings to something else that’s enjoyable or neutral can help in the moment if you’re struggling.

Examples of each skill

1) Activities

• Work on a task
• Watch a movie or TV show
• Clean your house
• Attend an event
• Play video games
• Go for a walk
• Exercise
• Surf the Internet
• Play sports
• Eat a delicious meal
• Call or spend time with a friend
• Listen to music
• Spend time with your family
• Read a book
• Do a puzzle

2) Contributing

• Volunteer (e.g. 7 Cups needs people 😉)
• Help a friend or family member
• Give someone a hug
• Make a card or gift
• Donate things you don't need
• Send a warm message to someone
  

3) Comparisons

Consider how things could be worse than they are now and how it’s a relief that things aren’t as bad as they could be. (If any of these don’t feel helpful, feel free to ignore.)

• Past experiences: If you’ve ever felt worse than you do now, think about how good it is that you aren’t experiencing that

• Coping skills: Maybe there’s a time when you didn’t have the same coping skills, resources, or perspective as you do now and you might have felt even worse in the current situation

• Others’ experiences: There might be worse or additional pains or difficulties that other people are struggling with that you’ve thankfully been able to avoid

4) Emotions

Do something that triggers a different feeling than what you’re currently experiencing.

• Fear: do something that helps you feel control, mastery, or power

• Sadness: do something that helps you feel active, competent, or confident

• Anger: do something that helps you feel gentle or peaceful

• Guilt/shame: do something that helps you feel kind or positive

5) Push Away

• Imagine a wall between you and the situation
• Imagine putting the feelings in a box
• Internally say "No" to any thoughts or images that come up

6) Thoughts

Do something that keeps your mind busy.

• Count to 10
• Identify colors around you
• Work on a puzzle or game
• Watch TV
• Read a book

7) Sensations

Do something that absorbs you in your senses.

• Squeeze an object really hard
• Listen to loud music
• Hold a piece of ice
• Take a hot or cold shower
• Drink a hot beverage

What are at least three things you’d feel comfortable doing as distractions?

Sources:

https://dbt.tools/distress_tolerance/accepts.php

https://www.goodtherapy.org/blog/distress-tolerance-dialectical-behavior-therapy-0117134

https://sunrisertc.com/distress-tolerance-skills/#accepts

https://www.dbtselfhelp.com/html/er_handout_10.html