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Parent showing teen how to use the ACCEPT Skill

ACCEPTS: A Useful DBT Skill for Stress

7 min.

ACCEPTS is a DBT skill you can use in everyday life to help with distress tolerance and improving overall mental health.

By: Charlie Health Editorial Team

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

April 29, 2023

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Table of Contents

Dialectical behavior therapy (DBT) is a form of psychotherapy that has gained popularity in recent years for its effectiveness in treating a variety of mental health conditions. DBT is a type of cognitive behavioral therapy that is based on the concept of mindfulness and acceptance. 

One of the skills taught in DBT is the acronym ACCEPTS, which is a distress tolerance skill. In this blog post, we will explore what DBT ACCEPTS is, how it is used, and its benefits in managing stress.

What is DBT ACCEPTS?

DBT ACCEPTS is a skill that is used in dialectical behavior therapy to help individuals manage distress. The acronym ACCEPTS stands for:  

  • Activities: Activities that are grounding or engaging such as going for a walk, doing a puzzle, or talking to a friend
  • Contributing: Distract yourself by being of service to others. Get involved with local volunteer networks, clean out your closet for donations, or surprise a loved one with a kind text. 
  • Comparisons: Think about a time when you felt differently than you do in the present moment. Remember that there are billions of people out there, right now, who are also dealing with big emotions. 
  • Emotions: Try to tap into an emotion other than the one you’re currently dealing with. For example, if you’re feeling sad, try watching a comedy. If you’re feeling angry, listen to music that reminds you of someone you love. 
  • Pushing away: Quite literally push the negative thoughts and emotions away. Imagine building a wall between yourself and the situation, box up the pain, and put it on the (imaginary) shelf. 
  • Thoughts: Direct your thoughts elsewhere from the current situation. Count by 7’s as high as you can, read a book, or try a new recipe. 
  • Sensations :Engage your senses. Squeeze a stress ball as hard as you can, hold ice in your hand, take a hot shower, or sing as loudly as you can. 

Each of these components is designed to help individuals manage their emotions and stress in a healthy way.

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An example of DBT ACCEPTS being used

John is struggling with intense anxiety and is finding it difficult to manage his emotions. John has been in therapy for a few weeks and has learned about the ACCEPTS skill in his DBT sessions. John’s therapist has provided him with an ACCEPTS worksheet to use as a tool to practice the skill.

One day, John receives some unexpected news that triggers his anxiety. He feels overwhelmed and starts to panic. Instead of resorting to unhealthy coping mechanisms, John remembers the ACCEPTS skill and pulls out his worksheet. He begins to work through each of the components of the skill:

Activities

John decides to go for a walk to clear his head and distract himself from his thoughts.

Contributing

John reaches out to a friend to talk about his feelings and gain support.

Comparisons

John reminds himself that he has faced similar situations in the past and has been able to manage his anxiety.

Emotions

John acknowledges his feelings of anxiety and allows himself to experience them without judgment.

Pushing away

John focuses his attention on a pleasant memory to help him disengage from his anxious thoughts.

Thoughts

John uses positive self-talk to counteract negative thoughts and replace them with more helpful ones.

Sensations

John engages in deep breathing exercises to help him relax and reduce physical symptoms of anxiety.

By using the ACCEPTS skill, John is able to manage his distress in a healthy way and avoid engaging in impulsive or harmful behaviors. Over time, with practice and continued use of the skill, John is able to develop greater emotional regulation and cope with challenging situations more effectively.

What is an ACCEPTS DBT worksheet?

An ACCEPTS DBT worksheet is a tool that is used in therapy to help individuals practice the ACCEPTS skill. The worksheet includes a list of activities, contributing behaviors, comparisons, emotions, pushing-away techniques, thoughts, and sensations that can be used to manage distress. The goal of the worksheet is to help individuals identify the techniques that work best for them and to practice using them in their daily lives.

Who uses ACCEPTS DBT worksheets?

ACCEPTS DBT worksheets can be used by anyone who is seeking to manage distress and develop healthier coping skills. They are particularly helpful for individuals who struggle with intense emotions and have difficulty managing them. They are also useful for individuals who struggle with impulsive behaviors, self-harm, or suicidal thoughts.

Teen using the ACCEPTS skill

What is DBT skills therapy used for?

DBT skills therapy is used to treat a variety of mental health conditions, including borderline personality disorder (BPD), depression, anxiety, and substance abuse. It is particularly effective in treating individuals who struggle with intense emotions and have difficulty regulating them.

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What are the 4 stages of DBT?

DBT therapy is typically broken down into four stages. In the first stage, the focus is on stabilizing the individual and reducing symptoms. The second stage focuses on developing skills and improving emotional regulation. The third stage focuses on addressing past traumas and improving self-esteem. The fourth stage focuses on integrating the skills learned in therapy into daily life and maintaining progress.

What is radical acceptance in DBT?

Radical acceptance is a key concept in DBT therapy. It involves fully accepting reality, even when it is difficult or painful. This does not mean that an individual has to like or approve of the situation, but rather that they acknowledge it and work to find ways to cope with it. Radical acceptance is a powerful tool in managing distress and can help individuals move forward in a healthy way.

What are examples of other DBT skills?

Some examples of other DBT skills include:

DBT FAST

The FAST DBT skill involves four steps:

1. Fair

Start by being fair and reasonable in your request. Make sure that your request is not unreasonable or unfair to the other person.

2. Apologies

If necessary, apologize for any past behavior that may have caused difficulties in the relationship. This can help to reduce tension and open up lines of communication.

3. Stick to values

When making your request, make sure that it aligns with your values and beliefs. This can help to make your request more compelling and convincing.

4. Truthful

Be honest and truthful when making your request. This can help to build trust and improve the likelihood that your request will be accepted.

TIPP

TIPP stands for: 

Temperature

Similar to the “Sensations” element of ACCEPTS, the “T” in TIPP directs you to use temperature to take your mind off your current emotional state. A cold shower or even a hot cup of tea can make a big difference in shifting your thoughts and feelings. 

Intensive exercise

Getting your heart rate up, sweating, and moving your body are all excellent ways to deal with big emotions. 

Paced breathing

Try the 4-7-8 method to relieve anxiety, stress, and tension. Inhale for 4 counts; hold for 7, and exhale for 8. It might feel hard at first, but try to repeat that cycle 3-4 times in a row to help calm your nervous system. 

Progressive muscle relaxation

This is a method rooted in mindfulness techniques that helps during a period of anxiety, panic, or stress. Moving through your body one muscle group at a time, clench all of the muscles beginning at your feet, hold for a few seconds, then relax them. Keep going until you reach the muscles of your face.

DEAR MAN

DEAR MAN is a communication tool rooted in DBT skills. It stands for: 

Describe the situation

Express your feelings

Assert yourself

Reinforce your position

Mindful of the other person 

Appear confident

Negotiate

Each of these steps describes the way you should (in order) try to navigate conflict with another person. It’s important to use “I” statements such as, “I feel overwhelmed when you raise your voice at me,” instead of accusatory language like, “You always scream at me! I hate you!” 

The goals of all DBT skills: 

Mindfulness

Observing and describing thoughts and emotions without judgment

Distress tolerance

Distraction, self-soothe, radical acceptance, self-soothing, improving the moment, and thinking of pros and cons

Emotion regulation

Identifying and labeling emotions, reducing vulnerability to emotions, increasing positive emotions, and decreasing negative emotions

Interpersonal effectiveness

Assertiveness, active listening, negotiating, and maintaining relationships

DBT with Charlie Health

If you think DBT might be a useful tool for yourself or a loved one, Charlie Health may be able to help – reach out to get signed up today. Charlie Health’s trained clinicians offer DBT as well as many other useful forms of therapy.

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