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DBT · Distress Tolerance

ACCEPTS

DBT distress tolerance — 7 ways to ride out a wave

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Some pain can be solved. Some has to be ridden out. ACCEPTS is a menu of distractions that help you wait without making things worse.

A
Activities

Do something that takes your full attention. The mind cannot hold two things at once.

Walk, clean, cook, puzzle, run errand, build something.

C
Contributing

Step out of yourself by offering something to someone else.

Text a friend a compliment, hold a door, volunteer 30 minutes.

C
Comparisons

Compare to a harder moment you've already survived — or to those facing more.

“I made it through ___.” Not to dismiss the pain — to remember you've done it before.

E
Emotions

Generate a different emotion intentionally. Watch a comedy when sad. Listen to angry music when scared.

A funny video, a sad song, a fierce playlist, a sweet memory.

P
Push Away

Mentally place the situation in a box and put it on a shelf. Visit it later, when you can.

“I am setting this down for one hour.” Then actually leave the room.

T
Thoughts

Crowd out the distressing thought with something the mind has to work at.

Count backward by 7 from 100. Recite lyrics. Name 5 things you see.

S
Sensations

Use a strong, safe sensation to anchor in the body. Sharp but harmless.

Ice cube in hand, hot shower, sour candy, strong scent, music turned up.

My personal ACCEPTS list — what works for me

“Distraction is not avoidance. It's how we make it to the other side.”

References & further reading

Conceptual background and further reading, not validation of this handout. Named instruments and methods belong to their original authors; custom prompts and trackers are not validated versions of those instruments.

  • Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.
© 2026 TherapistAssist · For clinical use · Not a substitute for assessment
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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. 1
    Teach the mnemonic

    Walk the seven letters with a real example the client brought in — abstract lists don't stick.

  2. 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. 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. 4
    Pre-commit a crisis order

    Circle the top 3 the client will try first, in order, when distress hits 7+/10.

  5. 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.