DBT Opposite Action for Fear Worksheet: Overcoming Anxiety and Avoidance

This DBT Opposite Action for Fear Worksheet guides clients through a comprehensive, two-page clinical process to deconstruct and confront fear. The first page features a “Check the Facts” audit, requiring the client to separate their catastrophic interpretations (e.g., “The plane will crash”) from the objective reality of the situation. It includes a critical appraisal of whether the intensity and duration of the fear match the factual risk. The second page moves into “Opposite Actions,” where the client identifies their specific urges—such as the urge to run away or cancel plans—and brainstorms “Opposite All the Way” actions, such as engaging in the feared activity repeatedly while maintaining an open, confident body posture. The worksheet concludes with a mental rehearsal and a commitment to repeated practice until the physiological fear response diminishes.

The structured layout ensures that the client evaluates the “effectiveness” of their fear-driven impulses. By documenting why avoidance is often counterproductive to their long-term goals, the client develops the cognitive motivation needed to engage in the difficult work of exposure and behavioral activation.

How This Worksheet Can Be Used

Clinical Sessions:
Therapists use the worksheet to design in-session exposure experiments or to process recent “avoidance slips.” It serves as a deconstruction tool to help the clinician and client identify specific “stuck points” in the client’s risk assessment and plan for behavioral confrontation.

Between-Session Practice:
Clients use the worksheet as a real-world tool for managing phobias, social anxiety, or anticipatory fear. It acts as a cognitive anchor, helping them choose to “approach” rather than “avoid” even when their “Emotional Mind” is demanding safety behaviors.

Emotion Regulation Training:
As a specialized application of the Emotion Regulation module, this worksheet helps clients understand the “action trends” of fear. It provides a concrete method for practicing the DBT skill of “Building Mastery” by overcoming obstacles that previously seemed insurmountable.

Benefits of the DBT Opposite Action for Fear Worksheet

• Provides a structured “Check the Facts” framework specifically tailored for anxiety and phobic responses.
• Identifies the self-defeating avoidance urges that keep fear alive and reinforced.
• Targets “All the Way” opposite actions to ensure a complete physiological and emotional shift.
• Reduces the power of irrational fear through structured, evidence-based behavioral exposure.
• Includes a “Wise Mind” inquiry to evaluate the long-term effectiveness of avoidance vs. approach.
• Supports the “Emotion Regulation” component of the evidence-based DBT protocol.

Integrating This Tool into Clinical Work

Integrating the DBT Opposite Action for Fear Worksheet is most effective when clinicians emphasize that “opposite” must be “all the way” to work. If the urge is to “look away,” the opposite action is to “keep looking”; if the urge is to “slouch,” the opposite is to “stand tall.” Clinicians should guide clients to repeat the opposite action until the fear drops—reminding them that a single attempt is often not enough for the brain to learn the situation is safe. In the “Action Urges” section, it is helpful to identify “safety behaviors” (like gripping a chair or avoiding eye contact) that must also be reversed. By consistently using this worksheet, the clinician helps the client replace the habit of avoidance with a habit of approach, leading to a more courageous and unrestricted 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.
• Barlow, D. H. (2014). Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. Guilford Press. (Providing context on exposure and opposite action).
• McKay, M., Wood, J. C., & Brantley, J. (2019). The Dialectical Behavior Therapy Skills Workbook. New Harbinger Publications.