DBT – Skill Set: ACCEPTS


I saw my group therapist yesterday for a 1-1. I’ve been gp having a few problems relating to quasi-psychosis, at least I thought, they’re not telling me I’m fully psychotic again. She explained to me that sometimes I can go into full psychosis but I’m not at the moment and I’m not a “psychotic person” because for the vast majority of the time I’m fully in touch with reality. This to an extent was comforting I suppose until she explained that I slip into quasi-psychosis regularly in response to stress. 
There are two ways of thinking about this: 
1) omg how am I ever going to manage normal stressors and life, and work and do anything without becoming unwell. 
2) ok, so I can’t handle stress. How can I work on managing stress better. 
My problem with number 2 though is that it takes very little stress for me to become unwell, and for me, managing my stress levels so I’m not quasi-psychotic, dissociating, depressed or manic is a full time job within itself and that, although I’m not entirely ashamed of illness, pisses me off to be frank. It pisses me off that my mum goes on like “you weren’t like this!” Comparing me to other 16 year old, no, perhaps it would have been more normal for me to act out in this way but you must remember at 16 I was bulimic and depressed. This isn’t mentioning the last 11 years I’ve spent in therapy, in and out of hospital and no, it’s not all genetic because other people with bipolar in my family have managed to stay out of hospital. It’s rather instead a beautiful combination of a neglected childhood and a poor genetic pool, but she refuses to believe this, and I find this stressful…and apparently triggering. 
I’m relatively new to the DBT group so we haven’t worked too much on distress tolerance skills but she told me about the ACCEPTS acronym system. 

Activities – do something. My list includes: Netflix, PS3, reading, writing about something outside of myself. 

Comparisons – comparing the current situation to a situation when it’s been worse for you in the past and saying, “hey, at least it’s not as bad as xy time before” 

Contributions – getting outside of yourself and contributing or doing something for someone else. I wrote down to have a conversation with someone entirely about them and listen one mindfully to them and ask how they are. 

Emotions – try to trigger other emotions to what you’re feeling. Doesn’t have to be a positive emotion but to some forging more bearable so if you’re scared, maybe sadness would be more bearable. Activities to do this include: reading the news, watching Netflix and reading a book. 

Push Away – push it away and deal with it later when you’re in a calmer space. Validating self that this is difficult, but put it on the shelf and don’t think about it for X amount of time. “I’ll think about it tomorrow” 

Thoughts – play mind games such as letter and number games. Counting things, look for distraction to play with that are everywhere. 

Sensations – smell, taste, hearing, touch. Use stuff like smelling salts, the cold water technique, vapours, vaping, exercise. 

These skills are aimed at improving the moment. I have been watching Netflix a lot as an activity distraction away from thinking about what is going on for me. I’ll be trying this method out in the coming weeks for distress tolerance and will let you know how I get on with it. 


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