Pros and Cons: Deciding Whether to Act on a Crisis Urge
The DBT distress tolerance skill for the moment before an impulsive action
Pros and Cons: Deciding Whether to Act on a Crisis Urge
The DBT distress tolerance skill for the moment before an impulsive action
Pros and Cons: Deciding Whether to Act on a Crisis Urge
The DBT distress tolerance skill for the moment before an impulsive action
In a crisis the mind narrows to one option and its immediate relief. Pros and Cons is the DBT skill that widens the frame back out (Linehan, 2015). It compares acting on the crisis urge with tolerating the distress, in a four-cell grid, and it is done in advance, when the person is calm, so the completed sheet can be read in the moment when thinking is not available. An urge is a crisis when it is very strong and acting on it would make things worse in the long term. It can be an urge to do something harmful (using, self-harm, a furious message, a text to an ex) or an urge to give in, give up, or avoid doing what needs to be done, which is the quieter crisis most people miss. This sheet explains how to fill in the grid so it is honest, and how to use it when the urge arrives. It pairs with Riding the Wave: A Practical Guide to Urge Surfing and, for urges toward self-harm, with a Personal Crisis Safety Plan.
The Four Cells
- Pros of acting on the urge Write these honestly. The relief is real, and a sheet that pretends otherwise gets thrown away in the moment. Immediate relief, a feeling of control, punishing someone, numbing.Example: Using: the anxiety stops within minutes. Sending the message: he will finally know how much he hurt me.
- Cons of acting on the urge Short-term and long-term, for yourself and for others. Include what it costs the goals you have set in treatment.Example: Using: the shame tomorrow, the lie to my sister, another month before I can trust myself. The message: it will be screenshotted, and I will have to see him at the wedding.
- Pros of tolerating the distress What is gained by getting through the next hour without acting. Self-respect, evidence that the urge passes, keeping a commitment, the thing you are protecting.Example: Every urge I have ridden out has passed within an hour. Each one makes the next one shorter.
- Cons of tolerating the distress Also honest. It is uncomfortable, it takes effort, and the relief is delayed. Naming the cost of the harder path is what makes choosing it a choice rather than a rule.
Using the Sheet in the Moment
- Fill it in when calm, read it when not The grid is written in advance for a specific recurring urge, then carried and rehearsed over and over while calm, so its contents are familiar before they are needed. In the crisis the job is only to find the sheet and read it. Keep a photo of it on the phone.
- Weight the long-term cells Crisis thinking overweights the next ten minutes. Rereading the long-term consequences in your own words is the correction. Imagine the good consequences of resisting, think through the bad consequences of giving in, and remember the times you acted on the urge before and what followed.
- Pair with a delay Commit to reading the sheet and waiting a set time, twenty minutes to start, before acting. Most urges peak and fall inside that window, which Urge Surfing explains.
- Then use a distraction or self-soothing skill Once the decision to tolerate is made, ACCEPTS and Self-Soothe with the Five Senses give the next hour something to do.
When to Get Help Now
- If you are in crisis or thinking about harming yourself, call or text 988 (Suicide and Crisis Lifeline) or go to the nearest emergency department.
- Pros and Cons is a tolerance skill, not a safety plan. If the urge is to end your life, the sheet is one step in a plan made with a clinician, never the whole plan.
References
- Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Related DBT Worksheets
View all DBT →Self-Soothe with the Five Senses: A Distress Tolerance Kit
The DBT skill for calming the body through sight, sound, smell, taste, and touch
DBTThe ACCEPTS Framework for Crisis Survival
Seven Distraction Strategies to Ride Out Emotional Storms
DBTUnderstanding Borderline Personality Disorder
What BPD is, what it isn't, and what actually helps
See also
Clinical guides that use this worksheet
Common Questions
What is the Pros and Cons: Deciding Whether to Act on a Crisis Urge worksheet?
In a crisis the mind narrows to one option and its immediate relief. Pros and Cons is the DBT skill that widens the frame back out (Linehan, 2015).
How do I use the Pros and Cons: Deciding Whether to Act on a Crisis Urge worksheet?
Read through this resource to learn key concepts. Share with your therapist or use as a study reference. You can print this sheet or bookmark it for quick access later.
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