Tolerate Distress with A-C-C-E-P-T-S

“The truth that many people never understand, until it is too late, is that the more you try to avoid suffering the more you suffer because smaller and more insignificant things begin to torture you in proportion to your fear of being hurt.” – Thomas Merton

Dialectical Behavior Therapy (DBT) offers many useful approaches to understanding and tolerating distress.  When we are in a state of distress, things may feel hopeless, unmanageable, or out of control.  There is often an urge to do something – anything – to make the distress “stop.”  For individuals with difficulty handling distress, it may seem impossible to tolerate extreme emotions.  There may even be urges to engage in self-destructive behaviors (e.g., substance abuse, self-harm, or other dangerous activities) to simply feel “different.”

Renowned DBT researcher Dr. Marsha Linehan offers helpful mnemonic devices to remember how to effectively tolerate distress in the moment. The idea behind DBT’s self-soothing skills is to offer solutions designed to both tolerate distress in the moment and avoid making matters worse.

For individuals with severe difficulty self-soothing and tolerating distress,  it can seem as if the present pain/suffering will “never” end.  There is often a false belief that one’s current emotional state is simply “how it is now” and there is no end in sight to the suffering.  When in this state of mind, it is not surprising that many individuals resort to destructive behaviors in futile attempts to end the pain.

The tragic irony to these attempts is that clouding awareness with substances, harming the self, or engaging in other impulsive activities often does reduce suffering – but not for long.  In fact, these destructive behaviors may act as temporary distractions from pain, but they end up causing more long-term suffering. This is a vicious cycle.

Distress Tolerance: A-C-C-E-P-T-S

How we can we learn how to use the DBT mnemonic device A-C-C-E-P-T-S to distract from distress in a healthy way and self-soothe? Depressed & Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression and Anxiety (Marra, 2004) offers helpful explanations for how to use A-C-C-E-P-T-S in moment of extreme distress or suffering.

Activities

Usually engaging in activities is the last thing one wants to do when experiencing intense distress.  Making the choice to simply get moving and engage in simple tasks around the house that need to get done (e.g., vacuuming, doing laundry, organizing the closet) is an effective (and non-destructive) way of distracting from temporary intense distress.

Contributing

Intense negative emotions often get us wrapped up in our own internal dramas to the point that we forget that there is a world outside of ourselves.  One way to tolerate distress is to move away from the potential self-absorption involved in intense emotions by contributing to something outside of yourself.  This does not invalidate the pain and distress that is being experienced, but simply redirects self-destructive energy in a healthy direction.  Getting involved with others and contributing to external causes can help one regain perspective when it seems like intense distress will never end.

Comparisons

Take a moment to reflect on how your life is different from those with far less than you have.  During intense distress, it is easy to forget how much there is to be grateful for.  When emotions are intense and seem unmanageable, there is a tendency to forget how life would be very different if living in a part of a nation without any running water, in a war zone, or in abject poverty.  Sometimes keeping a simple gratitude journal is very helpful in starting down the path towards recognizing small everyday occurrences worthy of a moment of gratitude and appreciation.  No matter how bleak one’s current situation is, it could always be worse and it could always be better.  But it is what it is.  And it will pass.

Opposite Emotions

Acting opposite to our current emotional state is a powerful tool to use in the moment when distress seems too overwhelming to bear.  Some examples of using opposite to emotion action include feeling tired/sluggish, but deciding to walk out of the front door and take a walk around the block, or feeling bored/lethargic and choosing to watch a funny movie or dance to your favorite song.  The idea behind opposite action is not only to actively shift your current affective state, but also to act as a reminder that all emotional states are temporary.  Intense pain, as well as intense joy, are not permanent.  We shift in and out of emotional states.  Remember to use opposite action when feeling intense discomfort.

Pushing Away

This technique encourages us to visualize whatever uncomfortable emotional states we are experiencing as shifting.  If you are feeling small and powerless, push that image away by visualizing yourself getting stronger and more powerful.  If you are feeling anger at a particular person, visualize that person as shrinking away.  Remember that none of these techniques are designed to invalidate or deny your current emotional experience – simply to transform powerful emotions until you are in a better state of mind to effectively process them.

Thoughts

When in an intense emotional state, use your cognitive abilities to provide a temporary respite from the intense emotions.  This is a time when moving into the world of thinking is your friend.  When emotions seem unbearable and overpowering, we are being controlled by what DBT terms “emotion mind.”  Until we are able to move into a long-term state of “wise mind,” use “reasonable mind” to help you move out of your intense emotional state.  Start reading a book (that is not emotionally evocative) and consciously shift your full attention to each word on the page.  Notice how consciously shifting away from emotion mind when in an intense affective state provides a noticeable internal shift.

Sensations

Physical sensations can provide powerful temporary distractions from intense negative emotional states.  This is partially why some individuals with difficulty regulating emotions engage in self-harm (e.g., cutting).  Use the distracting power of physical sensations to your advantage – not to further harm yourself.  Consciously decide to take a hot bath/shower, hold ice cubes in your hands, smell your favorite perfume, eat a bit (i.e., not overindulge) in your favorite food or nonalcoholic beverage.  Notice how experiencing pleasant physical sensations can provide temporary peace from intense negative emotional states.

How can you actively work towards utilizing these DBT distress tolerance techniques when in the throes of intense distress?  Some people find it helpful to make small note-cards of strategies that seem particularly appealing or helpful and then place them in an easily accessible spot.  When we are in a state of intense distress, it is unlikely that we will remember what it is that we can actually do to self-soothe.  This is why it is so important to prepare in advance for intense emotions by having note-cards or even a small shoebox filled with helpful strategies and self-soothing tips.

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Marra, T. (2004). Depressed & anxious: The dialectical behavior therapy workbook for overcoming depression and anxiety. Oakland, CA: New Harbinger Publications, Inc.

Featured image: Zen Water by darkpatator / CC BY 2.0