Sometimes the kindest thing you can do for yourself is simply to step away from intense emotions temporarily.
Distraction isn't avoidance—it's giving yourself space to let the emotional intensity pass before you address the situation.
The acronym ACCEPTS covers seven distraction strategies:
Activities that require focus—anything from cleaning to playing a video game to working on a project. The key is that it needs to genuinely engage your attention.
Contributing to others takes you out of your own pain by focusing on someone else's needs. Volunteer work, helping a friend, or even just sending a thoughtful message can shift your perspective.
Comparisons can be helpful if used carefully. This isn't about minimizing your pain, but about remembering times when you felt worse than this and survived, or recognizing that others face similar challenges.
Emotions that are different from what you're feeling now. If you're sad, watch something funny. If you're angry, listen to calming music. Deliberately shift your emotional state.
Pushing away means mentally putting the problem in a box for now. You're not ignoring it forever—you're acknowledging it exists but choosing to deal with it later.
Thoughts that take up mental space. Count backward from 100 by sevens, name all the countries you can think of, recite song lyrics—anything that occupies your mind.
Sensations that are intense enough to ground you. Hold ice, take a hot shower, listen to loud music, taste something sour. Physical sensations can anchor you to the present moment.
Self-Soothing: Kindness Through the Five Senses
Self-soothing involves deliberately creating comforting experiences through each of your five senses. This skill recognizes that you deserve comfort and care, especially when you're struggling.
For vision, surround yourself with beauty—light a candle, look at art, step outside and really see the sky. For hearing, create a playlist specifically for difficult moments, or listen to nature sounds. With smell, use essential oils, light incense, or bake something fragrant. For taste, have tea, savor a piece of chocolate, or eat something you genuinely enjoy. Through touch, take a warm bath, wrap yourself in a soft blanket, or get a massage.
The practice of self-soothing counters the tendency to punish ourselves when we're struggling. It's a radical act of self-compassion, and affectionate breathing is one way to practice it deliberately.
IMPROVE the Moment: Changing Your Internal Experience
When you can't change the external situation, you can still change how you experience it internally. The IMPROVE acronym offers seven ways to do this:
Imagery means visualizing yourself in a safe, peaceful place, or imagining yourself successfully handling the crisis. Mental rehearsal can be surprisingly powerful.
Meaning involves finding purpose in your pain. This doesn't mean the suffering is good, but you might grow from it, learn something, or use the experience to help others later.
Prayer or spiritual practice can provide comfort if that resonates with you. This could be traditional prayer, meditation, or connecting with something larger than yourself in whatever way feels meaningful.
Relaxation through progressive muscle relaxation, gentle stretching, or simply lying down and breathing deeply gives your body permission to soften.
One thing in the moment means radical focus on just the present. Not yesterday, not tomorrow—just this one moment right now, which is almost always manageable.
Vacation isn't necessarily physical travel. It's taking a brief mental break—reading a book, watching a show, or doing anything that gives you a psychological vacation from the crisis.
Encouragement involves being your own cheerleader. Talk to yourself the way you'd talk to a good friend in crisis—with compassion, reassurance, and belief that they can get through this.
Pros and Cons: Making Wise Decisions Under Pressure
When you're in crisis and tempted to act impulsively, the Pros and Cons skill helps you think through consequences. Draw four quadrants and honestly list:
- Pros of tolerating the distress (not acting impulsively)
- Cons of tolerating the distress
- Pros of acting on your impulse
- Cons of acting on your impulse
This isn't about judgment—it's about clarity. Sometimes seeing the consequences laid out visually helps you make the decision that serves your long-term wellbeing, even when short-term relief feels desperately appealing.
Radical Acceptance: Letting Reality Be Reality
Perhaps the most profound crisis survival skill is radical acceptance—fully accepting reality as it is in this moment, without fighting against it or insisting it should be different. This doesn't mean you approve of the situation or give up on changing it. It means you stop exhausting yourself by refusing to acknowledge what's real.
Pain is inevitable, but suffering often comes from our resistance to pain. When you stop fighting reality, you free up enormous energy to actually address your situation rather than simply raging against the fact that it exists.
Radical acceptance is a practice, not a one-time decision. You might accept reality, then start fighting it again, then need to accept it again. That's normal. Keep bringing yourself back to acceptance.
Where to go next
Part one of this pair, DBT crisis survival skills, covers what a crisis is and when these tools apply. For the fastest of them, see DBT TIP skills, and for choosing between them in the moment, finding the right DBT skill.
Dr. Jesse Finkelstein teaches these skills in individual therapy and in the DBT skills group at Axis Psychological Services in New York City. You can book a free consultation.
If you want to practice crisis survival skills with support, learn about DBT therapy in NYC, or join the DBT skills group in NYC.
Common questions about DBT distress tolerance skills
What do ACCEPTS and IMPROVE stand for?
They are the two families of DBT distress tolerance skills covered here. ACCEPTS is a set of distraction strategies: activities, contributing, comparisons, emotions, pushing away, thoughts, and sensations. IMPROVE works on the internal experience instead: imagery, meaning, prayer, relaxation, one thing at a time, a brief vacation, and encouragement. One moves your attention outward, the other changes how the moment feels from inside.
Is distraction not just avoidance?
It depends on the timing. Distraction used to get through a wave that will pass is a skill. Distraction used so that a problem never gets addressed is avoidance. The dividing line is whether you come back to the thing afterward, which is why these skills are taught with a return built into them.
What is radical acceptance?
Accepting reality as it is, including the parts that are unfair, rather than continuing to fight the fact that they happened. It is not approval and it is not giving up. It is the recognition that rejecting a reality which has already occurred adds suffering to pain without changing the pain.
How do I choose between all these DBT distress tolerance skills?
By how much time you have and how high the emotion is. Very high arousal needs body based skills first. Moderate distress responds well to ACCEPTS. A long stretch you cannot escape, a hospital waiting room or a hard month, is where IMPROVE and acceptance do the work. Most people end up with three or four that reliably suit them.
