About this worksheet
ACCEPTS is Marsha Linehan's mnemonic for the seven distress-tolerance moves that get a client through a crisis without making it worse. Activities, Contributing, Comparisons, opposite Emotions, Push away, Thoughts, and Sensations — each one is a different lever to pull when the affect is too high for problem-solving and the urge is to use, cut, binge, rage, or otherwise do something the client will regret in an hour. The point isn't to feel better; the point is to buy time. This worksheet lays out all seven categories on one page with room for the client to pre-populate options that actually work for them (generic ACCEPTS handouts fail because the client can't remember any of them at 11pm in the crisis). Use it as homework after teaching the skill, as an in-session personalization exercise, and as a fold-and-carry crisis card for clients with self-harm urges, cravings, or panic.
When to use it
- Distress-tolerance building in DBT — early skills training, standard curriculum position.
- Crisis moments where the urge is behavioral (self-harm, using, binge, blow-up).
- Between sessions for clients with high emotional reactivity and short crisis half-lives.
- Not a substitute for a full safety plan when suicidal ideation is active — pair with Stanley-Brown safety planning.
How to use it
- 1
Teach the mnemonic
Walk the seven letters with a real example the client brought in — abstract lists don't stick.
- 2
Personalize each letter
Client writes 2–3 of their own options per category. Generic answers ('call a friend') don't survive a 3am urge.
- 3
Rank by accessibility
Mark which options work at home vs public vs in-car vs middle of the night. Availability matters more than cleverness.
- 4
Pre-commit a crisis order
Circle the top 3 the client will try first, in order, when distress hits 7+/10.
- 5
Trial and debrief
Client tries the top 3 the next time distress spikes; debrief which worked, which didn't, and why in session.
Frequently asked questions
What does ACCEPTS stand for in DBT?+
Activities, Contributing, Comparisons, opposite Emotions, Push away, Thoughts, Sensations — the seven distress-tolerance categories in Marsha Linehan's standard DBT skills curriculum.
When should I teach ACCEPTS versus TIPP?+
TIPP is for extreme arousal — the body-first reset when the client is at 8+/10 and can't think. ACCEPTS is for the middle band, 5–7/10, where distraction and re-engagement still work. Teach TIPP first, then ACCEPTS.
Is ACCEPTS just distraction?+
It includes distraction (Activities, Push away), but also cognitive shifts (Comparisons, Thoughts) and somatic anchors (Sensations). The full skill is broader than 'go take a walk.'
Can I use ACCEPTS with adolescents?+
Yes — it's a core skill in DBT-A. Keep the personalization short and concrete, and use categories the teen can actually access without permission (no 'go for a drive').
Is this worksheet free?+
Yes. Free printable PDF for clinicians. Sign in to TherapistAssist to send it as a secure client link or add your practice name.
Worksheet — ACCEPTS — provided by TherapistAssist for clinical use. Not a substitute for assessment or treatment.
