DBT ACCEPTS Worksheet: Distress Tolerance Distraction Plan

This DBT ACCEPTS Worksheet guides clients through a structured planning process to create a personalized ACCEPTS distress tolerance plan. Across seven distinct sections, clients are prompted to identify Activities that require concentration, ways to focus on others through Contributing, and resilient Comparisons from their own past. The worksheet also facilitates the creation of competing Emotions, strategies for Pushing Away intrusive thoughts, mental tasks to distract the Thoughts, and physical Sensations to ground the body. This comprehensive layout ensures that the client has a multi-sensory approach to distraction that can be applied in various environments.

The structured format requires clients to move from abstract concepts to specific, actionable items. By documenting these strategies in advance, the client reduces the “cognitive load” required during an actual crisis, making it significantly more likely that they will utilize a healthy skill rather than falling back on habitual, unhelpful reactions.

How This Worksheet Can Be Used

Clinical Sessions:
Therapists use the worksheet during the Distress Tolerance phase of skills training. It serves as a collaborative brainstorming tool where the clinician can help the client identify which types of distraction (e.g., contributing vs. physical sensations) are most effective for their specific temperament and triggers.

Crisis Planning:
Clients use the completed worksheet as a “cheat sheet” during high-stress moments. Because it is pre-populated with strategies that the client has already vetted, it serves as an immediate guide when the “Emotional Mind” makes it difficult to think clearly.

In Skills Training Groups:
This tool is often used as a group exercise where members share different ideas for each category. This social learning helps clients expand their repertoire of coping strategies and reduces the isolation often felt during emotional crises.

Benefits of the DBT ACCEPTS Worksheet

• Provides a structured, 7-category framework for effective and intentional distraction.
• Reduces emotional intensity by creating “competing” internal and external experiences.
• Helps clients survive a crisis without engaging in self-harm or impulsive behaviors.
• Encourages a “Comparisons” focus that reinforces the client’s own history of resilience.
• Includes a “Contributing” section that fosters social connection and reduces self-centered rumination.
• Supports the “Crisis Survival” component of the evidence-based DBT protocol.

Integrating This Tool into Clinical Work

Integrating the DBT ACCEPTS Worksheet is most effective when clinicians emphasize that distraction is a “temporary bridge,” not a permanent escape. Clinicians should guide clients to choose activities that are “engaging enough” to truly occupy the mind—for example, a challenging puzzle rather than just watching television. In the “Sensations” section, the goal is to provide a “safe shock” to the system, such as holding an ice cube or taking a cold shower. When reviewing the “Pushing Away” section, it is vital to clarify that this is a deliberate choice to “put the problem on a shelf” for a short time, rather than denying it exists. By consistently reviewing and updating this worksheet, the clinician helps the client realize that they have a range of options to manage their distress, fostering a sense of mastery over their internal world.

References

• Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.
• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
• Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide. Guilford Press.
• McKay, M., Wood, J. C., & Brantley, J. (2019). The Dialectical Behavior Therapy Skills Workbook. New Harbinger Publications.