ACCEPTS: A DBT Distress Tolerance Skill

What Is the ACCEPTS Skill in DBT?

ACCEPTS is a DBT distress tolerance skill that provides seven structured ways to distract yourself during a crisis until the emotional intensity passes. The acronym stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. It’s one of the core distress tolerance skills and is designed for moments when you can’t solve the problem right now — the only task is getting through the next hour without making things worse.

Distraction often gets dismissed as avoidance. In DBT, it’s recognized as something very different. Avoidance is a chronic pattern of refusing to face difficult situations. Distraction is a temporary, deliberate strategy for reducing emotional intensity to a level where you can function. ACCEPTS gives that strategy structure so you’re not scrambling for ideas when you’re already in crisis.

The Seven ACCEPTS Skills Explained

A — Activities

Do something that requires your attention. The key word is “requires” — the activity needs to be absorbing enough that your mind can’t fully maintain the crisis narrative while doing it.

Effective activities tend to involve some combination of physical movement, mental focus, or sensory engagement. Cleaning the kitchen, going for a walk, doing a puzzle, cooking a recipe that demands attention, playing an instrument, organizing a drawer, or exercising. Less effective activities are passive ones that leave your mind free to ruminate — scrolling social media, for example, often makes things worse because it doesn’t demand enough cognitive resources.

The activity doesn’t need to be enjoyable. It needs to be engaging. When you’re in crisis, you may not enjoy anything. That’s fine. The point isn’t pleasure — it’s redirection.

C — Contributing

Help someone else. This might sound counterintuitive when you’re the one suffering, but contributing shifts your focus outward and activates neural circuits associated with meaning and connection that directly counteract the crisis state.

Contributing can be large or small. Text a friend to ask how they’re doing. Do a favor for a family member. Pick up litter on a walk. Write a supportive message to someone going through a hard time. Volunteer. Even small acts of contribution generate a subtle shift in perspective: if you’re capable of helping someone else, the crisis hasn’t completely defeated you.

This isn’t about ignoring your own needs or performing selflessness. It’s about interrupting the inward spiral of crisis by directing some attention and energy toward another person.

C — Comparisons

Compare your current situation to a time when things were worse and you survived. Or compare to people who are coping with equal or greater difficulty.

This skill often generates resistance because it sounds like “other people have it worse, so you shouldn’t complain.” That’s not what it is. Comparisons in ACCEPTS serves a specific psychological function: it activates your memory of your own resilience. When you recall surviving something harder than this, you generate evidence that you can survive this too. The comparison isn’t about minimizing your pain — it’s about reminding yourself that pain is survivable.

Choose comparisons carefully. Comparing yourself to others in a way that triggers guilt or shame defeats the purpose. The most effective comparisons are with your own past: “I got through that, and I can get through this.”

E — Emotions

Generate an emotion different from the one you’re stuck in. If you’re drowning in sadness, watch something funny. If you’re consumed by anger, listen to calm or melancholy music. If you’re numb, watch something that might make you cry.

This isn’t about faking happiness. It’s about breaking the emotional monopoly. When one emotion dominates, it narrows your thinking and your options. Introducing a different emotional signal — even briefly, even partially — widens the aperture. You don’t need to fully replace the crisis emotion. You just need to make room for something else alongside it.

Practical approaches: a comedy special, a playlist that reliably shifts your mood, a video of animals doing ridiculous things, a song that makes you feel powerful, a movie scene that always makes you cry in a cathartic way. Know what works for you and have it accessible before you need it.

P — Pushing Away

Mentally set the problem aside. You’re not solving it right now. You’re not engaging with it right now. You’re putting it in a box, closing the lid, and setting it on a shelf for later.

Visualization helps. Imagine writing the problem on a piece of paper, folding it, and putting it in a drawer. Imagine building a wall between yourself and the problem — brick by brick. Imagine placing the problem in a boat and watching it drift away. You can retrieve it later. Right now, it goes away.

Pushing away is the most controversial ACCEPTS skill because it overlaps with avoidance in a way the others don’t. The distinction is temporal: you’re pushing the problem away for hours, not months. You’re acknowledging the problem exists and consciously choosing not to engage with it right now because engaging right now would make things worse. That’s not avoidance — that’s strategic timing.

T — Thoughts

Occupy your mind with something that demands cognitive resources. Count backward from 100 by 7s. Name every country in Africa. Recite song lyrics. Do mental math. Play a word game. Anything that fills your working memory so there’s no room for the crisis narrative.

The less emotionally charged the thoughts, the better. This isn’t the time for deep reflection or meaning-making. It’s the time for purely mechanical cognitive tasks that take up bandwidth. Some people find puzzles effective — Sudoku, crosswords, word searches — because they demand just enough mental effort to crowd out rumination without requiring emotional engagement.

S — Sensations

Use strong physical sensations to redirect your nervous system’s attention. Hold ice cubes. Take a very cold or very hot shower. Eat something with an intense flavor — hot sauce, sour candy, strong mint. Listen to loud music. Snap a rubber band on your wrist.

The sensation needs to be intense enough to register above the emotional noise but not harmful. The goal is to give your nervous system a competing signal. When your body is processing the shock of ice water on your hands, it has fewer resources available for fueling the emotional crisis. This overlaps with the Temperature component of TIPP skills — and pairing them is often effective.

When to Use ACCEPTS vs Other Distress Tolerance Skills

ACCEPTS is designed for moderate-to-high distress — roughly 5 to 8 on a 10-point scale. It’s for the hours after the acute crisis peak, or for situations where the distress is real but not at its maximum intensity.

For acute crisis at maximum intensity (8-10), start with TIPP. TIPP targets your body chemistry directly and works faster. Once TIPP brings the intensity down a few notches, ACCEPTS becomes effective for maintaining that lower level.

For sustained, ongoing distress, consider IMPROVE the Moment or radical acceptance — these are designed for the long game rather than the immediate crisis.

For urges to act destructively, urge surfing is often the most direct intervention, with ACCEPTS available as support.

In practice, most crises involve cycling through several skills. You might start with TIPP (cold water on the face to bring your heart rate down), shift to ACCEPTS (go for a walk, listen to a podcast, hold ice), and use radical acceptance as the underlying framework throughout.

Building Your ACCEPTS Toolkit

The worst time to figure out which ACCEPTS skills work for you is during a crisis. The best time is now.

For each letter, identify two or three specific, concrete options that are accessible to you. Write them down. Put the list somewhere you can find it when your thinking brain goes offline.

Your Activities list might include: walking the dog, cleaning the bathroom, a specific video game, baking cookies. Your Contributing options might include: texting a specific friend, walking a neighbor’s dog, writing a thank-you note. Your Sensations toolkit might include: ice cubes in the freezer, a bag of sour candy in the drawer, a specific playlist at maximum volume.

The specificity matters. “Do an activity” is too vague to act on during a crisis. “Do 20 minutes on the exercise bike while listening to the true crime podcast” is specific enough that you can execute it on autopilot when your executive function is compromised.

ACCEPTS at Front Range Treatment Center

At Front Range Treatment Center, ACCEPTS is taught during the distress tolerance module of our DBT skills groups. You’ll develop your personal ACCEPTS toolkit, practice each skill during sessions, track what works and what doesn’t on your diary card, and refine your approach with feedback from the group and your therapist.

The skill is deceptively simple. Seven categories of distraction — what’s complicated about that? What’s complicated is actually using it when every fiber of your being is screaming at you to act on the crisis instead. That’s what the practice is for.

Frequently Asked Questions About ACCEPTS in DBT

What does ACCEPTS stand for in DBT? ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. It’s a distress tolerance skill in DBT that provides seven structured distraction strategies for surviving emotional crises without making things worse.

Is the ACCEPTS skill just distraction? Yes, and that’s the point. In DBT, distraction during crisis is a legitimate, evidence-based survival strategy — not avoidance. The distinction is that distraction is temporary and deliberate (you’re buying time until the intensity passes), while avoidance is chronic and unplanned (you’re refusing to face the problem altogether). ACCEPTS creates the window of reduced intensity where other skills become usable.

How is ACCEPTS different from TIPP skills in DBT? TIPP targets your body chemistry directly through Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation — it works fast and is designed for acute crisis at maximum intensity. ACCEPTS works through cognitive and behavioral distraction and is effective for moderate-to-high distress. In practice, many people use TIPP first to bring the intensity down, then shift to ACCEPTS to maintain that lower level.

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Related Reading

• Distress Tolerance Skills in DBT
• TIPP Skills in DBT: Fast Relief for Intense Emotions
• Urge Surfing in DBT: How to Ride the Wave
• Radical Acceptance in DBT
• STOP Skill in DBT: How to Pause Before You React
• What Are DBT Diary Cards?