How to apply the DBT Distress Tolerance "ACCEPTS” skill.

One of the things we have to accept as humans is that, we don’t always get to choose when emotions hit. There can be predictable cues and signals that will inform us that emotions are on their way and then there are other moments when just, wham! seemingly out of know where our emotion intensity shows up and steers us off course. For many high-performers, leaders, creatives, and people "wearing many hats" that quick jump of emotions can feel all too familiar.

To work with this, people will often come to me interested in learning emotion regulation skills. Emotion Regulation is powerful and what a lot of people don't know, is that there is also another set of skills, Distress Tolerance, that are equally important and can really buy us time in moments when we're close to "loosing it" or making things worse.

Emotion Regulation skills often take a lot of time and awareness to learn and then apply while Distress Tolerance skills, like the ACCEPTS skill, are quick, user friendly and can be a life saver.

What Is Distress Tolerance?

In DBT Skills Training, the module of distress tolerance is all about teaching people practical, concrete tools to help tolerate the reality of life, as it is. There are two key sections, one is all about navigating high intensity, short term "crisis" moments, and then there are the long term strategies that involve radical acceptance and changing our relationship with our thoughts.

Today I'm going to focus us on the first category, the crisis survival skills - think, skills that help you not throw fuel on the fire. There are a handful of strategies in this section and one of them is called the "ACCEPTS" skill which is an acronym that describes seven different distraction techniques that we can pull on, at any moment. The best part is that these tools don’t require special equipment, or hours of learning and refining; you only need a few minutes, awareness, and willingness to "ACCEPTS".

What Is ACCEPTS?

In moments of emotional overwhelm, say for example you're in the “yellow” or “red zone” on your internal emotional thermometer ACCEPTS offers the following different strategies to leverage and buy us time, so we can recalibrate and come into more emotional ease and cognitive flexibility.

Letter	Skill / Strategy
A	Activities — redirecting attention to a helpful, absorbing task.
C	Contributing — shifting focus outward by helping others or doing something kind.
C	Comparisons — placing your current distress in perspective by comparing self to tougher times, or acknowledging resilience.
E	Emotions — intentionally evoking different, more soothing or uplifting emotions (joy, calm, energized).
P	Pushing Away — mentally setting distressing thoughts aside temporarily; giving yourself a "pause".
T	Thoughts — using mental distraction or structured thinking to shift your focus (doing math, reciting something, practicing a language).
S	Sensations — engaging the body / senses with intense sensory input (cold water, strong scents, texture, movement).

Each of these categories in the ACCEPTS toolkit can offer temporary reprieve. You get to choose which one(s) will be effective for you. You often will not need all of them, in any given moment, but it's nice to know there are lots of options to pull from.

Why ACCEPTS Works —> From Distress Survival to Wise Response

When emotions surge, our nervous system gets hijacked and out goes logical thinking. Thoughts get flooded, or go missing, impulsivity rises and overwhelm feels like a tsunami. In moments like these trying to reason with yourself or apply logic is typically not accessible.

What is needed is time + distraction. ACCEPTS offers just that. By throwing yourself into skills from one of those sections listed above, it gives your nervous system a moment to de-escalate, and buys you space to come out of the red zone and into a place where you can access more skills.

In short, ACCEPTS:

• Buys time. By engaging attention elsewhere via activity, sensation, or distraction ACCEPTS helps us avoid impulsive behaviors until things calm down.

• It stabilizes the nervous system. Engaging in tasks activates different emotions that can help bring down the intensity of the problematic ones.

• It shifts perspective. Comparisons, contributing, and even emotion-shifting help you access resilient, resourceful parts of yourself — parts that remember you can survive hard times and you DO have the skills to do something different.

• It preserves integrity. Instead of reacting out of overwhelm, which often leads to decisions we regret, ACCEPTS helps us respond with skillfulness.

ACCEPTS doesn’t “solve” the problem. It stabilizes you, so you can then return to what's needed with more clarity and your wise mind.

When to Use ACCEPTS (and When You Might Reach for Other Tools)

ACCEPTS is especially helpful when:

• You feel emotionally overwhelmed or dysregulated (anxiety, panic, rage, grief, dissociation, etc.)

• You are running the risk of making things worse or acting in a way that you will later regret.

• You need a quick, portable way to ground yourself — no props or setup required

However, there are times when your body needs more regulation than mental distraction can offer. For instance: racing heart, panic attacks, or intense physiological arousal.

That’s where tools like TIPP (Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation) come in. TIPP works directly with the body to bring down arousal, after which ACCEPTS can become more accessible. To learn more on TIPP, visit The Skills Podcast episode 6.

So if you find that ACCEPTS skills aren't hitting the mark, try one of the TIPP skills then come back to these techniques.

How to Build Your Personal ACCEPTS Plan

Here’s a simple template you can use to build a personalized, ready-to-use ACCEPTS plan.

Step 1: Create a table with the 7 ACCEPTS letters (as shown below). Step 2: For each letter, brainstorm 3–5 concrete strategies that feel accessible for you. Step 3: Keep the plan somewhere visible (phone note, journal, sticky on your desktop). Step 4: Rehearse use the plan in calm moments or low-stakes emotional discomfort, so it becomes familiar before crisis hits. Step 5: Use in crisis when needed.

Example ACCEPTS Table (customizable)

ACCEPTS Letter	My Go-To Practices
A – Activities	Walk my dog; doodle / free-write; clean kitchen; work on a project; lift weights
C – Contributing	Text a friend just to check in; offer help at work; hold the door open for someone; donate/declutter
C – Comparisons - or - gratitude	Recall a past challenge I survived; remember times I felt strong; think "this moment will pass” or "I can tolerate this". Write out a gratitude list.
E – Emotions	Listen to my favorite upbeat song; watch a funny reel; dance; look at photos that bring warmth or joy
P – Pushing Away	Visualize placing the problem in a box and closing it; say “not now — I’ll return to this later”; when thoughts show up say "no" to yourself
T – Thoughts	Count backwards from 100 by 7's; recite your favorite song lyrics; work a puzzle; plan out a mundane task (groceries, to-do list)
S – Sensations	Hold an ice cube; splash cold water on face; bite something sour; step outside and feel the air; put on a textured fabric (blanket, scarf)

Tips for using the plan:

• Sometimes you don’t need more than one - so try one category, assess and then add more as needed.

• Remember, the goal is to buy yourself sometimes and not make things worse.

• Use it before emotion snowballs, or at first signs of escalation.

• Over time, build fluency: the more familiar these feel, the easier they are to access under stress.

Myth-Busting: What ACCEPTS Is — and Isn’t

What ACCEPTS is

• A temporary set of tools for emotional crisis or overwhelm.

• A way to stabilize, ground, and gain emotional distance.

• A method to preserve capacity and prevent impulsive or reactive behavior.

What ACCEPTS is not

• A long-term solution or cure for underlying issues.

• A way to avoid or suppress feelings permanently.

• A substitute for processing, making repairs, boundary-setting, or problem-solving

In fact, many DBT users describe ACCEPTS (and similar crisis survival skills) as first-aid: you use them to get through the moment and then later, when things have cooled, you return to processing, reflection, more sustainable coping, or action.

Why ACCEPTS Matters

Last week I was working with one of my clients who is a founder, a parent and an over-all high achiever. We had this moment in our work where we both realized that a lot of the strategies we had been discussing required a lot of time to implement. Helping this particular individual make the time to prioritize the required learning and skills acquisition was valuable AND they needed tools that would work, right now. And people need both tools, the deeper inner work that takes time to develop and those easy to apply, rapid fire skills to help us navigate complex life stress. Using Distress Tolerance skills like ACCEPTS

• Honors busy lives: you don’t need hours, fancy tools, or a special setting to apply these.

• Gives agency: instead of just reacting, you're reminded that you have a choice to do something different, even if it's a micro movement.

• Builds resilience: repeated use doesn’t erase pain but helps you weather it more effectively and reduce the chaos spins.

Practical Example: How You Might Use ACCEPTS

Scenario: You’re launching a big project. Deadline pressure + interpersonal friction + looming burnout. You just read a tough email from your co-worker. Your chest tightens, thoughts flood, panic rises.

Without a skill: You draft an angry reply. You schedule 3 back-to-back calls. You skip lunch. Stress spirals.

With ACCEPTS:

1. You close your laptop & momentarily push away. “Not now.”

2. You go splash cold water on your face - > sensation change.

3. You send off a quick text to a friend -> contributing.

4. You make yourself a snack, talk a quick walk around the block while listening to calming music - > distracting with activities, emotions, thoughts.

5. Then you sit back down at your desk and choose to respond to the email.

   
   

That pause, that breath, that shift... that’s what ACCEPTS offers to us in these moments.

Pain, uncertainty, overwhelm, they’re part of the human terrain. We don’t always get to control them. But we can learn how to show up for them in ways that we can feel proud of. With tools like ACCEPTS, you remember that you are in control of how you respond and even in this moment, you can redirect, anchor, and then proceed forward. Give them a try and let us know what you think.

Want a deeper dive on this skill, with more examples? Check out The Skills Podcast Episode 7.