We continue to travel through the Distress Tolerance module (one of the four “chapters” or modules of DBT, each presenting a number of strategies in each skills group) of DBT with the introduction of the “ACCEPTS” skill. Like other skills within the Distress Tolerance module, ACCEPTS help us to manage our responses and emotions during a crisis and prevent escalation of our emotional state. This skill, similarly to TIPS, provides us with tangible tools to use as an alternative to more destructive strategies often accessed during a crisis. ACCEPTS will help us to navigate these emotional states when we may feel desperation or as though the mind is flooded with negative thoughts and the body feels activated. ACCEPTS falls under the category of Distraction.
Distraction is a tool that is commonly used when we must distract ourselves from a distressing situation. Similar to mindfulness practices, the distress tolerance skill of distraction does not suggest that we push away or avoid strong feelings and experiences but rather that we immediately soothe ourselves in an attempt to avoid a response that is “too hot” or “too intense.” With distraction, there is an understanding that the issue will be dealt with at another time.
ACCEPTS is an acronym that is self-explanatory in nature (this makes it easy to remember!) and always accessible!
A-Activity: Engaging in an activity (any activity!) gets us moving, and temporarily distracts us from our feelings of distress. These activities can be as simple as making the bed, organizing your closet, painting a picture, writing a poem, you name it. While in a difficult moment we may not feel motivated to get up and do something, it is often an impactful and immediate intervention.
C- Contributing: When strong emotions take over, it is easy to feel as though our problems and worries are all-encompassing, or even the center of the universe! In these moments, it is important to step outside of ourselves. Maybe we contribute by asking a friend how they are doing or by contributing to an important cause.
C-Comparisons: Similar to the theory behind contributing, when we get caught up in ourselves and our emotions, it can be helpful to take a step back and express gratitude for what we do have. Perhaps we compare ourselves to someone residing in poverty, in war etc. In these moments we can write in our gratitude journal and consider what we do have, when our emotions or situations feel unmanageable.
E–Emotions: When caught up in the moment of strong emotion, we may use Opposite Emotion as a tool. In line with the balanced, dichotomous themes of DBT, this tool uses an opposite to bring us back to neutral ground. This technique tells us to engage in the opposite action. For example: Feeling angry? Watch a funny movie. Feeling sad? Listen to upbeat music. Alternatively, the behaviors can be more active, for example, are you lying in bed feeling down and lethargic? Get up and take a walk around the block.
P– Pushing Away: When we become emotionally activated, there is often a desire to hold on to stressful or “loaded” thoughts. When this begins to happen, we want to compartmentalize our thoughts and watch our emotions shrink away! Visualize your anger drifting away or setting it aside for later. Perhaps you need to take action by writing your negative thoughts down and crumpling, ripping or shredding them up. These activities help us demonstrate to ourselves that we are capable of pushing away the thoughts that do not serve a positive purpose while validating their existence.
T-Thoughts: When we are in an intense emotionally state, we are likely in “emotion mind,” an emotional state that is overpowering. On our way to a calmer emotional state, such as “wise mind” we will reach into our bag of tricks and pull out a useful thought! You may have go-to phrases and quotes nearby to read, or a feel-good thought saved to memory. For some, this looks like reading a soothing phrase or prayer or thinking through a breathing exercise.
S-Sensations: Physical sensations can provide us great relief when we are overcome with emotion. Luckily for us, this tool utilizes something we always have with us, our bodies! Splash cold water on your face, smell a soothing scent, apply hand or face cream etc. This tool acts to “bring us back to our senses!”
Through the use of distress tolerance skills, we are better able to endure our pain in a healthier, more productive way. Over the course of the next few blogs, we will discuss how distress tolerance teaches us to distract, calm and cope.
Dijk, S, (2013). Dbt made simple: a step-by-step guide to dialectical behavior therapy. Oakland, California: New Harbinger Publications
Chang, L (2018, February 2nd). Tolerate Distress with A-C-C-E-P-T-S. Retrieved from https://www.mindfulnessmuse.com/dialectical-behavior-therapy/tolerate-distress-with-a-c-c-e-p-t-s