Mastering ACCEPTS: A Guide for Autistic Adults to Dialectical Behavior Therapy Skills

Dialectical behavioral therapy (DBT) teaches practical tools for managing emotions and coping with distress. While it was originally developed to help those with borderline personality disorder (BPD), people who are neurodivergent or dealing with many mental health conditions can find DBT-based tools helpful.

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For many adults with autism spectrum disorder, the DBT skill “ACCEPTS” is helpful during moments of sensory overload, executive functioning fatigue or emotional dysregulation. It offers simple ways to shift focus and make space to regulate before taking action.

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Let’s take a closer look at what each part of ACCEPTS means and how you can make it work for you.

ACCEPTS is a DBT distress tolerance skill that uses short-term, healthy distractions to help you get through intense emotions without spiraling or shutting down. Each letter stands for a different coping strategy:

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• A – Activities: Do something engaging, like playing a video game, organizing a collection or making tea.
• C – Contributing: Shift your focus outward to help others, such as sending a supportive message to a friend or sharing resources online.
• C – Comparisons: Remind yourself of past challenges you've gotten through or times that were hard.
• E – Emotions: Intentionally give yourself different emotions to experience by listening to uplifting music or watching your favorite comfort show.
• P – Pushing Away: Mentally set aside distressing thoughts by imagining them boxed up or writing them down.
• T – Thoughts: Distract your brain with a mental exercise like listing your favorite Pokémon, counting backward or playing a simple memory game.
• S – Sensations: Use grounding sensory input such as holding an ice cube, stimming or using a weighted blanket. Grounding physical sensations help shift your focus and regulate your nervous system.

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These tools aren’t about ignoring your emotions—they give you space to manage them safely until you're ready to respond.

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The science behind ACCEPTS

Distraction isn’t avoidance—it’s a science-backed way to calm the brain during distress. Healthy distractions help reduce activity in the amygdala—your brain’s threat center—giving you space to think clearly again. For autistic adults, sensory strategies such as deep pressure or temperature shifts can also help calm the nervous system by stimulating the vagus nerve. This leads to reduced anxiety, improved body awareness and better emotion regulation.

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Autistic adults often experience intense emotions alongside sensory overload and executive functioning challenges, making it hard to cope in the moment. This can lead to meltdowns, shutdowns and a lot of frustration. ACCEPTS offers quick, accessible tools to redirect focus when things feel “too much, too fast.”

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How ACCEPTS supports distress tolerance

Distress tolerance is about getting through overwhelming moments without making things worse. Each ACCEPTS strategy helps shift your attention and reset your nervous system. It can be used on its own or with other DBT tools.

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Interpersonal effectiveness and ACCEPTS

Social situations can be draining or overwhelming, whether it's because of delayed processing, rejection sensitivity, masking exhaustion or just the overwhelm of back-and-forth communication. 

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ACCEPTS helps create space before, during or after tough moments. This can look like calming your body, interrupting negative thought loops or shifting your focus to something more comfortable, like your special interests.

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By practicing and customizing these skills ahead of time, you can build a go-to toolbox for when things feel too big. ACCEPTS won’t solve everything—but it can help you survive the moment, protect your energy and come back to your challenges with more clarity, control and self-compassion.

The real power of ACCEPTS comes from using it in ways that make sense for you. The more you practice these skills when you're not overwhelmed, the easier it becomes to reach for them when distress hits. Many autistic adults find it helpful to create an “ACCEPTS toolbox” that’s easy to grab or glance at in a hard moment. 

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Building your own ACCEPTS toolbox

Creating a personalized ACCEPTS plan can make a huge difference. Think of it like a menu. When you're overwhelmed, it’s hard to think clearly. Having a list of options already written down means you don’t have to figure it out in the heat of the moment.

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You might try:

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• Write or type out a list of preferred tools under each part of the acronym. Or, you can use cue cards, checklists or an app to outline strategies under each letter. Keep these items visible and easily accessible.
• Save favorite videos, images or sound clips in a folder or app so they’re easily accessible.
• Ask a trusted person to remind you of these tools when you’re struggling.

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By experimenting with these tools, you can discover which ones help you feel calmer and more in control.

Think of ACCEPTS as a first response tool—it helps distract and ground you when emotions feel too big or overwhelming to manage directly. Once you’ve created a little space, you can move on to other DBT skills that focus on processing, problem-solving or navigating relationships.

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It’s also important to note that distraction shouldn’t be the only coping skill you rely on. If you continuously, actively choose to ignore your problems, distraction becomes avoidance––which is harmful to your mental health. 

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Here are some powerful ways to combine ACCEPTS with other DBT skills:

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DEAR MAN

Use ACCEPTS to regulate before a hard conversation. Distracting with a comforting task or grounding sensation can help reduce emotional dysregulation, allowing you to think more clearly and communicate more effectively. During the conversation, you can use DEAR MAN to assert your needs or boundaries.

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TIPP

TIPP and ACCEPTS are both crisis tools. TIPP—temperature, intense exercise, paced breathing and progressive muscle relaxation—focuses on changing your physical state using cold water, movement and breathwork. You can easily combine this with ACCEPTS.

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Self-soothing & radical acceptance

After you’ve distracted yourself with ACCEPTS, you can try self-soothing strategies. These might look like falling back on familiar daily routines or engaging in sensory soothing activities. You can also consider practicing radical acceptance, which is acknowledging what you can’t change without judgment.

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Mindfulness

Mindfulness plays two key roles when using ACCEPTS: it helps you recognize when you’re becoming overwhelmed and supports your ability to return to the present once the distress has passed. Whether through walking, focusing on breath or body scans, mindfulness can deepen the impact of ACCEPTS.

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While ACCEPTS is helpful on its own, it becomes even more powerful when combined with other tools or DBT skills training. 

Using ACCEPTS isn’t always easy, especially during intense distress. To make ACCEPTS more accessible, consider the following adaptations:

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• Customize it – Every part of ACCEPTS is flexible. “Activities” might mean something calm and repetitive, like sorting or coloring. “Sensations” might mean warmth instead of cold temperature changes. You get to define what works for you.
• Ask for support – Using these tools doesn’t mean you should be able to regulate all on your own. It’s okay to practice with a therapist or loved one and to ask for help when you’re struggling. ACCEPTS is a skill, not a solo test.
• Let go of guilt – Distraction isn’t failure—it’s a bridge to safety and clarity. If a strategy doesn’t “work” right away, try another and revisit it later with support.

Like all DBT skills, ACCEPTS isn’t something you have to master overnight, and it isn’t meant to be used “perfectly.” It’s a flexible, adaptable tool that you can make your own and revisit whenever you need it. For autistic adults, especially, building emotion regulation and distress tolerance skills takes time, practice and self-compassion.

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Start small and build fluency

You don’t have to wait for a major crisis to try ACCEPTS. In fact, practicing during low-stakes moments—like a frustrating delay, sensory discomfort or a bad mood—can help you get comfortable using the skill without the pressure of high emotional intensity. The more you use it, the easier it becomes to reach for during bigger emotional waves.

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You might try:

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• Practicing one ACCEPTS letter a day (e.g., focusing on activities today and sensations tomorrow)
• Asking a friend, therapist or support person to help you brainstorm personalized options for each category

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Reflect and Adjust

As with any skill, reflection helps you learn what works for you. After trying ACCEPTS, ask yourself:

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• What helped me feel a little more grounded or distracted?
• What didn’t feel accessible or effective at that moment?
• Was there a component I forgot about that might have helped more?
• Is there something I can adjust to make this easier next time?

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Give yourself grace

Learning how to use ACCEPTS takes practice, not perfection. You might forget about it during tough moments or feel like it doesn’t help right away. That doesn’t mean you’re doing it wrong—it means you’re learning.

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The real goal of ACCEPTS isn’t to eliminate distress entirely. It’s to give yourself the space you need to pause, ground yourself and practice self-care before moving on. 

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You’re allowed to give yourself that space. You deserve tools that work with how you naturally process the world, and ACCEPTS can be one of them.

If you’re feeling overwhelmed by intense emotions, sensory overload or executive functioning fatigue, Prosper Health is here to help. 

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Our virtual therapy services are designed specifically for autistic and neurodivergent adults, offering evidence-based tools like DBT therapy and skills training to support emotional regulation and distress tolerance. 

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With experienced clinicians—many of whom identify as neurodivergent themselves—we tailor care to your unique needs. We accept most major insurance, and 90% of visits are covered. Plus, you can self-schedule an intake within days. 

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With Prosper Health’s support, building a sustainable, personalized self-regulation toolkit is possible. Fill out the form below or contact us to get started.