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Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based treatment developed by Marsha Linehan for individuals with severe emotion regulation difficulties, particularly those with borderline personality disorder (BPD). Over the years, DBT has expanded to treat various conditions, such as depression, anxiety, and substance use disorders. Among the many skills taught in DBT, the TIP skill is particularly crucial for managing acute emotional distress. TIP stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation. This article explores the theoretical foundations, components, empirical support, and practical applications of the TIP skill within DBT.
What Is the Pros and Cons Skill in DBT?
Most people have filled out a pros and cons list at some point. DBT takes this intuitive idea and turns it into a deliberate, structured distress tolerance skill aimed at reducing harmful, impulsive behavior.
In DBT, the Pros/Cons skill is used when:
You feel a strong urge to do something that may help in the short term but hurt in the long term (e.g., self-harm, substance use, quitting therapy, avoiding a feared task).
You are caught between two courses of action and need clarity about which is more effective.
You want to increase motivation to use skills instead of old coping behaviors.
Rather than a single list, DBT often uses a four-quadrant grid (Linehan, 2015; Counseling Center Group, 2024):
Pros of acting on the urge / not using skills
Cons of acting on the urge / not using skills
Pros of resisting the urge / using skills
Cons of resisting the urge / using skills
This layout forces you to look not only at what you “get” from problem behavior (e.g., numbing, control, attention) but also at what it costs you—and what you stand to gain by tolerating distress and acting skillfully instead (dbt.tools, n.d.; WithLight, 2025).
How the DBT Pros/Cons Skill Works
Focusing on Crisis Urges
DBT defines an urge as a crisis when:
It’s very strong, and
Acting on it is likely to make things worse in the long run (e.g., damage relationships, health, safety, or treatment progress).
Distress tolerance handouts explicitly recommend using Pros/Cons when deciding whether to act on crisis urges or whether to persist in doing something necessary but uncomfortable (Distress Tolerance Handout 5; Linehan, 2015).
The skill helps you:
Step out of emotion mind long enough to see the bigger picture.
Bring reasonable mind online without dismissing emotional needs.
Move closer to wise mind, where both are integrated.
Beyond “Normal” Pros and Cons
Everyday pros/cons often focus on short-term outcomes (“Will this feel better right now?”). DBT Pros/Cons explicitly asks you to:
Consider short-term and long-term effects.
Look at both options: acting on the urge and resisting it.
Include pros and cons related to your goals and values, not just feelings in the moment (DBTSelfHelp, n.d.; Counseling Center Group, 2024).
Used repeatedly, this process strengthens:
Motivation to use skills.
Commitment to behavioral change.
Awareness of patterns that keep you stuck (WithLight, 2025).
“Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength.”
"It is not the strength of the body that counts, but the strength of the spirit."
Theoretical Foundations: Why Pros and Cons Matters in DBT
From a behavioral perspective, many high-risk behaviors (e.g., self-harm, substance use, binge eating) are negatively reinforcing: they quickly reduce emotional pain, which makes it more likely the person will repeat them (Linehan, 1993).
In the moment, the short-term pros of the behavior are very loud:
“I’ll feel better right away.”
“I’ll get out of this conversation.”
“I won’t have to feel this shame.”
The long-term cons (scars, health risks, relationship damage, shame later) are quieter, further away, and easy to ignore when emotions are intense. The Pros/Cons skill deliberately pulls those long-term consequences into awareness and contrasts them with the long-term benefits of resisting urges and using skills.
Research on DBT suggests that skills use itself is a key mechanism of change: increased use of DBT skills mediates reductions in self-harm, depression, and anger among individuals with BPD (Neacsiu et al., 2010). Tools like Pros/Cons support this by increasing motivation to choose skills over problem behaviors. Clinical summaries highlight that DBT Pros/Cons strengthens commitment to behavioral change and reduces impulsivity by making the cost–benefit trade-offs explicit (WithLight, 2025).
At a cognitive level, Pros/Cons also:
Interrupts automatic thinking loops.
Encourages more deliberative decision-making.
Supports the wise-mind process of integrating emotion and logic (Linehan, 2015).
Step-by-Step: How to Use the DBT Pros and Cons Skill
You can use this skill anytime there’s a meaningful decision, but it’s especially powerful with crisis urges.
Name the Urge and the Situation
Write at the top of a page (or in a notes app):
Situation: “What is happening?”
Urge: “What do I strongly feel like doing?”
Example:
Situation: I had a fight with my partner and feel rejected.
Urge: I want to cut, cancel therapy, and ignore their messages.
Draw the Four-Quadrant Grid
Divide the page into four boxes:
Pros of acting on the urge / not using skills
Cons of acting on the urge / not using skills
Pros of resisting the urge / using skills
Cons of resisting the urge / using skills
DBT handouts sometimes use similar formats specifically for “Pros and Cons of acting on crisis urges” or “Pros and Cons of using skills vs. not using them” (Linehan, 2015; Distress Tolerance Handout 5).
Fill In All Four Quadrants
Be honest and specific. For example:
Pros of acting on the urge
“Immediate relief from emotional pain.”
“I won’t have to think about the fight for a while.”
Cons of acting on the urge
“I’ll feel ashamed afterwards.”
“It could leave scars / damage my health.”
“My partner and therapist will worry; trust may be hurt.”
“I move further away from my goal of building a stable life.”
Pros of resisting the urge / using skills
“I’ll prove to myself I can do something different.”
“I’ll build confidence in my ability to cope.”
“I protect my body and my relationships.”
Cons of resisting the urge / using skills
“I’ll still feel this pain for a while.”
“It takes time and effort.”
“I might feel restless or frustrated.”
This is where the dialectic shows up: both sides of each choice are allowed to exist. You’re not pretending that using skills is easy or painless; you’re seeing the full picture.
Re-Read and Ask Wise-Mind Questions
Once you’ve filled in the grid, slow down and read it back. Ask:
“Which option moves me closer to the life I say I want?”
“If I imagine looking back a year from now, which choice would I be proud of?”
“If someone I cared about were in this situation, what would I want for them?”
These questions help bring Wise Mind online, integrating emotional reality with long-term values (Linehan, 2015).
Commit to a Short-Term Plan
Based on your Pros/Cons:
Choose one next skillful action (e.g., TIPP, Self-Soothe, calling a friend, going to bed, journaling, scheduling a talk with your partner).
Make a time-limited commitment:
“For the next 30 minutes, I will not act on this urge. I will use skills instead.”
If the urge is still strong after that, you can revisit the list, add new insights, and renew the commitment.
Case Example: Applying DBT Pros and Cons Skill in Practice
Imagine Alex, a 24-year-old student, sitting on their bed late at night after getting a curt text from their partner: “I think we need a break.” A wave of panic hits—tight chest, racing thoughts, and that familiar sinking feeling of being abandoned. Within minutes, Alex’s distress feels like a 9/10, and a powerful urge shows up: to send a barrage of angry messages and then drink until they black out. Part of them knows this usually makes everything worse, but in the moment, all they can think is, “I can’t stand this, I need it to stop now.”
Remembering DBT, Alex grabs their journal and quickly sets up a Pros/Cons grid. In the first box—Pros of acting on the urge—they write things like “I’ll feel powerful for a moment,” “I won’t have to sit in this anxiety,” and “Drinking will numb this.” In the Cons of acting box, they write, a bit slower this time: “I’ll probably say things I can’t take back,” “My partner may block me,” “I’ll wake up ashamed and hungover,” and “This keeps proving to me that I can’t handle emotions without alcohol.” Already, seeing those consequences written out makes Alex pause; it’s harder to pretend none of that matters.
Next, Alex moves to Pros of resisting the urge / using skills: “I’ll protect the relationship if there’s still something to save,” “I’ll be proud of myself tomorrow,” “I’ll feel a bit more in control,” and “This fits with my goal of drinking less.” Under Cons of resisting, they’re honest: “The pain will last longer,” “I’ll feel restless and alone,” and “It will take effort to use skills when I’m exhausted.” Reading the four boxes back, Alex doesn’t suddenly feel calm—but the choice looks different. Acting on the urge now reads like trading a few minutes of relief for a lot of damage.
With that in front of them, Alex makes a short commitment: for the next 30 minutes, they will not text or drink. Instead, they use other DBT skills—splashing cold water on their face, doing paced breathing, and watching one comforting show while holding a warm mug of tea. Their distress drops from a 9 to a 6. The urge is still there, but it no longer feels like a command, more like a loud suggestion they don’t have to obey. By morning, Alex is tired but sober, with no explosive messages sent—and a clear, written reminder that in their worst moments, they were still able to choose a different path.
Limitations and Considerations
Like all skills, Pros/Cons works best when used wisely:
Too dysregulated to think. In very high arousal (panic, rage), you may not be able to think clearly enough to complete a worksheet. In those moments, TIPP or grounding might need to come first.
Rationalizing harmful behavior. If used superficially, someone might over-emphasize the “pros” of harmful behavior and underplay the cons. It’s important to bring Wise Mind and honesty to the exercise, sometimes with therapist support.
Not a substitute for trauma work or problem-solving. Pros/Cons helps with decision-making in the moment; it doesn’t, by itself, heal trauma, fix systemic problems, or replace other DBT modules.
Cultural and personal values. What counts as a “pro” or “con” is deeply tied to values, culture, and context. Therapists should explore how these factors shape the lists rather than assuming a universal hierarchy of pros and cons.
Used appropriately and repeatedly, however, Pros/Cons can become a reliable pause button and decision-support tool that helps people move away from crisis behaviors and toward their long-term goals.
Conclusion
The Pros/Cons skill in DBT transforms a familiar decision-making tool into a targeted distress tolerance strategy for moments when emotions run high and urges to act impulsively are strong. By systematically exploring:
The advantages and disadvantages of acting on urges, and
The advantages and disadvantages of resisting urges and using skills,
individuals gain a clearer view of how their choices affect both short-term relief and long-term wellbeing.
Within the broader DBT framework—alongside mindfulness, emotion regulation, and interpersonal effectiveness—Pros/Cons supports Wise Mind decision-making, strengthens commitment to change, and helps reduce reliance on self-destructive coping. For those living with BPD or other forms of emotional dysregulation, it offers a concrete, portable way to bring clarity and values back into the picture when it matters most.
FAQ
Most frequent questions and answers about the DBT Pros and Cons Skills
Use the Pros/Cons skill when you notice a strong urge to do something that:
Might feel good or relieving right now, but
Is likely to hurt you or your life in the long run (e.g., self-harm, quitting therapy, using substances, blowing up at someone, ghosting, bingeing).
You can also use it when you’re stuck between two choices and want to see more clearly which one aligns with your long-term goals and values.
A regular pros and cons list usually just asks, “What are the good and bad things about this option?”
The DBT version is more structured and focused on crisis urges:
You look at both options: acting on the urge and resisting it/using skills.
You consider short-term relief and long-term consequences.
You tie the pros and cons back to your values, goals, and treatment.
It’s less about “Which seems nicer?” and more about “Which choice helps me build the life I actually want?”
That’s actually common when you’re in Emotion Mind—your brain is naturally focused on immediate relief. A few tips:
Take your time and really stretch to list long-term cons, even if they feel far away.
Ask, “If I did this every time I felt this way, where would I be in a year?”
Imagine someone you love in your situation—what would you see as the downsides for them?
You can also do the worksheet with a therapist or trusted person who can gently help you see blind spots without shaming you.
If your distress is at a 9–10/10, doing a detailed worksheet might be too much. In those moments, try:
Using a faster skill first (like TIPP, paced breathing, or grounding) to bring distress down a bit.
Doing a “micro” Pros/Cons:
Pros of acting on urge: …
Cons of acting on urge: …
Pros of resisting: …
Cons of resisting: …
Even a brief, mental version can create just enough distance from the urge to help you choose a safer action.
No. It means you’re human and practicing something new under stress. The skill still:
Slowed you down—even a little.
Gave you more awareness of why you’re doing what you’re doing.
Created material you and your therapist can learn from later (e.g., “What pros felt most convincing?” “What cons did I minimize?”).
DBT sees progress not as “never acting on urges again,” but as acting on them less often, less intensely, and with more awareness over time. Each time you use Pros/Cons—even if the outcome isn’t perfect—you’re building that capacity.
DBT Pros and Cons Skills Book Recommendations
Here is a collection of the best books on the market related to DBT Pros and Cons Skills:
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Click on the icon to see all your thoughts in the Dashboard.
Your Thoughts about the DBT Pros and Cons Skills
It’s highly recommended that you jot down any ideas or reflections that come to mind regarding the DBT Pros and Cons Skills, including related behaviours, emotions, situations, or other associations you may make. This way, you can refer back to them on your Dashboard or Reflect pop-ups, compare them with your current behaviours, and make any necessary adjustments to keep evolving. Learn more about this feature and how it can benefit you.
References
- Booth, R., et al. (2014). Living through distress: A skills training group for reducing deliberate self-harm. Behavioural and Cognitive Psychotherapy, 42(2), 156–169.
- Counseling Center Group. (2024). DBT Pros and Cons skill: Balance your decisions effectively.
- DBTSelfHelp. (n.d.). Pros and cons. DBT Self Help.
- dbt.tools. (n.d.). Pros/Cons skill – Distress tolerance.
- Haga, E., et al. (2018). Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm. Child and Adolescent Psychiatry and Mental Health, 12, 18.
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
- Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.
- Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839.
- WithLight. (2025). Pros and cons | Distress tolerance DBT tool. WithLight.
