Pros & Cons (DBT Distress Tolerance) — "Tolerate vs. Don't Tolerate"

Distress Tolerance skills help you get through intense moments without making things worse, especially when you can't change the situation right away.

DBT Pros & Cons is different from a typical pros/cons list. In DBT, you compare:

  • Pros/Cons of tolerating distress (coping / not acting on urges)
  • vs.
  • Pros/Cons of not tolerating distress (acting on urges / impulsive coping)

This helps you step back from urgency and choose the option with better long-term outcomes.

What is this for?

Use this when:

  • an urge feels very strong
  • acting on the urge would make things worse long-term
  • your brain says "I don't care, I need relief NOW"
  • you feel stuck between two paths: cope vs. act impulsively

Step-by-step: DBT Pros & Cons

Step 0 — Name the crisis urge (10 seconds)

Finish the sentence:

"My urge right now is to ________."

Examples:

text repeatedly, lash out, quit suddenly, self-harm, avoid, isolate, use substances, binge, spend, give up.

(DBT uses pros/cons specifically for "crisis urges"—strong urges that can lead to long-term harm.)

Step 1 — Define the two choices (15 seconds)

Write two headings:

  • Choice A: Act on the urge (Not coping / Not tolerating distress)
  • Choice B: Resist the urge (Coping / Tolerating distress)

DBT asks you to list pros/cons for both choices.

Step 2 — Draw the 2x2 grid (20 seconds)

Use this grid:

  • Pros of Acting on the Urge
  • Cons of Acting on the Urge
  • Pros of Resisting the Urge
  • Cons of Resisting the Urge

(You'll fill it fast—imperfect is fine.)

Step 3 — Fill it in: SHORT-TERM first (1 minute)

Start with what your brain cares about right now.

Pros of Acting on the Urge (short-term)

Examples:

  • "Immediate relief"
  • "I feel powerful / in control"
  • "I get attention / validation"
  • "I don't have to feel this"

Cons of Acting on the Urge (short-term)

Examples:

  • "More conflict tonight"
  • "I'll lose my evening to the aftermath"
  • "I'll feel shaky / dysregulated"

Pros of Resisting the Urge (short-term)

Examples:

  • "I stay safe"
  • "I avoid making the situation worse"
  • "I prove to myself I can ride the wave"

Cons of Resisting the Urge (short-term)

Examples:

  • "It feels awful"
  • "I have to tolerate discomfort"
  • "It takes effort"

Step 4 — Now add LONG-TERM consequences (1 minute)

This is the part crisis brain tries to skip. DBT explicitly asks you to consider long-term outcomes.

Ask:

  • "If I do this repeatedly, what happens to my life?"
  • "What happens to my relationships, money, health, self-respect?"
  • "What pattern am I reinforcing?"

Common long-term cons of acting on urges:

  • regret/shame
  • damaged trust
  • lost opportunities
  • stronger future urges (habit loop)

Common long-term pros of resisting urges:

  • more self-trust
  • fewer blowups
  • better long-term stability
  • easier skill use next time

Step 5 — Circle your "top 2" on each side (30 seconds)

Circle:

  • the two biggest benefits of coping/tolerating
  • the two biggest costs of acting on the urge

This makes your decision clearer when your mind is loud.

Step 6 — Make the smallest commitment (10 seconds)

Choose one:

  • "For the next 10 minutes, I will not act on this urge."
  • "For the next hour, I will delay."
  • "I will use one distress tolerance skill first."

DBT often uses pros/cons to support delay + skill use rather than white-knuckling.

Step 7 — Rehearse it (this is the DBT secret)

DBT materials recommend:

  • write your pros/cons before a crisis when possible
  • carry them
  • rehearse them repeatedly
  • when an urge hits, review them and imagine the outcomes

Quick rehearsal script:

  • "If I act on the urge, I get ______ now, and I pay ______ later."
  • "If I resist, I feel ______ now, and I get ______ later."

Example (short)

Urge: "Yell at the instructor and storm out."

Pros of acting: immediate release, feels powerful
Cons of acting: can't return, shame later, conflict
Pros of resisting: stay in class, self-respect, emotions pass
Cons of resisting: discomfort, effort

Result: choose "ride the wave," then distract later if needed. (This matches the DBT example style of comparing coping vs not coping.)

Practice (so it works when you need it)

Practice on low-stakes situations first (DBT recommends rehearsal when you're not highly emotionally invested).

Try one:

  • "Pros/cons of going to bed on time"
  • "Pros/cons of not sending the third follow-up text"
  • "Pros/cons of taking a 10-minute walk instead of doomscrolling"

The goal is for Pros/Cons to become quick enough to do in your head when distress hits.

Try the Worksheet (pdf)Pros & Cons Practice (pdf)