DBT Opposite Action for Disgust Worksheet: Managing Avoidance Urges

This DBT Opposite Action for Disgust Worksheet guides clients through a comprehensive, two-page clinical process to regulate feelings of disgust. The first page features a “Check the Facts” audit, requiring the client to separate their visceral interpretations (e.g., “This will contaminate me” or “This is morally wrong”) from the objective reality of the trigger. This section includes a critical appraisal of whether the intensity and duration of the disgust are proportionate to the actual level of threat. The second page moves into “Opposite Actions,” where the client identifies their specific urges—such as the urge to look away, wash, or vomit—and brainstorms “Opposite All The Way” actions, such as physically moving closer or engaging the senses (smelling, looking, tasting). The worksheet concludes with a mental rehearsal phase and a commitment to repeated practice until the emotional repulsion dissipates.

The structured layout ensures that the client evaluates the “effectiveness” of their impulses. By documenting why acting on disgust is often counterproductive to their personal or clinical goals, the client develops the behavioral motivation needed to engage in the difficult work of sensory exposure and cognitive reframing.

How This Worksheet Can Be Used

Clinical Sessions:
Therapists use the worksheet to process visceral reactions that occur during session or between sessions. It serves as a deconstruction tool to help the clinician and client identify specific “stuck points” in the client’s sensory processing or moral appraisals and plan for behavioral “exposure” experiments.

Between-Session Practice:
Clients use the worksheet as a real-world tool for managing situations where they feel an urge to avoid something safe but “unpleasant.” It acts as a cognitive anchor, helping them pause and choose to move toward the experience rather than withdrawing in response to an automatic urge.

Emotion Regulation Training:
As a specialized application of the Emotion Regulation module, this worksheet helps clients understand the biological function of disgust. It provides a concrete method for practicing the DBT skill of “Observing and Describing” visceral sensations without immediately reacting to them.

Benefits of the DBT Opposite Action for Disgust Worksheet

• Provides a structured “Check the Facts” framework specifically tailored for repulsion and contamination fears.
• Identifies the destructive behavioral urges (avoiding, cleaning, pushing away) that maintain maladaptive disgust.
• Targets “All the Way” opposite actions to ensure a complete physiological and emotional shift through exposure.
• Reduces behavioral avoidance by encouraging clients to move closer to triggers in a controlled, skillful manner.
• Includes a “Wise Mind” inquiry to evaluate the long-term effectiveness of acting on disgust-driven urges.
• Supports the “Emotion Regulation” component of the evidence-based DBT protocol.

Integrating This Tool into Clinical Work

Integrating the DBT Opposite Action for Disgust Worksheet is most effective when clinicians emphasize that “opposite” means total immersion rather than “half-way” engagement. If the urge is to “spit it out,” the opposite action is to “swallow”; if the urge is to “wash,” the opposite is to “stay dirty” (within safe limits). Clinicians should guide clients to use the “Opposite All The Way” section to practice somatic shifts, such as relaxing the face and opening the posture, as disgust is often carried in a “scrunched” facial expression and closed body. When reviewing the “Repeat Acting Opposite” section, it is vital to remind the client that the visceral “nausea” or repulsion may persist initially; the goal is to “act the opposite” until the biological system habituates. By consistently using this worksheet, the clinician helps the client replace instinctive rejection with a stance of “effective engagement,” leading to a more expansive and less restricted life.

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.
• Power, M., & Dalgleish, T. (2015). Cognition and Emotion. Psychology Press. (Providing context on the function and regulation of the disgust response).