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ACCEPTS Skill DBT

During dialectical behavior therapy (DBT), “distress tolerance” refers to skills and proper tools for coping with uncomfortable emotions. One such skillfulness is represented by the acronym “ACCEPTS.” ACCEPTS DBT is a 6-skill guide to navigating emotional problems.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based borderline personality disorder treatment (BPD). The patient populations for which DBT has the most empirical support include parasuicidal women with borderline personality disorder (BPD). Still, there have been promising findings for patients with BPD and substance use disorders (SUDs), persons who meet the criteria for binge-eating disorder, and depressed elderly patients. Although DBT has many similarities with other cognitive-behavioral therapy approaches, several critical and unique elements must be in place for the treatment to constitute DBT.

Some of these elements include:

  • Serving the five functions of treatment
  • The biosocial theory focuses on emotions in the treatment
  • A consistent dialectical philosophy, and
  • Mindfulness and acceptance-oriented interventions, such as ACCEPTS DBT.

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DBT ACCEPTS Acronym

Distress Tolerance skills are a set of DBT techniques that teach you how to deal with tough emotions and circumstances and tolerate (deal with, sit with, and accept) the things you can’t change immediately. Extreme emotions sometimes result in inefficient behavior. You might not be able to alter the stressful circumstance you find yourself in, but you can alter how you feel. Distress Tolerance abilities are designed to improve the effectiveness of your reaction to distress.

A Key Distracting Skill is Wise Mind ACCEPTS. This Acronym Stands For:

  • Activities
  • Contributing
  • Comparisons
  • Emotions
  • Pushing Away
  • Thoughts
  • Sensations
Accepts DBT
DBT ACCEPTS is designed to keep your emotions manageable until you can resolve the problem.
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Activities

Engage in something to distract yourself from your situation. Make your decision(s) mindfully. Lose yourself in it and try not to think about your distress again until you have finished your activities. Cook, garden, go fishing, go shopping, watch a DVD, go for a walk, play a sport. The list goes on and on. The more energetic your activity, the simpler it will be to forget your discomfort temporarily.

List your upcoming activities and post them on your refrigerator to make them easy to find. Make a list of tried activities that always work and some new ones to try.

Contributing

By focusing on someone else, contributing allows you to avoid thinking about your suffering. Volunteer, watch children so a friend can go out, show kindness or surprise someone, or get in touch with a friend to check in or listen to them vent.

Contributing will help you forget about your troubles and make you feel better. You don’t have to tackle a tremendous task or end world hunger. Simply being courteous to the cashier will help lift both of your spirits.

Comparisons

Compare your current state to where you were one, two, or five years ago when you weren’t coping. Not to minimize the suffering you are currently experiencing but to serve as a reminder to yourself that things have been worse. This is useful to some people but not to others. Just follow your plan.

Emotions

Develop another emotion to divert from the first. Read a moving book, see a movie, or listen to a touching song. You must read, watch, or listen to something that evokes an emotion other than the one you are experiencing for this to work. Watch a comedy if you’re depressed. Observe a disturbing film. Play amusing music. If you are depressed or enraged, watch a goofy or humorous film and start laughing. You have altered your emotion and position as a result of doing so.

Keep a collection of upbeat music or a list of your favorite TV shows to watch when you’re feeling depressed. Having these things in writing will save you time and effort when you’re in a difficult situation.

Accepts DBT
ACCEPTS DBT is intended to help distract us and get us through difficult emotional situations one moment at a time.

Pushing Away

Leave a difficult scenario in your mind for a while to push it away. This skill works best in situations troubling you but that you can’t currently resolve. It shouldn’t be utilized to avoid a problem that can be fixed. Stop thinking about the circumstance. Tell it to stop whenever it arises, or replace it with something else, preferably something more pleasant. Refuse to consider it. Try placing it on a shelf or in a box to contain the pain and get it out of the way. Consider locking it up and putting it on a shelf in a closet. You can return to it later, but it should be currently inaccessible.

These are all methods to help you take a break from experiencing discomfort. The difficult situation hasn’t been handled, but it has been placed on hold for a bit so that you can take a breather and try to live some of your life without it.

Thoughts

The idea behind “Thoughts” is you can only properly concentrate on one subject at a time. If you’re preoccupied with thinking about something else, you can’t be thinking about the thing that’s upsetting you.

To maintain your attention on counting, you can, for instance, count to ten or the tiles on a floor, the panes of a window, or the stars in the night sky. You can name things around you in a similar way. These are wonderful ones to utilize in a last-minute emergency when you need to pull anything from your toolbox swiftly. You only need what is already in your immediate environment.

Focus your whole attention on naming or counting to prevent the painful thoughts from returning swiftly. But that’s hard to do, so don’t give up if your thoughts wander. As soon as you notice the difference, gently nudge it back on course.

Sensations

“Sensations” is the last skill in ACCEPTS. A powerful physical stimulus might break your connection to your discomfort and cause you to get distracted. This is an excellent technique if your despair leads to self-destructive actions. You might listen to loud music, take a hot or cold shower, swim in extremely cold water, hold ice in your hand or apply it to the back of your neck. After attempting one of these exercises, you might want to go on to another ACCEPTS that operates differently.

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Explore More DBT Skills

A fundamental ability for distress tolerance is “IMPROVE the Moment.” There are several different skills involved, one for each letter of IMPROVE. Every single one is a habit that might make you feel better. You can add these skills to your DBT radical acceptance worksheet.

IMPROVE stands for:

  • Imagery
  • create Meaning
  • Prayer
  • Relaxation
  • One Thing in the Moment
  • Vacation
  • Encouragement
  • Imagery: You can imagine yourself in a setting or environment distinct from the one you are now in. In a sense, even if you can’t physically escape the environment, you can still leave emotionally. You can run away to a secure location or visualize the scenario playing out the way you want it to.
  • create Meaning: Changing our sentiments by changing how we think about ourselves and our circumstances is one of the ways to improve the moment. How we perceive ourselves in circumstances and environments greatly influences how we feel. While it sometimes requires effort and time, doing this can be incredibly beneficial and consoling in a trying time.
  • The word “Prayer” is the P in “IMPROVE”: You can pray to God, another deity, a higher power, or even to your Wise Mind in this way. Prayer has the power to ease severe distress or improve your ability to handle it.
  • Relaxation: We can use relaxation and stress-reduction techniques to help us feel better right now. Many of us are uptight, and when we’re upset, we get much tenser. Relaxation modifies that reaction. Instead of resisting or pushing reality away, the idea is to accept it with the body. The mind and body are intertwined. Our mind is also relaxed when our body is.
  • One Thing in the Moment is the same as One-mindfully or Mindfulness. It means focusing on the one thing you are doing right now, in the present moment. This can be very helpful if you are in a distressing situation or a crisis. It can give you some time to settle down and calm down.
  • Vacation: A short break from your circumstances might make you feel better. You don’t have to pack your bags, book a flight, and stay at a hotel for it to be a real vacation. Go for it if you can pull that off. However, there are methods of vacation practice that are far more widely available.
    • Try taking a mini-vacation. Shut your office door to get a moment to yourself. Lie on the couch with a pillow or a mask over your eyes. Take your lunch to the park. Take a walk around the block. Make some space between you and your situation.
  • Encouragement: Encouragement is the letter E. This ability involves speaking positively to yourself. The way we communicate with ourselves has a big impact on our moods. When we’re upset, we tend to talk negatively to ourselves. Having some uplifting remarks ready to counteract such pessimistic ideas is crucial.
ACCEPTS DBT
You can create a self-help ACCEPTS worksheet DBT or a DBT Radical Acceptance by journaling the different DBT skills.

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Radical Acceptance DBT PDF

RADICAL ACCEPTANCE is the skill of accepting the things you cannot change. Radical acceptance is when you stop fighting reality, stop reacting with impulsive or destructive behaviors when things aren’t going as you want them to, and let go of the bitterness that may be keeping you entangled in a cycle of despair.

Radical means all the way, complete and total. Consider one thing in your life that you need to accept radically: a situation or challenge. Record or journal them into your DBT ACCEPTS pdf. Download the Accepts Skill DBT pdf (Radical Acceptance DBT pdf) below:

Download the DBT Radical Acceptance pdf or DBT ACCEPTS skills pdf and try to apply it in your daily life.

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DBT Therapy

DBT is a comprehensive treatment program consisting of individual therapy, DBT group therapy, and a therapist consultation team. In this way, DBT is a program of treatment rather than a single treatment method conducted by a practitioner in isolation. Often, clinicians are interested in applying DBT but find the prospect of implementing such a comprehensive treatment daunting. In this case, it is important to remember that the most critical element of any DBT program is whether it addresses the five key treatment functions.

Although the standard package of DBT has the most empirical support, different settings and circumstances may necessitate innovative and creative applications of DBT. In all cases, however, any adaptation of DBT must fulfill the following five functions:

Function #1: Enhancing capabilities. Within DBT, the assumption is that patients with BPD either lack or need to improve several important life skills, including those that involve:

  • Regulating emotions (emotion regulation skills)
  • Paying attention to the experience of the present moment and regulating attention (mindfulness skills)
  • Effectively navigating interpersonal situations (interpersonal effectiveness), and
  • Tolerating distress and surviving crises without making situations worse (distress tolerance skills).

Function #2: Generalizing capabilities. If the skills learned in therapy sessions do not transfer to patients’ daily lives, then it would be difficult to say that therapy was successful. As a result, a second critical function of DBT involves generalizing treatment gains to the patient’s natural environment. This function is accomplished in skills training by providing homework assignments to practice skills and troubleshooting regarding how to improve upon skills practice. In individual therapy sessions, therapists help patients apply new skills in their daily lives and often have patients practice or apply skillful behaviors in sessions. In addition, the therapist is available by phone between sessions to help the patient apply skills when they are most needed (e.g., in a crisis).

Function #3: Improving motivation and reducing dysfunctional behaviors. The third function of DBT involves improving patients’ motivation to change and reducing behaviors inconsistent with a life worth living. This function is primarily accomplished in individual therapy. Each week, the therapist has the patient complete a self-monitoring form (called a “diary card”) on which he or she tracks various treatment targets (e.g., self-harm, suicide attempts, emotional misery).

The therapist uses this diary card to prioritize session time, giving behaviors that threaten the patient’s life (e.g., suicidal or self-injurious behaviors) highest priority, followed by behaviors that interfere with therapy (e.g., absence, lateness, noncollaborative behavior), and behaviors that interfere with the patient’s quality of life (e.g., severe problems in living or unemployment.)

Function #4: Enhancing and maintaining therapist capabilities and motivation. Another important function of DBT involves maintaining the motivation and skills of the therapists who treat patients with BPD. Although helping multiproblematic BPD patients can be stimulating and rewarding, these patients also engage in a potent mix of behaviors that can tax the coping resources, competencies, and resolve of their treatment providers (i.e., suicide attempts, repeated suicidal crises, behaviors that interfere with therapy).

As a result, one essential ingredient of an effective treatment for BPD patients is a system of providing support, validation, continued training and skill-building, feedback, and encouragement to therapists.

Function #5: Structuring the environment. A fourth important function of DBT involves structuring the environment that reinforces effective behavior/progress and does not reinforce maladaptive or problematic behavior. Often, this involves structuring the treatment to most effectively promote progress. In DBT, the individual therapist is the primary therapist and is “in charge” of the treatment team. He or she ensures that all of the elements of effective treatment are in place and that all of these functions are met.

ACCEPTS DBT
DBT Radical Acceptance is a distress tolerance skill designed to keep pain from turning into suffering.

 In DBT, several interventions and skills are geared toward conveying acceptance of the patient and helping the patient accept him or herself, others, and the world. One such intervention is mindfulness. In DBT, mindfulness skills help patients attend to what is happening in the present. Some of the mindfulness skills involve attending to and nonjudgmentally observing the current experience, describing the facts of the current experience or situation, and fully participating in the activity/experience of the present while attending to one thing at a time (“one-mindfully”) and focusing on effective, skillful behavior. Therapists teach patients mindfulness skills in skills training, encourage mindfulness in individual therapy, and often practice mindfulness themselves.

Taught in the distress tolerance module of skills training, another acceptance intervention in DBT is called radical acceptance, which essentially involves accepting the present moment’s experience without struggling to change it or willfully resisting it. Finally, another acceptance intervention in DBT involves conveying acceptance of the patient through validation, which involves verifying or acknowledging the validity or truth in the patient’s experience, emotional reactions, thoughts, or opinions.

An essential skill for therapists in DBT involves knowing when and how to apply the most effective acceptance-oriented strategies, given the characteristics and difficulties of the patient and the context of the therapy session.

DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:

Deciding to get help and taking steps to start can be hard. There are several effective mental health treatments. This means you have options. Many professionals provide evidence-based talk therapy and medication to people who go through trauma. Treatments with the strongest evidence should be the first line of mental health treatment whenever possible, considering patient preferences, values, and clinician expertise.

We Level Up FL provides world-class care with round-the-clock medical professionals available to help you cope. If you have any questions about ACCEPTS DBT or looking for treatment options, connect with one of our mental health counselors. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Your call is private and confidential, and there is never any obligation.

FAQs

What is DBT ACCEPTS skills?

It involves accepting the present moment’s experience without struggling to change or willfully resisting it. ACCEPTS outlines strategies for distracting oneself from distressing emotions, giving them time to lessen in intensity or fade away.

What is the purpose of ACCEPTS DBT skill?

This DBT skill stands for Activities, Contributing, Comparisons, Emotions, Push away, Thoughts, and Sensations. These techniques are designed to keep your emotions manageable until you can resolve the problem.

Search ACCEPTS DBT – Dialectical Behavior Therapy Tools & Other Resources
Sources:

[1] Chapman AL. Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont). 2006 Sep;3(9):62-8. PMID: 20975829; PMCID: PMC2963469. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/
[2] Dialectical Behaviour Therapy: Description, Research, and Future Directions – https://files.eric.ed.gov/fulltext/EJ880555.pdf
[3] Practice-based Outcomes of Dialectical Behavior Therapy (DBT) Targeting Anger and Violence, with Male Forensic Patients: A Pragmatic and Non-Contemporaneous Comparison – https://www.ojp.gov/ncjrs/virtual-library/abstracts/practice-based-outcomes-dialectical-behavior-therapy-dbt-targeting
[4] May JM, Richardi TM, Barth KS. Dialectical behavior therapy as a treatment for borderline personality disorder. Ment Health Clin. 2016 Mar 8;6(2):62-67. DOI: 10.9740/mhc.2016.03.62. PMID: 29955449; PMCID: PMC6007584. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007584/