ACCEPTS: The DBT Distress Tolerance Skill for Getting Through a Hard Moment
ACCEPTS is a DBT distress tolerance skill: seven ways to distract yourself on purpose, for a limited time, from a painful situation you cannot change right now. Build your own ACCEPTS plan below and download it.
Reviewed byMichael Callans, MSWAbout this tool
ACCEPTS is a distress tolerance skill from dialectical behavior therapy (DBT), an acronym that Marsha Linehan uses to list seven ways of distracting yourself from a painful situation that you cannot change in the moment. The letters stand for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts and Sensations. Linehan's handouts often call it Wise Mind ACCEPTS, a reminder that the distraction is chosen from a settled state rather than grabbed in a panic. Its purpose is narrow and useful: to get you through a crisis without making it worse, so that you can deal with the problem when you are able to think.
The skill sits inside the distress tolerance module of DBT, one of the four skills modules alongside mindfulness, emotion regulation and interpersonal effectiveness. Distress tolerance is split into two halves. The crisis survival skills, which include STOP, pros and cons, TIPP, ACCEPTS, self-soothing with the five senses and IMPROVE the moment, are for surviving an acute spike of emotion. The reality acceptance skills, which include radical acceptance, turning the mind and willingness, are for the longer work of living with what cannot be changed. ACCEPTS is a crisis survival skill: short-term by design.
Here is what each letter asks of you. Activities means doing something that takes attention: cleaning a room, a walk, a game, cooking, exercise. Contributing means doing something for someone else, a message to a friend who is struggling, a small favor, volunteering, which pulls attention outward and often shifts mood. Comparisons means comparing your situation to a time you coped less well, or to people coping with the same or worse, in order to see your current coping differently. Emotions means deliberately generating a different emotion: a funny film, upbeat music, a scary book, anything that crowds out the one you are drowning in. Pushing away means mentally putting the situation on a shelf for a while, building an imaginary wall between you and it, with the explicit intention of taking it down later. Thoughts means filling your mind with other thoughts: counting, puzzles, reciting lyrics, reading something dense. Sensations means intense but safe physical input: ice in the hand, a hot or cold shower, loud music, a very sour sweet.
Distraction gets a bad name in mental health, and the objection is fair when distraction is the whole strategy. ACCEPTS is different in three ways. It is deliberate: you choose it, knowing what you are stepping away from. It is time-limited: you decide in advance how long the distraction lasts. And it is conditional: it is for situations you cannot act on effectively right now, the problem that cannot be solved at three in the morning, the message that must wait until the person is sober, the result that will not arrive until Monday. Avoidance is unplanned and open-ended, and it grows the problem. Deliberate distraction parks the problem and comes back for it.
The Comparisons step needs care, and Linehan's own handouts are more nuanced than the acronym suggests. Used well, it is a perspective shift: remembering that you have survived worse, or that others carry similar loads, can make the present moment feel survivable. Used badly, it tips into minimizing, the inner voice that says other people have it worse so you have no right to feel this. That is invalidation, which DBT treats as a cause of distress rather than a cure for it, and it tends to add shame on top of the original pain. If Comparisons makes you feel smaller rather than steadier, drop it. The acronym offers seven doors; you do not have to walk through all of them.
DBT as a full treatment has randomized trial support for borderline personality disorder and for reducing suicidal and self-harming behavior, going back to Linehan's 1991 trial, and a 2015 component analysis by Linehan and colleagues, in women with borderline personality disorder and recent suicidal or self-harming behavior, found that DBT skills training combined with case management performed as well as full DBT on several outcomes, including suicide attempts and suicidal ideation, while every arm used the DBT suicide risk assessment and management protocol and standard DBT kept more people in treatment. That is evidence for an intensive, year-long program delivered by trained clinicians, not for a skills list. Research on emotion-regulation choice by Sheppes, Gross and colleagues found that people tend to choose distraction over reappraisal when a negative situation is intense; that study measured which strategy people pick, not how well distraction works in a real crisis. What the evidence does not show is the effect of ACCEPTS in isolation; it has not been tested as a stand-alone skill, and the broader literature warns that distraction used chronically can prevent a problem from ever being processed.
The skill suits anyone who hits moments of emotion so intense that reasoning is temporarily offline: after a breakup text, during a wait for test results, in the hours after an argument. It is less suitable when the problem can be solved now, when the distraction you reach for is itself the problem, such as drinking, gambling or endless scrolling, or when what you are feeling needs to be felt and processed, such as grief. People who dissociate should choose Sensations carefully and prefer grounding that keeps them oriented rather than input that takes them further away.
Common mistakes: using ACCEPTS to dodge a conversation that is overdue; expecting it to fix the feeling rather than ride it out; choosing passive options like scrolling that do not actually occupy attention; picking a Sensation that causes harm, which is self-harm, not a skill; and making the plan for the first time in the middle of a crisis. The worksheet on this page exists to prevent the last one. Two concrete options per letter, chosen while calm, is a plan you can reach for at 2am.
If you find yourself needing crisis survival skills most days, or if the moments you are trying to survive involve urges to hurt yourself, that is a sign the underlying problem needs a clinician, not a better distraction list. A therapist trained in DBT can teach the whole module, including the acceptance skills that ACCEPTS is meant to make room for. The Psychology.com therapist directory lets you search by specialty, including dialectical behavior therapy, at no cost. On this site, TIPP Skills and the DBT Distress Tolerance page cover the body-based crisis skills, and the Radical Acceptance Worksheet covers the other half of the module.
References
- Linehan MM. DBT Skills Training Manual. 2nd ed. Guilford Press; 2014.
- Linehan MM. DBT Skills Training Handouts and Worksheets. 2nd ed. Guilford Press; 2014.
- Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press; 1993.
- Linehan MM, Korslund KE, Harned MS, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015;72(5):475-482.
- Sheppes G, Scheibe S, Suri G, Gross JJ. Emotion-regulation choice. Psychological Science. 2011;22(11):1391-1396.
Cite this source
Psychology.com. (2026, October 19). ACCEPTS (DBT Distraction Skill). Psychology.com. https://psychology.com/tools/accepts-dbt
ACCEPTS (DBT Distraction Skill) FAQ
What does ACCEPTS stand for in DBT?
ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts and Sensations. It is Marsha Linehan's acronym for seven ways to distract yourself, on purpose and for a limited time, from a painful situation you cannot change right now. Each letter is a category rather than a single technique: Activities might be a walk or a game, Sensations might be ice in the hand or a cold shower. Linehan's handouts often label it Wise Mind ACCEPTS, meaning the distraction is chosen from a settled state rather than grabbed in panic.
Isn't ACCEPTS just avoidance?
It can become avoidance if it is used badly, which is why DBT frames it carefully. Avoidance is unplanned, open-ended and used for problems you could act on. ACCEPTS is deliberate, time-limited and reserved for problems you cannot act on effectively right now, such as a result that will not come until Monday or a conversation that must wait until everyone is calm. The skill includes a return: you decide in advance when you will come back to the problem. If you notice you keep extending the distraction, that is the signal it has slipped into avoidance.
What is the difference between ACCEPTS and self-soothe?
Both are DBT crisis survival skills, but they work differently. ACCEPTS distracts: it moves your attention away from the pain onto something else, whether an activity, a task for someone else or an intense sensation. Self-soothing with the five senses comforts: it stays with you in the moment and makes it gentler through pleasant sights, sounds, smells, tastes and textures. Many people use them in sequence, distracting first to get through the peak and then soothing to settle. IMPROVE the moment is a third sibling, which uses imagery, meaning, prayer, relaxation and similar tools.
When should I use ACCEPTS?
Use it when three things are true: the emotion is intense enough that reasoning is not working, you cannot act usefully on the problem right now, and acting on the urge you have would make things worse. The classic examples are the hours after an argument, a wait for medical results, or the night before a difficult conversation. It is not the right tool when the problem can be solved now, when what you feel is grief that needs to be felt, or when the distraction you reach for is itself a problem, such as drinking or gambling.
The Comparisons step makes me feel worse. Am I doing it wrong?
Probably not; this is the step that most often misfires. Comparisons is meant to be a perspective shift, remembering that you have survived worse or that others manage similar loads, so that the present feels survivable. It goes wrong when it turns into a verdict: other people have it worse, so I have no right to feel this. That is minimizing, and DBT treats self-invalidation as a source of distress, not a remedy. If the step adds shame instead of steadiness, skip it. The acronym offers seven options and nobody needs all seven.
Does ACCEPTS work for anxiety and panic attacks?
It can take the edge off an anxiety spike, particularly Sensations, which overlaps with the body-based TIPP skills, and Thoughts, which occupies the mind. Research on emotion-regulation choice suggests people tend to pick distraction over reappraisal when emotion is very high, which fits how the skill is meant to be used, though that research measured preference rather than how well distraction works. For panic specifically, distraction is a short-term aid rather than a treatment; the treatments with the strongest evidence, such as cognitive behavioral therapy with interoceptive exposure, work by approaching the sensations rather than escaping them. If panic is frequent, use ACCEPTS to get through the moment and a therapist to treat the cause.