DBT Pros and Cons Worksheet: Tool for Improving Decision-Making

This DBT Pros and Cons Worksheet guides clients through a detailed four-quadrant analysis of their current crisis or urge. It begins by defining the specific distressing situation, followed by a structured matrix where the client must list the advantages and disadvantages of two distinct paths: “Choosing to Cope” (tolerating the distress skillfully) and “Choosing Not to Cope” (acting on the impulsive urge). By documenting the “Pros of Not Coping” (e.g., immediate relief) alongside the “Cons of Not Coping” (e.g., shame, legal issues, or health problems), the client is forced to acknowledge the temporary nature of emotional relief versus the permanence of destructive consequences.

The layout ensures that the client evaluates both the short-term and long-term impacts of their choices. This process is vital for interrupting the “cognitive narrowing” that occurs during high arousal, helping the client stay focused on their values even when their emotions are demanding an escape.

How This Worksheet Can Be Used

Clinical Sessions:
Therapists use the worksheet to conduct a “post-mortem” analysis of a recent crisis. It helps the therapist and client identify the specific “pros” the client is seeking when they act impulsively, allowing for more targeted skill-building in those areas (e.g., finding healthier ways to achieve emotional relief).

Crisis Planning:
Clients use the worksheet to pre-plan for recurring urges. By filling out the Pros and Cons of a specific habit (like binge eating or lashing out) during a calm state, the client creates a “rational roadmap” they can refer to when the urge is at its peak.

Distress Tolerance Training:
As a core skill in the Distress Tolerance module, this worksheet is used to teach the “Acceptance” phase of DBT. It helps clients understand that while they cannot always change their pain, they can always choose how to respond to it.

Benefits of the DBT Pros and Cons Worksheet

• Provides a structured, visual framework for resisting impulsive and self-destructive urges.
• Helps clients recognize the hidden “long-term cons” of behaviors that offer only “short-term pros.”
• Supports “Wise Mind” functioning by encouraging a balanced appraisal of consequences.
• Reduces emotional reactivity by creating a cognitive “delay” between trigger and action.
• Increases self-efficacy by helping clients consciously choose skillful coping over habitual reactions.
• Builds foundational skills for long-term behavioral change and relapse prevention.

Integrating This Tool into Clinical Work

Integrating the DBT Pros and Cons Worksheet is most effective when clinicians emphasize that the “Pros of Not Coping” are real—if acting on an urge didn’t provide some relief, the client wouldn’t do it. Acknowledging this helps reduce shame and fosters a collaborative clinical alliance. Clinicians should guide clients to focus especially on the “Cons of Not Coping,” as these are often the “forgotten facts” during a crisis. It is also helpful to have clients carry a completed version of this worksheet with them as a “flashcard” for high-risk situations. By consistently reviewing this worksheet, the clinician reinforces the idea that effectiveness is more important than immediate emotional comfort, which is the cornerstone of building a life worth living in DBT.

References

• Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.
• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
• Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide. Guilford Press.
• McKay, M., Wood, J. C., & Brantley, J. (2019). The Dialectical Behavior Therapy Skills Workbook. New Harbinger Publications.