Managing Distress With the DBT Skill “ACCEPTS”
Using the distraction skills helps tolerate distress by creating a gap between whatever set it off initially and what you are subsequently choosing to focus your attention on. Although Distress Tolerance is about “not making a situation worse” as opposed to making it better, the skills in ACCEPTS can help to influence other less distressing emotions as a secondary benefit.
Because it is fundamentally a Distress Tolerance technique it is important not to become over-reliant on distraction skills. Of course, if you were to distract from all your problems it would be likely to be ineffective as it would become total avoidance. Therefore, these skills are specifically helpful to implement only during times when:
1. ACTIVITIES
Activities which are neutral, positive or opposite to the distressing emotions and urges can help reduce distress momentarily, as well as longer-term. They flood your short-term memory with distractions and activate other parts of the brain so that destructive thoughts and urges are reduced.
E.g. Playing an instrument, doing a puzzle, watching a comedy.
2. CONTRIBUTING
Contributing towards someone or something else can help shift your attention off yourself and away from the distress currently being experienced. Additionally, giving to others can help boost a sense of meaning, self-worth and joy within oneself.
E.g. Calling an elderly relative, making a card of appreciation for a friend, sending a text donation to a charity.
3. COMPARISONS
This can be done in one of two ways: comparing to self (at other times), or comparing to others. For some people, comparing your own distress to that of someone else going through their own trauma or distress can help put things in perspective and provide some grounding. For others, it may be more helpful to focus on a time in your own life when things were different – either more difficult, to show yourself you can survive crises, or less difficult, to remind yourself there is hope, it can be like that again.
E.g. Watch the news and see all the people suffering in wars, poverty, crimes etc around the world. Write a gratitude list based on these differences. Or, say to yourself “this time last year I was experiencing X, look how far I have come”.
4. (opposite) EMOTIONS
Influencing other emotions to the distressing ones currently being experienced is a helpful crisis survival skill. It challenges and changes the current mood state and hence any destructive thoughts and urges will reduce as a result.
E.g. Listen to happy music if feeling sad, do something kind for someone instead of going with anger.
5. PUSHING AWAY
In some situations it may be temporarily effective to push away whatever distressing experiences are being felt. This can be done physically by leaving a situation to decrease triggers, or mentally by blocking it out of your mind. Consciously blocking experiences associated with distressing emotions should only be done for a short period of time, otherwise it can tip into avoidance, or the distress will come back even stronger when you take your foot off the break. It should only be used when completely necessary, as a last resort. Also, it is important to come back to whatever experience you have pushed away later on, so that it can be attended to and problem-solved effectively where necessary.
E.g. Visualise putting your emotions into a balloon and watching them float away or building an imaginary wall between yourself and others. This could be done in a work situation or family function where neither leaving nor going with the emotion and subsequent urges is effective. Another example is putting off self-harm urges by saying to yourself “I’ll just get through the next 5 minutes without self harming”, every 5 minutes until the urges pass.
6. THOUGHTS
Distracting from a distressing situation with other thoughts floods the short-term memory with alternative stimuli to distract from the painful experience you are currently in. This is especially helpful for distracting from and dealing with negative intrusive thoughts, ruminating, worry thoughts and thoughts relating to urges.
E.g. Counting or labelling things in the environment, playing A-Z animals, reading number plates as fast as you can, doing mental maths, singing a song over and over in your head.
7. SENSATIONS
Intense physical sensations help redirect attention to something concrete and alternative to experiences related to emotional distress. Sensations flood the brain with alternative messages and activate a totally different neural system.
E.g. Holding ice cubes, smelling Tiger Balm, eating wasabi, chewing gum, listening to engaging music, stroking a pet.
Because it is fundamentally a Distress Tolerance technique it is important not to become over-reliant on distraction skills. Of course, if you were to distract from all your problems it would be likely to be ineffective as it would become total avoidance. Therefore, these skills are specifically helpful to implement only during times when:
- You are becoming overwhelmed by your emotions to the point it is not effective to go with them.
- You are in a situation where it is inappropriate to fully experience distressing emotions.
- When a problem cannot be solved straight away but the sense of urgency to do so remains. (It is not wise to try and solve a problem when in Emotion Mind as it is likely to be negatively influenced and therefore potentially ineffective.)
1. ACTIVITIES
Activities which are neutral, positive or opposite to the distressing emotions and urges can help reduce distress momentarily, as well as longer-term. They flood your short-term memory with distractions and activate other parts of the brain so that destructive thoughts and urges are reduced.
E.g. Playing an instrument, doing a puzzle, watching a comedy.
2. CONTRIBUTING
Contributing towards someone or something else can help shift your attention off yourself and away from the distress currently being experienced. Additionally, giving to others can help boost a sense of meaning, self-worth and joy within oneself.
E.g. Calling an elderly relative, making a card of appreciation for a friend, sending a text donation to a charity.
3. COMPARISONS
This can be done in one of two ways: comparing to self (at other times), or comparing to others. For some people, comparing your own distress to that of someone else going through their own trauma or distress can help put things in perspective and provide some grounding. For others, it may be more helpful to focus on a time in your own life when things were different – either more difficult, to show yourself you can survive crises, or less difficult, to remind yourself there is hope, it can be like that again.
E.g. Watch the news and see all the people suffering in wars, poverty, crimes etc around the world. Write a gratitude list based on these differences. Or, say to yourself “this time last year I was experiencing X, look how far I have come”.
4. (opposite) EMOTIONS
Influencing other emotions to the distressing ones currently being experienced is a helpful crisis survival skill. It challenges and changes the current mood state and hence any destructive thoughts and urges will reduce as a result.
E.g. Listen to happy music if feeling sad, do something kind for someone instead of going with anger.
5. PUSHING AWAY
In some situations it may be temporarily effective to push away whatever distressing experiences are being felt. This can be done physically by leaving a situation to decrease triggers, or mentally by blocking it out of your mind. Consciously blocking experiences associated with distressing emotions should only be done for a short period of time, otherwise it can tip into avoidance, or the distress will come back even stronger when you take your foot off the break. It should only be used when completely necessary, as a last resort. Also, it is important to come back to whatever experience you have pushed away later on, so that it can be attended to and problem-solved effectively where necessary.
E.g. Visualise putting your emotions into a balloon and watching them float away or building an imaginary wall between yourself and others. This could be done in a work situation or family function where neither leaving nor going with the emotion and subsequent urges is effective. Another example is putting off self-harm urges by saying to yourself “I’ll just get through the next 5 minutes without self harming”, every 5 minutes until the urges pass.
6. THOUGHTS
Distracting from a distressing situation with other thoughts floods the short-term memory with alternative stimuli to distract from the painful experience you are currently in. This is especially helpful for distracting from and dealing with negative intrusive thoughts, ruminating, worry thoughts and thoughts relating to urges.
E.g. Counting or labelling things in the environment, playing A-Z animals, reading number plates as fast as you can, doing mental maths, singing a song over and over in your head.
7. SENSATIONS
Intense physical sensations help redirect attention to something concrete and alternative to experiences related to emotional distress. Sensations flood the brain with alternative messages and activate a totally different neural system.
E.g. Holding ice cubes, smelling Tiger Balm, eating wasabi, chewing gum, listening to engaging music, stroking a pet.