The ACCEPTS Skills: What to Do When You Can't Fix It Right Now

ACCEPTS is a DBT distress tolerance acronym for seven ways to get through a painful moment without making it worse: Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. Each works by shifting your attention away from the distress until the intensity drops to a level you can think from. These are deliberately short-term skills — they don't solve the problem, and they aren't meant to.

That's where most of the frustration with distress tolerance comes from. You're not being handed a fix — you're being handed a way to not make things worse while a fix isn't available.

What Distress Tolerance Is For

Marsha Linehan, who developed dialectical behavior therapy, separated the skills into ones that change a situation and ones that get you through it. ACCEPTS is firmly in the second group, and its job is preventing the second injury. A painful moment is one problem. The text you send at 2am, the drink, the thing you say to your partner — that's a second problem stacked on the first.

So the bar is low on purpose. You didn't have to feel better — only to reach the other side of the hour without adding to the pile.

The Seven ACCEPTS Skills

A — Activities

Do something that occupies enough of your attention that there isn't much left over. The key word is enough — folding laundry usually isn't, because your mind stays free to circle. What works has a demand attached: a recipe you haven't made before, a video game with a fail state, a call to a talkative relative.

C — Contributing

Do something for someone else. Not as a moral exercise — attention aimed outward isn't aimed at your own distress. Text a friend and ask how their interview went. Walk the neighbor's dog. Small and specific beats large and vague, which never gets done at 11pm.

C — Comparisons

The one that backfires. See the section below.

E — Emotions (opposite emotion)

Deliberately generate a different emotion than the one you're in. A comedy you've already seen and know is funny. Music that reliably shifts you — not music that matches the mood, which deepens it. The requirement is that you already know it works; mid-crisis is no time to try an unfamiliar album and hope.

P — Pushing away

Set the problem down on purpose, for a set period. Also below.

T — Thoughts

Fill your mind with something that leaves no room. Count backwards from 300 by sevens. Name every state capital. Recite song lyrics. Counting isn't soothing — it's that you can't do it and catastrophize at once.

S — Sensations

Give your body a strong, safe physical input. Hold an ice cube. Cold water on your face. Something sour — a lemon wedge, strong mint. Loud music through headphones. Intense sensation takes your attention involuntarily, which is why it works when nothing chosen does.

Comparisons: The One That Goes Wrong

Comparisons is routinely taught, and heard, as other people have it worse, so pull yourself together. If that's how it reads to you, you're not misreading the skill — you're correctly identifying how it often gets used.

The intended use is narrower and points inward. Compare yourself to your own past — a time you were in something similar and got out the other side. Last February I thought I couldn't do this either, and I did. That's evidence about your own capability, not a ranking of suffering.

Skip it entirely if you already minimize your own pain, if you grew up being told other people had it worse, or if it produces guilt rather than perspective. Six other skills work without it.

Pushing Away Is Not Avoidance

Pushing away means deliberately shelving something for a defined stretch of time. Picture the problem in a box on a high shelf, and tell yourself explicitly: I'm not thinking about this until tomorrow at 10. Then tomorrow at 10, you take it down.

That last part is the whole distinction. Deliberate, time-limited, and you come back — that's the skill. Indefinite, and you never come back — that's avoidance, and it grows the problem quietly. If you can say when you'll pick it up again, you're pushing away. If the answer has been "later" for weeks, you're not.

Build Your List Before You Need It

Here's what nobody tells you about crisis skills: you will not remember them in a crisis. The acronym that seemed obvious in a calm moment evaporates when your heart rate is up. That's what high distress does to working memory, which is why the real work happens beforehand. Write your own list somewhere you'll find it fast:

1. Fill in two or three specific things that work for you under each letter. Not "do an activity" — make the lemon pasta, reorganize the bookshelf.
2. Cross off anything that doesn't apply. If Comparisons is a trap, cut it.
3. Put it where you can reach it in ten seconds. A note at the top of your phone beats a notebook in another room.
4. Add to it whenever something works, and mark what didn't.

The DBT ACCEPTS Skills Workbook is built for exactly this — each of the seven with concrete options and space to build your own list, so you're choosing from something written down rather than inventing options mid-crisis. If what you're getting through is a longer, flatter stretch of unhappiness rather than an acute spike, Navigating Emotional Tides works at that pace instead.

The Honest Limitation

Distress tolerance is not a life plan. If you're running ACCEPTS every day, the skill is doing its job — you're getting through — but something underneath isn't being addressed. Daily crisis survival is information. It usually means the situation needs to change, or that an emotion arriving that often deserves examination rather than management.

Two directions to take that. If the emotion keeps arriving out of proportion to what's happening, Check the Facts tests whether it fits the situation. If the distress is about things you can't do anything about, the circle of control sorts what's yours to act on from what isn't. And if what drives the spikes is persistent worry rather than a crisis, read about worry versus an anxiety disorder.

And plainly: if you're having thoughts of harming yourself, distress tolerance skills are not a substitute for contacting a clinician or a crisis line. Use them to get through the next few minutes, then call.

The Bottom Line

ACCEPTS is seven short-term ways to get through a painful moment without making it worse. It prevents the second problem you create while escaping the first; it doesn't fix the first. Write your own version while you're calm, skip the letters that don't suit you, and treat daily use as a signal that something needs attention.

What the skills buy is time, and what's often on the other side of it is acceptance — unreachable at full intensity, possible once the volume drops. ACCEPTS gets you to where radical acceptance is available at all. That isn't avoiding the harder skill; it's sequencing.

For clinicians: if you're teaching these skills in a group, I've written a separate guide to running a DBT skills group in private practice.

— Nina-Lucia Rodriguez, LMHC

This article is educational and is not a substitute for individual mental health care. If you're in crisis or having thoughts of harming yourself, please contact a mental health professional or a crisis line rather than relying on skills alone.