15 Easy ACCEPTS Skill Group Activities

General Instructions for Therapists

As you guide clients through these ACCEPTS skill activities, the goal is to help them learn how to manage distressing emotions by distracting themselves with healthy alternatives. The ACCEPTS skill encourages clients to focus on constructive ways to deal with emotional pain, rather than reacting impulsively. The activities cover various methods like engaging in physical activities, helping others, comparing situations, and focusing on sensations.

Encourage clients to experiment with each distraction method and reflect on which ones work best for them in different emotional situations.

General Instructions for Clients

Today’s activities focus on practicing the ACCEPTS skill, which helps you manage emotional distress by distracting yourself with healthy alternatives. ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. These methods provide different ways to shift your focus and cope with challenging emotions.

These exercises will guide you through the different parts of the ACCEPTS skill, helping you discover what works best for you when you’re feeling overwhelmed. After each exercise, we’ll reflect on how it felt and how you might use it in the future when dealing with emotional distress.

What is the ACCEPTS Skill in DBT?

The ACCEPTS skill in Dialectical Behavior Therapy (DBT) is a distress tolerance technique used to help distract yourself from painful emotions. It stands for:

1. Activities: Engaging in enjoyable or distracting activities to shift focus from distress.
2. Contributing: Helping others or doing something nice for someone else to take the focus off yourself.
3. Comparisons: Comparing your situation to others or to a time when things were worse, to gain perspective.
4. Emotions: Generating opposite emotions (like watching a funny movie when you’re sad) to change how you feel.
5. Pushing away: Mentally pushing distressing thoughts or situations aside for a short time.
6. Thoughts: Focusing on something else (like a puzzle or problem) to redirect your mind.
7. Sensations: Using physical sensations (like holding an ice cube) to distract from emotional pain.

By practicing these techniques, you can cope with distress in healthier ways.

15 ACCEPTS Skill Activities

Activity 1: Distraction Through Physical Activity

Intro to activity:
This activity helps clients practice the “Activities” part of the ACCEPTS skill by engaging in physical movement to distract from distressing emotions.

How to practice this activity:

Prompt:
“We’re going to focus on using physical activity to distract from distressing emotions. The goal is to engage in movement to shift your focus away from painful thoughts or feelings.”

Preparation:
The therapist asks clients to think about a recent moment when they felt emotionally overwhelmed. They are then asked to engage in simple physical activity like stretching or walking in place.

Guidance:
Therapist says: “When you feel distressed, try engaging in physical activity. You can walk in place, stretch, or do any simple movement that feels comfortable. Focus on how your body feels as you move, and let the movement help distract you from your emotions.”

Experience:
Clients spend 5-10 minutes engaging in light physical activity while focusing on how it feels to move their body. The therapist encourages them to reflect on how the movement helps shift their emotional focus.

Observation:
Clients reflect on how they felt after engaging in physical activity. Did the movement help distract from their distressing emotions and make them feel more in control?

Discussion:
After the activity, the therapist asks: “What did it feel like to use physical activity to distract from your emotions? Did it help shift your focus away from distress?”

Reflection:
Reflect on how physical activity can help you manage emotional distress. In a group, the therapist might ask: “How could engaging in simple physical activities help you distract yourself when emotions feel overwhelming?”

Activity 2: Helping Others to Shift Focus

Intro to activity:
This activity helps clients practice the “Contributing” part of the ACCEPTS skill by focusing on helping others, which can shift attention away from their own distressing emotions.

How to practice this activity:

Prompt:
“We’re going to focus on contributing to help distract from distressing emotions. The goal is to engage in an act of kindness or help someone else, which can take the focus off your own emotional pain.”

Preparation:
The therapist asks clients to think about a small way they can help others in the group setting, such as offering a kind word, assisting with a task, or helping clean up the space.

Guidance:
Therapist says: “When you feel emotionally overwhelmed, try focusing on how you can contribute to others. Offering help or being kind to someone else can take the focus off your distress. Think about a way you can assist or offer support to someone in the group.”

Experience:
Clients spend 5-10 minutes thinking of and engaging in small acts of contribution within the group, such as offering support or helping with tasks. The therapist encourages them to reflect on how contributing affects their emotional state.

Observation:
Clients reflect on how they felt after helping someone else. Did focusing on contributing reduce their emotional distress and help them feel more grounded?

Discussion:
After the activity, the therapist asks: “What did it feel like to help someone else in the group? Did contributing to others help shift your focus away from your emotions?”

Reflection:
Reflect on how contributing to others can help you manage emotional distress. In a group, the therapist might ask: “How could helping others be a useful way to distract yourself when you’re feeling overwhelmed?”

Activity 3: Using Comparisons to Gain Perspective

Intro to activity:
This activity helps clients practice the “Comparisons” part of the ACCEPTS skill by reflecting on how their current situation compares to others or to more difficult times in the past.

How to practice this activity:

Prompt:
“We’re going to focus on using comparisons to gain perspective and distract from distressing emotions. The goal is to reflect on how your current situation compares to others or to a time when things were worse.”

Preparation:
The therapist asks clients to think of a time in the past when they faced a more difficult challenge or reflect on someone who may be facing greater struggles.

Guidance:
Therapist says: “When you feel overwhelmed, try comparing your current situation to a time when you faced something harder, or think about how others might be dealing with greater challenges. This can help put your emotions into perspective.”

Experience:
Clients spend 5-10 minutes reflecting on comparisons—either comparing their current situation to a past struggle or considering how others face challenges. The therapist encourages them to think about how this comparison helps shift their perspective.

Observation:
Clients reflect on how they felt after making comparisons. Did reflecting on a past challenge or comparing to others help them feel more in control of their current emotions?

Discussion:
After the activity, the therapist asks: “What did it feel like to compare your current emotions to a past challenge or to others’ situations? Did it help you gain perspective on your emotional distress?”

Reflection:
Reflect on how comparisons can help you put your current emotions into perspective. In a group, the therapist might ask: “How could using comparisons help you manage difficult emotions in the future?”

Activity 4: Creating Opposite Emotions with Humour

Intro to activity:
This activity helps clients practice the “Emotions” part of the ACCEPTS skill by generating opposite emotions through humour, such as watching a funny video or sharing jokes to shift away from distressing feelings.

How to practice this activity:

Prompt:
“We’re going to focus on using humour to generate opposite emotions. The goal is to create positive emotions, like laughter or joy, to counter distressing emotions like sadness or anger.”

Preparation:
The therapist asks clients to think of something that makes them laugh, such as a funny video or a joke they can share with the group.

Guidance:
Therapist says: “When you’re feeling upset, try using humour to create the opposite emotion. Watching a funny video or telling jokes can bring positive emotions and shift your focus away from distress. Let’s take a few minutes to share something funny with the group.”

Experience:
Clients spend 5-10 minutes sharing funny stories or watching a short video together as a group. The therapist encourages them to notice how the laughter helps generate positive emotions.

Observation:
Clients reflect on how they felt after using humour. Did laughing or creating positive emotions help reduce the intensity of their distressing feelings?

Discussion:
After the activity, the therapist asks: “What did it feel like to laugh or use humour when you were feeling upset? Did it help shift your emotions to something more positive?”

Reflection:
Reflect on how humour and creating opposite emotions can help you manage distressing feelings. In a group, the therapist might ask: “How could using humour or generating positive emotions help you cope when you’re feeling overwhelmed?”

Activity 5: Mentally Pushing Away Distress

Intro to activity:
This activity helps clients practice the “Pushing away” part of the ACCEPTS skill by mentally setting aside distressing thoughts or emotions for a period of time, allowing them to create some emotional distance.

How to practice this activity:

Prompt:
“We’re going to focus on mentally pushing away distressing thoughts or emotions. The goal is to set aside your distress for a short time, creating emotional distance to help you cope.”

Preparation:
The therapist asks clients to think of a distressing thought or emotion they’ve been struggling with, which they can mentally “push away” for a while.

Guidance:
Therapist says: “When you feel emotionally overwhelmed, imagine mentally placing your distressing thought or feeling in a box or on a shelf, where you can set it aside for now. You don’t have to solve it immediately—just push it away for a little while and focus on something else.”

Experience:
Clients spend 5-10 minutes visualising pushing away their distressing thoughts by mentally setting them aside, such as putting them in an imaginary box. The therapist encourages them to focus on how it feels to create this emotional distance.

Observation:
Clients reflect on how they felt after mentally pushing away their distress. Did setting the thought aside help them feel more in control and less overwhelmed?

Discussion:
After the activity, the therapist asks: “What did it feel like to push away distressing thoughts or emotions? Did mentally setting them aside help create emotional space?”

Reflection:
Reflect on how mentally pushing away distress can help you cope with overwhelming emotions. In a group, the therapist might ask: “How could this technique help you handle difficult thoughts in the future?”

Activity 6: Distracting Thoughts with a Simple Puzzle

Intro to activity:
This activity helps clients practice the “Thoughts” part of the ACCEPTS skill by engaging in a simple puzzle or problem-solving activity to distract from distressing emotions.

How to practice this activity:

Prompt:
“We’re going to focus on using a simple puzzle or mental task to distract from distressing emotions. The goal is to occupy your mind with a problem to solve, which can shift your focus away from emotional pain.”

Preparation:
The therapist provides clients with simple puzzles or mental tasks, such as word searches, crossword puzzles, or a mental arithmetic challenge. Clients are encouraged to focus fully on solving the puzzle.

Guidance:
Therapist says: “When you’re feeling distressed, try distracting your mind by focusing on a puzzle or a challenging mental task. Engaging your brain in problem-solving can take the focus off your emotions. Let’s take a few minutes to work on a simple puzzle together.”

Experience:
Clients spend 5-10 minutes working on puzzles or engaging in mental tasks provided by the therapist. The therapist encourages them to reflect on how focusing on the puzzle shifts their emotional focus.

Observation:
Clients reflect on how they felt after working on the puzzle. Did focusing on the task help reduce emotional distress and give their mind something productive to focus on?

Discussion:
After the activity, the therapist asks: “What did it feel like to focus on a puzzle when you were feeling distressed? Did it help distract your thoughts and reduce emotional intensity?”

Reflection:
Reflect on how engaging your brain in problem-solving can help distract you from distressing emotions. In a group, the therapist might ask: “How could using puzzles or mental challenges help you cope when you’re feeling overwhelmed?”

Activity 7: Using Music to Change Your Emotions

Intro to activity:
This activity helps clients practice the “Emotions” part of the ACCEPTS skill by using music to create opposite emotions and change their mood.

How to practice this activity:

Prompt:
“We’re going to focus on using music to change your emotions. The goal is to listen to music that generates positive or calming emotions, helping shift away from distress.”

Preparation:
The therapist asks clients to choose a piece of music that makes them feel positive or calm. If in a group setting, the therapist can also play calming or uplifting music for the entire group.

Guidance:
Therapist says: “When you’re feeling distressed, try listening to music that brings up opposite emotions. Focus on how the music makes you feel, whether it’s calm, joyful, or peaceful. Let the music guide your emotions away from distress.”

Experience:
Clients spend 5-10 minutes listening to music that brings up positive emotions. The therapist encourages them to notice how their emotions shift as they listen to the music.

Observation:
Clients reflect on how they felt after listening to music. Did the music help create opposite emotions and shift their mood in a more positive direction?

Discussion:
After the activity, the therapist asks: “What did it feel like to use music to change your emotions? Did listening to calming or joyful music help distract you from distress?”

Reflection:
Reflect on how music can help shift your emotions during emotional crises. In a group, the therapist might ask: “How could listening to music when you’re feeling overwhelmed help you manage your emotions more effectively?”

Activity 8: Savoring a Physical Sensation

Intro to activity:
This activity helps clients practice the “Sensations” part of the ACCEPTS skill by focusing on a positive or neutral physical sensation to distract from emotional distress.

How to practice this activity:

Prompt:
“We’re going to focus on savoring a physical sensation to distract from emotional pain. The goal is to focus your attention fully on a sensation, helping shift your focus away from distressing emotions.”

Preparation:
The therapist provides clients with objects they can hold and experience physically, such as a soft fabric, a stress ball, or a scented item. Clients are encouraged to choose one sensation to focus on.

Guidance:
Therapist says: “When you’re feeling emotionally overwhelmed, focus on a physical sensation that’s calming or neutral, like the texture of fabric or the scent of an object. Pay attention to how it feels and let that sensation distract your mind from emotional pain.”

Experience:
Clients spend 5-10 minutes focusing on the physical sensations of the object they’ve chosen, whether it’s the texture, temperature, or scent. The therapist encourages them to observe how focusing on the sensation helps shift their emotional focus.

Observation:
Clients reflect on how they felt after focusing on the physical sensation. Did the sensation help distract from their distressing emotions and bring a sense of calm or relief?

Discussion:
After the activity, the therapist asks: “What did it feel like to focus on a physical sensation when you were feeling upset? Did it help shift your focus and distract from emotional pain?”

Reflection:
Reflect on how focusing on physical sensations can help you manage emotional distress. In a group, the therapist might ask: “How could focusing on sensations help you distract from overwhelming emotions when you’re feeling upset?”

Activity 9: Writing a Letter to Push Away Distress

Intro to activity:
This activity helps clients practice the “Pushing away” part of the ACCEPTS skill by writing down their distressing thoughts or feelings in a letter, then putting it aside for a period of time.

How to practice this activity:

Prompt:
“We’re going to focus on pushing away distress by writing a letter to express your emotions, then setting it aside. The goal is to create emotional distance by putting your thoughts or feelings on paper.”

Preparation:
The therapist provides clients with paper and pens. Clients are encouraged to think about a distressing thought or feeling they’ve been carrying and write it down as if they were writing a letter.

Guidance:
Therapist says: “When you’re feeling distressed, try writing a letter about your emotions. You don’t have to send it—it’s just a way to express your feelings on paper. Once you’ve written it down, set the letter aside and mentally push away the distress for a while.”

Experience:
Clients spend 5-10 minutes writing a letter about their distressing emotions or thoughts, then setting the letter aside. The therapist encourages them to reflect on how writing down their emotions helps create emotional distance.

Observation:
Clients reflect on how they felt after writing the letter. Did expressing their emotions on paper and pushing the letter aside help them feel more in control of their distress?

Discussion:
After the activity, the therapist asks: “What did it feel like to write down your distressing emotions in a letter and set it aside? Did it help you create distance from your feelings?”

Reflection:
Reflect on how writing can help you express and push away distressing emotions. In a group, the therapist might ask: “How could writing down your thoughts and putting them aside help you manage difficult emotions in the future?”

Activity 10: Using Sensory Grounding to Calm Emotions

Intro to activity:
This activity helps clients practice the “Sensations” part of the ACCEPTS skill by using sensory grounding, which focuses on the five senses to bring attention away from distressing thoughts.

How to practice this activity:

Prompt:
“We’re going to focus on sensory grounding to distract from emotional pain. The goal is to focus on your five senses—sight, sound, touch, taste, and smell—to shift your attention away from distress.”

Preparation:
The therapist asks clients to choose an item or experience that stimulates one or more of their senses, such as listening to music, holding an object, or tasting a piece of candy.

Guidance:
Therapist says: “When you feel emotionally overwhelmed, use sensory grounding by focusing on your five senses. Look around and name five things you see, four things you can feel, three things you hear, two things you can smell, and one thing you can taste. This will help bring your attention to the present moment and away from distressing thoughts.”

Experience:
Clients spend 5-10 minutes using sensory grounding by going through each of the five senses, focusing on what they see, hear, feel, smell, and taste. The therapist encourages them to reflect on how this sensory focus helps calm their emotions.

Observation:
Clients reflect on how they felt after using sensory grounding. Did focusing on their five senses help distract from distressing emotions and bring them back to the present moment?

Discussion:
After the activity, the therapist asks: “What did it feel like to use your senses to ground yourself when you were feeling distressed? Did it help you shift your attention away from difficult emotions?”

Reflection:
Reflect on how sensory grounding can help you manage emotional overwhelm. In a group, the therapist might ask: “How could focusing on your five senses help you calm down and stay present when you’re feeling upset?”

Activity 11: Distracting with Gratitude

Intro to activity:
This activity helps clients practice the “Thoughts” part of the ACCEPTS skill by focusing on gratitude as a way to shift their thoughts away from distressing emotions and toward positive aspects of their life.

How to practice this activity:

Prompt:
“We’re going to focus on using gratitude to shift your thoughts away from distress. The goal is to think about things you’re grateful for, which can help you focus on the positives instead of distressing emotions.”

Preparation:
The therapist asks clients to think about a few things in their life that they are thankful for—whether it’s people, experiences, or even simple comforts.

Guidance:
Therapist says: “When you’re feeling emotionally overwhelmed, try focusing on gratitude. Write down or think about three things you’re grateful for right now. This can help shift your focus away from distress and remind you of the positive things in your life.”

Experience:
Clients spend 5-10 minutes writing down or reflecting on things they are grateful for. The therapist encourages them to focus on how gratitude can help redirect their thoughts from emotional pain.

Observation:
Clients reflect on how they felt after focusing on gratitude. Did thinking about positive aspects of their life help reduce emotional distress and shift their perspective?

Discussion:
After the activity, the therapist asks: “What did it feel like to focus on gratitude when you were feeling upset? Did it help shift your emotions or thoughts toward something more positive?”

Reflection:
Reflect on how focusing on gratitude can help you manage emotional distress. In a group, the therapist might ask: “How could practicing gratitude regularly help you cope with difficult emotions?”

Activity 12: Using Visualization to Push Away Distress

Intro to activity:
This activity helps clients practice the “Pushing away” part of the ACCEPTS skill by using visualization techniques to mentally “push away” distressing thoughts and create emotional distance.

How to practice this activity:

Prompt:
“We’re going to focus on using visualization to push away distress. The goal is to mentally picture setting aside your distressing thoughts, giving you emotional space.”

Preparation:
The therapist asks clients to close their eyes and think of a distressing emotion or thought they’d like to push away. Clients can imagine placing this thought in a container, box, or balloon.

Guidance:
Therapist says: “When you’re feeling overwhelmed, visualize placing your distressing thoughts into a container or balloon. Picture closing the lid on the box or releasing the balloon into the air, mentally setting aside the distress. You don’t have to solve it now—just give yourself some space.”

Experience:
Clients spend 5-10 minutes visualizing pushing away their distressing thoughts, whether by putting them in a box or imagining them floating away. The therapist encourages them to focus on the relief that comes from creating this emotional distance.

Observation:
Clients reflect on how they felt after using visualization to push away their distress. Did mentally setting aside the thought help create space and reduce the intensity of their emotions?

Discussion:
After the activity, the therapist asks: “What did it feel like to use visualization to push away distress? Did it help create emotional space and bring relief?”

Reflection:
Reflect on how using visualization can help you manage distressing thoughts. In a group, the therapist might ask: “How could this technique help you create space from overwhelming emotions in the future?”

Activity 13: Generating Emotions by Watching a Group Performance

Intro to activity:
This activity helps clients practice the “Emotions” part of the ACCEPTS skill by generating positive emotions through watching or participating in a group performance, such as a short skit or song.

How to practice this activity:

Prompt:
“We’re going to focus on generating positive emotions by watching or participating in a group performance. The goal is to create emotions like joy or excitement to counter distressing feelings.”

Preparation:
The therapist invites the group to perform a simple skit, song, or dance, or watch a video of a light-hearted performance. Clients can choose to participate or be part of the audience.

Guidance:
Therapist says: “When you’re feeling upset, try engaging with or watching something fun, like a performance or act of creativity. The positive emotions that come from performing or watching others can shift your mood.”

Experience:
Clients spend 5-10 minutes either watching or participating in the group performance. The therapist encourages them to focus on the positive emotions that arise from being part of a creative or joyful activity.

Observation:
Clients reflect on how they felt after watching or participating in the performance. Did engaging with a creative, fun activity help create positive emotions and distract from distress?

Discussion:
After the activity, the therapist asks: “What did it feel like to watch or participate in the group performance? Did it help generate positive emotions and shift your mood?”

Reflection:
Reflect on how watching or participating in creative performances can help you manage emotional distress. In a group, the therapist might ask: “How could engaging in fun, creative activities help you generate positive emotions during emotional challenges?”

Activity 14: Using Temperature Change to Focus on Sensations

Intro to activity:
This activity helps clients practice the “Sensations” part of the ACCEPTS skill by using a temperature change, such as placing hands in warm or cool water, to shift focus from distressing thoughts.

How to practice this activity:

Prompt:
“We’re going to focus on using temperature changes to distract from emotional pain. The goal is to focus fully on the sensation of warmth or coolness to shift your mind away from distressing thoughts.”

Preparation:
The therapist provides access to warm and cool water (or heat and cold packs) and invites clients to place their hands in one or the other, depending on their preference.

Guidance:
Therapist says: “When you’re feeling emotionally overwhelmed, use temperature changes to bring your focus back to your body. Place your hands in warm or cool water, and focus on how the sensation feels. Let this physical experience distract your mind from distressing emotions.”

Experience:
Clients spend 5-10 minutes placing their hands in warm or cool water, focusing on the temperature change and how it feels against their skin. The therapist encourages them to observe how focusing on the sensation shifts their emotional focus.

Observation:
Clients reflect on how they felt after using the temperature change. Did the warmth or coolness help distract from emotional pain and bring a sense of calm or relief?

Discussion:
After the activity, the therapist asks: “What did it feel like to focus on temperature changes when you were feeling distressed? Did it help shift your attention and bring emotional relief?”

Reflection:
Reflect on how focusing on sensations, like temperature, can help you manage distressing emotions. In a group, the therapist might ask: “How could using temperature changes help you distract yourself from emotional pain in the future?”

Activity 15: Distracting by Changing the Environment

Intro to activity:
This activity helps clients practice the “Activities” part of the ACCEPTS skill by changing their environment, whether through moving to a different space or rearranging the area around them.

How to practice this activity:

Prompt:
“We’re going to focus on using a change of environment to distract from emotional distress. The goal is to shift your perspective by physically moving to a different space or changing something in your surroundings.”

Preparation:
The therapist asks clients to either move to a different part of the room or rearrange something in their current environment, such as moving chairs or adjusting the setup.

Guidance:
Therapist says: “When you’re feeling distressed, try physically changing your environment. Move to a new space, rearrange furniture, or go for a walk. Shifting your surroundings can shift your emotional state and help create a new perspective.”

Experience:
Clients spend 5-10 minutes either moving to a new area of the room or rearranging their surroundings in small ways. The therapist encourages them to reflect on how changing their environment helps change their emotional focus.

Observation:
Clients reflect on how they felt after changing their environment. Did moving to a different space or rearranging their surroundings help reduce emotional distress and shift their perspective?

Discussion:
After the activity, the therapist asks: “What did it feel like to change your environment when you were feeling emotionally distressed? Did it help shift your emotions or thoughts in a positive way?”

Reflection:
Reflect on how changing your environment can help you manage emotional overwhelm. In a group, the therapist might ask: “How could shifting your surroundings help you distract yourself when emotions feel overwhelming?”