Distress Tolerance and Learning to ACCEPTS it

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Welcome to distress tolerance episode 3! Last time you read, we talked a lot about what DBT therapy is and some of the distress tolerance skills use. I decided to make a series of posts about distress tolerance because it is such an important topic (and an important skill to have). In this post, we will tackle another distress tolerance skill in the hopes you will have more information about how the brain works and even more information about how to make those painful situations a little less painful.

To recap my post, DBT and Distress Tolerance Skills :

  • DBT is a form of psychotherapy to help us remain present in the moment and

    engage in reactions that are healthy and helpful
  • the core pillars of DBT include distress tolerance, mindfulness, emotional regulation, interpersonal effectiveness

  • Some distress tolerance skills are: TIPP, self-soothing, and IMPROVE

Despite going over these amazing distress tolerance skills, there are still more! Why are there so many distress tolerance skills? As we know, each person (and their brains) are individuals. What might work for one brain, may not work for another. Hey, the more skills that we have access to, the better the chances you have of gaining control of that darn amygdala and the chaos it brings to the party when we have anxiety and depression.

If you haven’t yet, take a read of my previous post:

DBT and Distress Tolerance Skills

This will help you better understand what this post is about

Lets start with another acronym, shall we? This acronym is known as ACCEPTS. This amazing little acronym is a great way to not only build up distress tolerance, but release dopamine and serotonin into our brain when we need it the most. ACCEPTS stands for:

  • Activities
  • Contributing
  • Comparisons
  • Emotions
  • Pushing away
  • Thoughts
  • Sensations

Sounds like a lot to remember doesn’t it? That’s OK, I will have a handout at the end of this particular post to help you remember the steps of ACCEPTS. Let us start at the top of this acronym and work our way down.

Coping Skills Alert

Activities (similar to the I in TIPP), represents the use of an activity that requires your full attention for at least 15 minutes. If you recall from the last post, participating in an activity will allow your prefrontal cortex to tell that darn amygdala “hey stupid! Your body is in motion! We need to focus on this so we don’t die!” By doing so, we are actively engaging our brain in distraction, releasing feel good neurotransmitters, in removing our self from the distressful feelings that come with stressful situations. These activities can be as simple as going for a walk, or as complex as putting together a puzzle or creating a new recipe for supper that your family may or may not like.

Credit to Carissa Weber at www.thatdarnamygdala.com

Next on the list is contributing. I really enjoy this one as it helps our brain release oxytocin, creating bonding experiences, and exploring what needs others may need to have met. The act of giving ourselves through volunteering, visiting a friend, writing a thank-you note, or even participating in a service project (like cleaning up your elderly neighbor’s yard), has a great deal of benefits. The prefrontal cortex triggers the thalamus to help the hypothalamus and hippocampus to pull memories that support why helping others is a good idea. This helps quiet down that darn amygdala, helping it see that you are not actually in any sort of danger. Serotonin and dopamine slowly release as the oxytocin builds up, making it easier to identify positive things happening, not just the icky stressful things.

Now we have comparisons. I want to start and say I use this particular part of the ACCEPTS acronym cautiously. Comparison is all about searching your brain for times you have felt the same way, and looking at how you made it through that stressor. That information can help your darn amygdala to calm it’s butt down and realize that the distress we are experiencing won’t last forever. Sometimes, comparing our current situations with past situations we have been through, can trigger more stress to come our way. It is important when we search our hippocampus and hypothalamus for situations we have been through, that we look at ALL of the facts of that situation. This includes how we resolved the stress, how we felt when the stress was over, and how long the stressor actually impacted your life.

Emotions is up on the list. I love this part of the acronym because it is all about identifying (wait for it) the emotions you are feeling! That’s right, by labeling our feelings we help take the panic away from that darn amygdala. Why is that? Well, the prefrontal cortex is taking time to identify what is going on in the situation. As it does so, it works hard to help that darn amygdala identify what is in its control. Once we know what the emotion is, we now have control to change that emotion into something a bit more pleasant. For example, have you ever noticed how a song can change your day? Between you and me, I can think of several songs I can put on and my mood instantly changes. By engaging in an activity that provokes the emotion you want to feel, we are going to release the feel good neurotransmitters and offer a slight distraction to the stress. Blair that song! Tell that bad dad joke! Watch that hilarious viral cat video! These activities allow your brain to take a small break and regain the energy it needs to help that darn amygdala view the information it is receiving differently.

Looking for a good read? Check out Marsha Linehan’s book on the right

Pushing away is kind of an odd ball. Here, we are specifically acknowledging what unhealthy coping skills we would like to do when we are stressed (you know, using drugs, self-harming, procrastinating, deliberately putting ourselves in harm’s way, things like that) and putting them on the back burner for a few minutes. In their place, we are going to put in one of the many healthy coping skills we have talked about (like in Mindfulness: The Art of Becoming Calm, Cool, and Collected or Cognitive Behavioral Therapy: Why it Works). Why? We are essentially putting that darn amygdala in a time-out and allowing the prefrontal cortex to assist the thalamus rewire the pathways in the brain that are saying that the unhealthy skills relieve the stress faster. This will help the brain also build up some natural frustration tolerance.

On to the next letter of thoughts. Just like with emotions, we are allowing our prefrontal cortex to take the wheel and focus on things in the situation that are in our control. Maybe it is focusing on everything in the situation that starts with the letter “B.” Perhaps it is counting all the ceiling tiles. By allowing our brain to focus on those neutral events, we are tapping the breaks on that darn amygdala, lowering the production of acetylcholine, and start producing the neurotransmitter, glutamate. This helps slow down our heart rate and blood pressure, increase the oxygen exchange happening in the blood, and stops the triple F response that keeps us feeling so stressed.

We made it to S (about damn time, too, am I right?)! S stands for sensations. Remember the self-soothing we did in DBT and Distress Tolerance Skills? Sensations is exactly what self-soothing is using our five senses. I won’t go into too much depth here as I covered this awesome skill in the last post.

credit to Carissa Weber at http://www.thatdarnamygdala.com

That was one heck of a coping skill! Remember, practice makes progress! By doing so, you are assisting your brain in rewiring itself to healthier emotional reactions, releasing the feel good neurotransmitters, all while seeing progress made to collecting mental wealth. I will be doing another post on distress tolerance next, as there are many different skills related to this important subject.

Thank you so much for taking the time to value to mental health and help grow your knowledge. It takes courage to find the information, and strength to implement it. If you don’t hear it from anyone else, I’m so proud that you have made the choice to educate yourself on the things you can do to help keep your mental health, healthy.

To recap this post:

– ACCEPTS is a great tool to practice daily, not just when you are feeling distressed

– Practice is needed in order to feel the benefit of distress tolerance skills

Bonus Material

Get the Worksheet Bundle!

With your purchase of the worksheet bundle , you get fun (and helpful) handouts. These handouts are designed for your personal use and to help you remember the facts of each post. This week’s handouts (that’s right, handouts!) goes over ACCEPTS and why it works. Enjoy!

Get the one-time payment option

The one-time payment option allows you to get all the handouts in one neat file, or with each post.


  • Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.

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4 responses to “Distress Tolerance and Learning to ACCEPTS it”

    1. Thank you so much for reading! Hopefully the information in this post will help you on your journey to mental wealth 🙂

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