Distraction with ACCEPTS

A Psychoeducational Lesson on ACCEPTS

A Distress Tolerance Strategy in Dialectical Behavior Therapy

Distress tolerance is a fundamental component of Dialectical Behavior Therapy (DBT), a therapeutic approach developed by Marsha M. Linehan in the late 1980s. DBT was originally designed to help people with borderline personality disorder (BPD), but it has since been adapted to treat a variety of mental health issues. One of the key strategies used in DBT for managing distress is the ACCEPTS method. This acronym stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. ACCEPTS is particularly effective in helping individuals learn how to tolerate and survive crises without resorting to harmful behaviors. This article will explore each component of ACCEPTS, offering insights into how this method can be utilized in distress tolerance skills training.

Activities: Engage in Positive Actions

The first component of ACCEPTS encourages individuals to engage in activities that are positive or neutral. This could include hobbies, exercise, or any task that requires concentration and provides a sense of achievement. The goal is to distract oneself from distressing thoughts or emotions by being actively involved in something else.

Activities:

  • Focus attention on a task you need to get done.
  • Rent movies; watch TV.
  • Clean a room in your house.
  • Find an event to go to.
  • Play computer games.
  • Go walking.
  • Exercise.
  • Surf the Internet.
  • Write e-mails.
  • Play sports.
  • Go out for a meal or eat a favorite food.
  • Call or go out with a friend.
  • Listen to music; download music.
  • Build something.
  • Spend time with your children.
  • Play cards.
  • Read magazines, books, comics
  • Do crossword puzzles or Sudoku.

Contributing: Help Others to Help Yourself

Contributing involves doing something that benefits others. This might include volunteering, helping a friend, or even smaller acts of kindness like holding a door open for someone. By focusing on others, individuals can step outside their own distress and gain a sense of purpose and self-worth.

  • Find volunteer work to do.
  • Help a friend or family member.
  • Surprise someone with something nice (a card, a favor, a hug).
  • Give away things you don’t need.
  • Call or send an instant message encouraging someone or just saying hi.
  • Make something nice for someone else.
  • Do something thoughtful.
  • Random act of kindness from internal motivation

Comparisons: Gain Perspective by Comparing

This part of the acronym suggests comparing oneself to people who are in a worse situation or recalling past personal hardships that have been overcome. The purpose is not to minimize one’s own pain but to gain perspective and appreciate the progress and strengths one has.

  • Compare how you are feeling now to a time when you felt different.
  • Think about people coping the same as you or less well than you.
  • Compare yourself to those less fortunate.
  • Watch reality shows about others’ troubles; read about disasters, others’ suffering.

Emotions: Evoke Opposite Emotions

Engaging in activities that evoke the opposite emotion to what one is currently experiencing can be beneficial. For instance, if someone is feeling sad, they might watch a comedy. This helps in altering emotional states and provides a break from ongoing distress.

  • Read emotional books or stories, old letters.
  • Watch emotional TV shows; go to emotional movies.
  • Listen to emotional music. (Be sure the event creates different emotions.)
  • Ideas: Scary movies, joke books, comedies, funny records, religious music, soothing music or music that fires you up, going to a store and reading funny greeting cards.

Pushing Away: Create a Mental Barrier

Pushing away involves deliberately putting aside distressing thoughts and feelings. This can be temporary, like deciding not to think about a problem until a later time, which allows for a period of relief from distress.

  • Un-blend from a protector part; or, if you are unable to un-blend…
  • Push the situation away by leaving it for a while.
  • Leave the situation mentally.
  • Build an imaginary wall between yourself and the situation.
  • Block thoughts and images from your mind.
  • Notice ruminating: Yell “No!”
  • Refuse to think about the painful situations.
  • Put the pain on a shelf.
  • Box it up and put it away for a while.
  • Deny the problem for the moment.

Thoughts: Change Your Thoughts

This component focuses on shifting one’s thought patterns. Engaging in activities that require concentration, like solving puzzles or reading, can redirect the focus from distressing thoughts to more neutral or engaging ones.

  • Count to 10; count colors in a painting or poster or out the window; count anything.
  • Repeat words to a song in your mind.
  • Work puzzles.
  • Watch TV or read.

Sensations: Use Physical Sensations

Finally, intense physical sensations can serve as powerful distractions. This could involve holding an ice cube, taking a hot shower, or engaging in intense exercise. The physical sensation demands attention, thereby providing a diversion from emotional pain.

  • Squeeze a rubber ball very hard.
  • Listen to very loud music.
  • Hold ice in your hand or mouth.
  • Go out in the rain or snow.
  • Take a hot or cold shower.
  • Use cold on your face to change your body temperature (the T in the TIPP skills)

Conclusion

The ACCEPTS method is a versatile and practical tool within DBT that offers a structured way to manage distress. It is important to remember that while these strategies are effective for coping with immediate distress, they are not solutions to underlying problems. In DBT, ACCEPTS is used alongside other skills like emotion regulation and mindfulness to create a comprehensive approach to mental health and wellness. As with any therapeutic technique, the effectiveness of ACCEPTS varies from person to person, and it is often most beneficial when practiced under the guidance of a trained mental health professional.

This lesson has provided a brief overview of the ACCEPTS method within DBT for distress tolerance. For those interested in further exploring DBT and its applications, it is recommended to seek resources and professionals trained in this therapeutic approach. As always, the journey towards mental wellness is personal and unique, and strategies like ACCEPTS can be valuable tools in navigating this path.