GUIDE · DBT

Wise Mind ACCEPTS in DBT: seven places to put your attention until the worst of it passes

The email from your landlord says the building's been sold and your lease ends in 60 days, and it landed five minutes before you're due to present at work. Wise Mind ACCEPTS is a set of distraction skills from dialectical behavior therapy (DBT) for moments like this one, when you can't make things better right away and don't want to make them worse. Each letter names a different place to send your attention for a while.

What Wise Mind ACCEPTS is, and when it fits

ACCEPTS comes from DBT, the treatment Marsha Linehan developed. It belongs to distress tolerance, one of DBT's four skill modules, and it's one of six crisis survival skills there, next to STOP, pros and cons, TIPP, self-soothing and improving the moment. Linehan's handout offers the phrase "Wise Mind ACCEPTS" as a memory aid.

Her teaching notes say distraction works by cutting down your contact with whatever set off the distress. It's meant for short stretches. Success is modest by design: if time passes and you haven't made anything worse, the skill did its job, even if you don't feel better.

Her notes say it fits pain that threatens to swamp you at work or in a meeting. It also fits a problem with no fix until tomorrow, when the urge to solve it tonight crowds out everything else. Linehan's handout adds the pull to act on an emotion when you know acting will make things worse, like firing off an angry text.

The handout rules out everyday problems, and distraction is the wrong tool for a problem you could start on now. It isn't a safety plan either. If you're thinking about suicide or about hurting yourself, reach out now, using the crisis contacts at the bottom of this page.

The seven ACCEPTS skills, with examples

A for Activities: do something unrelated to the crisis or at odds with it, like a run, a recipe with a lot of steps or the junk drawer you've meant to sort. Linehan's notes say activities fill your mind with something besides the crisis.

C for Contributing: do something for someone else, like texting a friend about her new job or carrying a neighbor's groceries. Helping moves your attention off yourself. In a 2016 study, 77 adults kept daily diaries, and on days when they did more small favors, like holding a door, stress took less of a toll on their mood.

C for Comparisons: set your situation next to another one, such as a time you felt this bad and came through, or people coping with the same thing or worse. The aim is to see your situation in a better light for a while. This letter needs care, as the next section explains.

E for Emotions: do something that brings up a different feeling, like a stand-up special you've seen five times or a playlist that makes you want to dance. Linehan's notes point out that willpower alone won't produce a new emotion, so pick an activity that reliably does. Name what you're feeling first, and skip anything likely to drag you further down.

P for Pushing away: put distance between you and the problem. Leave the room, or block it from your mind by picturing it in a box on a high shelf. Putting off a harmful urge for five minutes, then five more, counts too. This letter has limits, covered below.

T for Thoughts: give your mind a job, such as counting floor tiles, working a crossword or naming an animal for each letter of the alphabet. In Linehan's notes, other thoughts take up short-term memory, so the thoughts the emotion stirs up stop feeding it.

S for Sensations: use a strong, different sensation to grab your attention, like an ice cube in your palm, a bite of lemon or loud, fast music in your headphones. Linehan singles out holding ice as especially helpful.

Comparisons and Pushing away: two letters to use with care

Comparisons can turn into self-criticism. Comparing helps when it widens your view. It backfires when it becomes a verdict, like "Other people have real problems, so why am I falling apart?" That only adds shame to the pain. In two 1990 studies, comparisons in either direction could raise or lower how people felt about themselves. Patients with cancer who had low self-esteem or little sense of control were more likely to read comparisons with worse-off patients as bad news for themselves.

A gentler version compares you with you: a night you felt this bad and got through. If a comparison leaves you feeling small or ungrateful, drop it. Our pages on the inner critic and on comparing yourself to others go further.

Pushing away is a short-term move. Linehan's notes say it shouldn't be your first choice and can help in an emergency, as long as you don't overuse it. In the 1987 "white bear" study, people told not to think about a white bear couldn't manage it. Once they were allowed to, they thought about it more than people who'd been asked to think about it from the start. A 2001 meta-analysis put this rebound at small to moderate. A 2012 meta-analysis found that suppressing thoughts of an upsetting event didn't ease the emotion on average.

The 1987 study also found less rebound in people who had a specific thought to use as a distraction. So pair Pushing away with Thoughts or Activities. Give the problem a set time to come back, like tomorrow at 8, the same idea that drives worry time.

Make your own ACCEPTS list

Build the list on a calm day, since a crisis is a bad time to come up with ideas. In a 2021 study, researchers interviewed 24 people in DBT about their distress tolerance skills, and two-thirds said the skills were hard to use when their tension ran very high.

1. Name your hardest moments. List two or three situations where your distress tends to spike, like late at night or while waiting for results.
2. Write at least one idea per letter. Go through A, C, C, E, P, T and S, borrowing from the examples above or adding your own, and cross out anything that leaves you feeling worse.
3. Sort the ideas by how upset you'll be. Put no-thinking ideas, like an ice cube or a fast walk, at the top for when you're at a 9, and save puzzles for calmer moments. If nothing works at a 9, add TIPP.
4. Include a few quiet options. Add two or three that nobody will notice at work or on a bus, such as counting or a sour candy. In that study, 18 of the 24 people wanted to use their skills without anyone noticing.
5. Give each idea an end point. Write how long each one lasts, like one episode or 20 minutes, and what comes next, such as the call you need to make in the morning.
6. Keep the list where you'll see it. Save it on your phone's home screen or tuck a card in your wallet, and tell someone close to you about it. A quarter of the people in the study said reminders from others helped.
7. Try it on a 4 before you need it on a 9. Use one idea on an ordinary bad day to see whether it really holds your attention. Linehan's worksheets for ACCEPTS start with two practice rounds between sessions.
8. Rate it, then revise. Before and after, rate from 0 to 100 how well you can bear the distress, the scale Linehan uses. Count getting through as a win, and replace whatever didn't hold your attention.

Save the last line for when distraction isn't enough: the name of someone you can call and a note that the crisis contacts are at the bottom of this page.

Wise Mind ACCEPTS examples: three made-up moments

The people below are made up. Their scenes show how ACCEPTS might look in use, and they aren't evidence of how it'll go for you.

Waiting for biopsy results over a weekend. Dana's results won't come until Tuesday, and by Saturday afternoon she's reread the same medical pages a dozen times. She repaints the bathroom trim (Activities), then works a jigsaw puzzle with a podcast on (Thoughts). On Sunday she cooks chili for a friend with a new baby (Contributing). She checks the patient portal only at noon and at 5. The fear stays, but the weekend passes without a midnight search spiral.

An urge to text an ex at midnight. Jordan sees a photo of his ex with someone new and starts typing. He saves the message as a draft, leaves the phone in the kitchen and gives himself 15 minutes before deciding anything (Pushing away). He holds an ice cube (Sensations), then folds laundry with loud music on (Activities). When the timer goes off he gives it 15 more minutes, and by then he's tired enough to sleep. In the morning he deletes the draft.

A fight you can't settle tonight. Nia and her partner agreed to finish their argument about money tomorrow, when they're less tired. She writes her three main points on a sticky note and shuts it in a drawer (Pushing away). Then she puts on a comedy special that always makes her laugh (Emotions). When a sharp comeback pops into her head, she counts backward from 100 by threes (Thoughts). She still feels raw, but she doesn't wake her partner to restart the fight.

How ACCEPTS differs from self-soothing, TIPP and urge surfing

Self-soothing comforts you through your senses, with things like a warm drink or a soft blanket, while ACCEPTS moves your attention somewhere else entirely. Even its Sensations letter uses jolts, not comfort. The two can work in sequence: distract through the worst of it, then settle in with something soothing. STOP can come before either one, as the pause before you act.

TIPP works through your body, with cold water, intense exercise, paced breathing and paired muscle relaxation. Linehan's notes recommend it for a crisis you can't distract yourself from, and they point out that it doesn't take much thinking. If you're too worked up to follow a show, start with TIPP and switch to ACCEPTS once you can focus.

Urge surfing goes the other way: you turn toward the urge and watch it rise and fade without acting on it. In a 2014 study, 84 heavy drinkers sat in a mock bar with their preferred drink in front of them. Those told to distract themselves reported less craving than those told to observe it with acceptance, who did no better than people with no strategy. The authors suggest mindfulness may need more practice than one brief instruction. Distraction may be the better bet when an urge is close to winning, and surfing is worth practicing on milder ones.

When distraction turns into avoidance, and other snags

Distraction can slide into avoidance. Linehan warns against using distraction as a routine way to dodge painful emotions. Warning signs include grabbing a distraction the moment any feeling shows up, never giving the problem its turn and losing whole evenings to it. Contributing can drift the same way. Her notes mention people so busy with others' problems that they never get to their own.

A 2011 lab study hints at a cost. Distraction dampened the brain's response to upsetting pictures sooner than rethinking them did. When the same pictures came back later, though, the ones handled with distraction drew a bigger response than ones people had simply watched. Treat distraction as a bridge, then: once the pain comes down, Linehan's notes point to longer-term skills, such as emotion regulation, Check the Facts or, for what can't change, radical acceptance.

Reaching for a puzzle at a 9 out of 10. In the interview study, 11 of the 24 people couldn't manage skills that took thinking or fine motor control when their tension ran very high. At the peak, start with Sensations or TIPP and save the crossword for later.

Expecting distraction to make you feel better. Six of the 24 said unpleasant feelings came back after they used a skill, sometimes stronger at first. By Linehan's measure, a skill worked if you got through without making things worse. Have your next step ready for when the feeling returns.

How strong the evidence is

We searched PubMed and found no study that tested ACCEPTS on its own. In the 2021 interview study, 23 of the 24 participants had used it, more than any other distress tolerance skill. Interviews like that show how people experience a skill, though, not whether it works.

Most trials test DBT as a package. A 2015 trial of 99 women with borderline personality disorder who'd attempted suicide in the past year found that versions with skills training reduced self-injury and depression more than DBT without it. A 2010 analysis of 108 women linked rising skills use to fewer suicide attempts and less depression, but it averaged all the skills together. A 2015 review of 17 trials called the evidence for skills training on its own preliminary.

Outside DBT, a 2012 meta-analysis of 306 experimental comparisons found a small benefit from distraction (d = 0.27). ACCEPTS is reasonable to try when the goal is getting through a few hours without making things worse. It doesn't treat any condition, and it doesn't replace therapy.

Build your ACCEPTS list with Helpy

The chat below runs with Helpy, the site's AI assistant. Describe the moment that tends to get away from you, like a late-night urge or a long wait for news. It can help you pick an idea for each letter and plan what you'll do once the worst has passed.

Evidence and sources

• Distress Tolerance chapter (teaching notes), Linehan, DBT Skills Training Manual, Second Edition (Guilford, 2015): how distraction works, when it's useful, the seven sets of ACCEPTS skills, the cautions on overuse and on pushing away, when TIPP fits better and the 0 to 100 rating. Teaching notes from a sample chapter the publisher posts, not a study.
• Wesleyan University Counseling and Psychological Services, Crisis Survival Skills handouts: a university's copy of Linehan's 2015 handouts, including when to use crisis survival skills and the Wise Mind ACCEPTS list. Not research.
• Schaich et al., PLoS One, 2021 (PubMed): interviews with 24 people with borderline personality disorder in DBT at a German university clinic; 23 had used ACCEPTS, and many found the skills hard to use at very high tension. It names DBT's four modules and Linehan as its developer. A qualitative study that can't show whether skills work, and some authors give DBT trainings; we read the full text.
• Linehan et al., JAMA Psychiatry, 2015 (PubMed): 99 women with borderline personality disorder; versions with skills training reduced self-injury and depression more than DBT without it. No single skills were tested, and we read only the abstract.
• Neacsiu, Rizvi and Linehan, Behaviour Research and Therapy, 2010 (PubMed): in 108 women from three trials, rising skills use accounted for drops in suicide attempts and depression. Self-reported use, averaged across all skills; we read the full text.
• Valentine et al., Journal of Clinical Psychology, 2015 (PubMed): a review of 17 trials of DBT skills training without the rest of DBT found preliminary evidence. Study limits rule out strong conclusions; we read only the abstract.
• Webb, Miles and Sheeran, Psychological Bulletin, 2012 (PubMed): a meta-analysis of 306 experimental comparisons; distraction had a small effect on emotional outcomes (d = 0.27), and suppressing thoughts of the upsetting event showed no benefit. These were instructions in experiments, not DBT skills; we read only the abstract.
• Thiruchselvam et al., Biological Psychology, 2011 (PubMed): an EEG study in which distraction dampened responses to upsetting pictures sooner than reappraisal, but those pictures drew larger responses when shown again than ones people had simply watched. A lab study with pictures, not real distress; we read only the abstract.
• Murphy and MacKillop, Alcoholism: Clinical and Experimental Research, 2014 (PubMed): 84 heavy drinkers in a mock bar; distraction cut craving and urge distress more than brief mindfulness instructions or no strategy. Drinking itself wasn't measured, and the mindfulness was a single brief instruction; we read the full text.
• Wegner et al., Journal of Personality and Social Psychology, 1987 (PubMed): the "white bear" experiments; people told not to think of something thought about it more later, less so when they had a specific distracter. Lab experiments with a neutral thought; we read only the abstract.
• Abramowitz, Tolin and Street, Clinical Psychology Review, 2001 (PubMed): a meta-analysis of controlled studies found a small to moderate rebound after thought suppression, varying with the thought and how it was measured. Few studies included people with clinical diagnoses; we read only the abstract.
• Buunk et al., Journal of Personality and Social Psychology, 1990 (PubMed): two studies, in patients with cancer and in married people, in which comparisons in either direction could bring positive or negative feelings, depending on things like self-esteem and sense of control. Specific groups and older data; we read only the abstract.
• Raposa, Laws and Ansell, Clinical Psychological Science, 2016 (PubMed): 77 adults kept 14-day diaries; on days with more small helping acts, stress was less tied to worse mood and mental health. Correlational, with a mostly white, young sample recruited for a drinking study; we read the full text.

Read next

Distress tolerance: the TIPP skill for getting through an unbearable momentAnother crisis survival skillThe self-soothe skill in DBT: comfort for a moment you can't fix yetComfort instead of distractionThe STOP skill in DBT: a pause between the urge and the actionA pause before acting on an urgeIMPROVE the moment in DBT: seven ways to make a painful stretch easier to bearSeven ways through a painful momentStress eating: why you crave food when you're stressed, and how to stopEating to calm down

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