Managing Distress With the DBT Skill “ACCEPTS”

In DBT skills class this week we went through the Distress Tolerance distraction-based skill of 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. You are becoming overwhelmed by your emotions to the point it is not effective to go with them.
  2. You are in a situation where it is inappropriate to fully experience distressing emotions.
  3. 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.)

Here are the 7 Wise Mind ACCEPTS skills:

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.


*I personally do not like the comparisons skill as I feel every moment of pain is subjective – it is MY current internal experience – and therefore cannot be compared to that of anyone else, nor my own self at a different time. I feel invalidated when I try and use this skill, so it is not one I go for, personally. It does however work for some people. Just make sure not to invalidate yourself or your pain.

Advertisements

6 thoughts on “Managing Distress With the DBT Skill “ACCEPTS”

  1. I appreciate your DBT Skills Group posts SO MUCH, you have no idea how grateful I am.

    I’ve been on the NHS waiting list for DBT for over 2 years. I feel like it’s the only thing left that I haven’t tried that might help me have at least half a chance of living decent life with BPD, bipolar and a handful of other illnesses. So your DBT skills posts help me immeasurably.

    Actually your whole blog gives me a sense of hope, and I can’t thank you enough. I wish you all the best of luck in your recovery and am really rooting for you 🙂 xxx

    Liked by 1 person

    • This is an especially heartwarming message, and makes me happy and motivated to keep posting. Thanks so much. I am so sorry you’ve been on that waiting list for so long, the lack of resources makes me so angry and sad… I really hope that you get the support and help you need ASAP. I never thought things could be different but they are changing, slowly but surely… X

      Liked by 1 person

  2. This post is really helpful, but people need to get it mind that it doesn’t work right aways – it takes time (like everything in therapy).
    And about comparision – I feel the same, even though my therapist told me that I need more compasion for others (I understood that as ‘you’re a selfish bitch’ but ok :D) to actually use this comparision skill – but let’s be real, it works almost never with BPD people.

    Liked by 1 person

    • Well the ACCEPTS skills are meant to help pretty short term, that’s why they are crisis survival skills! However for me if I’m actually in a crisis I tend to go for TIPP, then ACCEPTS stuff as a follow-up.
      Totally agree about comparisons!! Thanks for commenting 🙂

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s