James Fitzgerald Therapy PLLC

Distress Tolerance Module

ACCEPTS Skills

The DBT Distress Tolerance module has practical strategies to help you manage intense emotional pain and distressing situations without resorting to harmful or maladaptive behaviors. One foundational set of skills in this module is summarized by the acronym ACCEPTS. The ACCEPTS skills will help you temporarily shift your attention away from distressing emotions and circumstances, enabling you to tolerate difficult moments without exacerbating emotional suffering. Importantly, these skills are not meant to avoid or suppress emotions indefinitely; rather, they offer practical, short-term relief until you are better able to cope with situations directly through more regulated emotional states.

The acronym ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. Each of these elements provides distinct strategies for reducing immediate distress and managing overwhelming feelings effectively.

Activities involve engaging in actions that divert attention away from painful emotions or stressful thoughts by participating in activities that require mental or physical engagement. Examples include exercising, reading, crafting, drawing, cooking, gardening, or watching a movie. Engaging actively in such activities helps shift the focus away from distress, allowing the intensity of emotions to subside naturally. Activities that involve creative expression or physical movement are particularly beneficial, as they not only divert attention but also stimulate neurotransmitters such as endorphins, dopamine, and serotonin, enhancing mood and emotional well-being.

Contributing involves redirecting attention from personal suffering to helping or supporting others. Engaging in acts of kindness, volunteering, assisting friends or family members, or performing small favors or tasks for others can significantly alter one’s emotional state. By contributing positively to others, clients experience a sense of purpose, usefulness, and social connectedness. This shift in attention fosters empathy and compassion, diminishing the intensity of personal emotional pain. Additionally, contributing creates reciprocal positive interactions, enhancing self-esteem and reducing feelings of isolation or helplessness.

Comparisons involve placing one’s current distressing situation in perspective. While DBT generally cautions against making comparisons that lead to self-criticism or feelings of inadequacy, in the ACCEPTS skills context, comparisons refer specifically to gaining perspective by reflecting on past experiences or the experiences of others who have faced greater adversity or difficulties. By considering situations where they have managed distress successfully or recalling circumstances faced by others who have coped effectively with challenges, clients may realize their capacity for resilience and recognize the relative manageability of their current distress. This perspective-taking enhances self-efficacy and instills hope that emotional suffering can be overcome.

Emotions involves intentionally engaging with stimuli or activities that elicit alternative emotions opposite or incompatible with the distressing feelings currently experienced. For instance, listening to uplifting music, watching comedy shows, recalling pleasant memories, or talking to people who evoke joy or calmness can produce emotional shifts toward feelings of happiness, peace, or contentment. By deliberately creating contrasting emotional states, clients can diminish the intensity of distressing feelings, providing a valuable emotional reset. This strategy draws upon principles of emotional regulation, highlighting the effectiveness of deliberate emotional shifts in managing temporary distress.

Pushing away involves mentally setting aside or temporarily distancing oneself from distressing thoughts or situations until one is more emotionally prepared to address them directly. It is essential to understand that this skill is distinct from prolonged avoidance, which can be detrimental to long-term emotional health. Instead, “pushing away” serves as a brief, conscious decision to create emotional space, offering time for the intensity of emotions to diminish naturally or for additional coping skills to be applied effectively. Imagery techniques, visualization, containment exercises, or mindfulness practices can support clients in temporarily “placing” distressful emotions at a safe distance, ensuring they can return later with greater resilience and clarity.

Thoughts involves temporarily occupying the mind with cognitively engaging activities that distract from emotional distress. Examples include counting backward, reciting poems, recalling positive memories, doing mental puzzles, crossword puzzles, Sudoku, or engaging in complex cognitive tasks. This approach draws on cognitive-behavioral principles, recognizing that focusing mental energy on neutral or engaging cognitive tasks can reduce emotional reactivity and provide clients with psychological relief from immediate distress. Such cognitive engagement also helps interrupt negative thought cycles, preventing escalation or spiraling of distressing thoughts and emotions.

Sensations involves grounding oneself through deliberate engagement with strong sensory experiences. Utilizing the senses—touch, taste, smell, sight, or hearing—clients can effectively shift attention away from intense distress and anchor themselves in the present moment. For example, clients might hold ice cubes or take a cold shower, chew strongly flavored gum or candy, listen to loud or calming music, smell calming essential oils, or look at visually stimulating images. Sensory grounding exercises effectively interrupt overwhelming emotional states by providing immediate, concrete experiences that anchor the client in present sensations rather than distressing internal states. Sensory engagement also taps into neurological pathways that rapidly alter emotional arousal and promote emotional regulation.

In therapeutic practice, the ACCEPTS skills are introduced and practiced as part of DBT groups and individual sessions, and clients are encouraged to integrate these skills into their daily lives. Psychoeducation about these strategies helps clients understand their purpose, and therapists typically guide clients through exercises to identify which ACCEPTS strategies work best for their individual emotional challenges and preferences. Clients may benefit from keeping a diary card or journal to track the effectiveness of these skills in various distressing situations, refining their skillset based on personal experience and feedback.

The ACCEPTS skills are particularly helpful during crises, emotional surges, or moments when clients feel overwhelmed and unable to apply more analytical or insight-based coping strategies. By having clear, practical, and readily applicable strategies for immediate emotional relief, clients build confidence in their ability to manage distress without resorting to maladaptive coping mechanisms, such as substance use, self-harm, or impulsive behaviors. Over time, consistent application of these distress tolerance skills strengthens emotional resilience and promotes overall emotional and psychological health.

References:

• Linehan, M. M. (2015). DBT® skills training handouts and worksheets (2nd ed.). Guilford Press.
• McKay, M., Wood, J. C., & Brantley, J. (2019). The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance (2nd ed.). New Harbinger Publications.
• Pederson, L. D. (2017). The Expanded Dialectical Behavior Therapy Skills Training Manual: Practical DBT for Self-Help, and Individual & Group Treatment Settings (2nd ed.). PESI Publishing & Media.
• Rathus, J. H., & Miller, A. L. (2014). DBT® Skills Manual for Adolescents. Guilford Press.
• Van Dijk, S. (2013). Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life. New Harbinger Publications.