dbt group notes: weighing pros and cons

MINDFULNESS

Paced breathing from the DBT TIPP skills is meant to slow the breath down and restore balance when you are panicking or very upset. We tend to hyperventilate–or breath in much more than we breath out when we are panicking. The idea here is to reverse that and breath out twice as much as you breath in.

Play this little guided meditation to help you practice Paced Breathing.

INDEX CARDS/DISTRESS TOLERANCE TOOL KIT

As we move through the Distress Tolerance Unit, keep your index cards handy! Write down each idea for a coping activity that appeals to you. Give each idea its own index card.

This way, when you are distressed and needing to figure out a skill to use in the crisis, you can flip through the cards quickly. Usually people will flip through and think “This is a terrible idea! Why did I write this one down?” or “That’s too expensive, I can’t do that right now.” or “no, I don’t feel like doing that.” Until you finally hit on the card that you think, “Okay, I could try that.”

Wrap a rubber band around your index cards and take them with you everywhere. You never know when you will need them!

Just the other day, a former client reached out to me (Diana) to say, “I just found my index cards a few days ago in an old purse. And the timing was so perfect, because I really needed them! And I have been using them constantly to help me get through this!”

Be generous about writing down ideas. But also be really specific. So for the Contributing skill, don’t just write “Contributing”. I promise when you are in a crisis, you will not be able to think of any ideas. Instead write “Mow my (little old lady) neighbor’s lawn” “Do a random act of kindness like paying for the person’s coffee in line behind me” “mail a thoughtful card to an old friend” “finally actually volunteer to walk dogs at the shelter”… The more specific the ideas, the easier it will be to find something that helps….when you need it.

THE STOP SKILL

The Stop skill as it is taught in DBT is a little bit different from the version I like to teach that comes from Mindfulness Based Stress Reduction. To learn more about that version, please visit my blog post: https://dbtforlife.com/2020/12/31/dbt-stories-two-skills-observe-and-stop/

In DBT the acronym stands for:

This video does an excellent job explaining the STOP skill:

ENTERING INTO THE DIALECTIC ABOUT THE STOP

Of course, it’s very easy to say, “Just STOP! Freeze! Stop talking! Stop doing whatever you are doing!” Actually stopping is really hard. The only real solution for this is to practice. So I strongly recommend setting STOP reminders in your phone. (In Group I periodically send them out to help clients practice.) Just a little reminder to STOP, Take a breath, Observe and Proceed.

A dialectic is two opposing truths that can both be true at the same time. So to honor the dialectic between the effectiveness of the STOP skill, and how it can feel to have someone tell you “Just stop”, I hope you will enjoy this little video–and find it validating and entertaining.

WEIGHING PROS AND CONS

Another great distress tolerance skill is the four quadrant DBT Pros and Cons lists. In DBT, we not only weigh the pros and cons of doing something, we also weigh the pros and cons of NOT doing it. There is usually alot of overlap between the pros of doing something and the cons of not doing it. As well as overlap between the cons of doing something and the pros of not doing it. But there are differences–sometimes subtle and sometimes quite striking.

In the DBT Skills Training Handouts and Worksheets, the examples refer to impulsive behaviors, but this skill can be used to assess any decision large or small.

One aspect of the pros and cons that can be particularly helpful is to look for solutions to the cons on your list. This can change the balance of your decision making. For example if the con of not acting on your crisis urge is that you won’t have a way to stop your pain–then look for other ways to ease the pain (other distress tolerance skills!)

A SAMPLE PROS AND CONS LIST: WEIGHING THE PROS AND CONS OF VERBAL RETALIATION

Ideally, you will keep practicing pros and cons lists so that when you are in a crisis situation, you can quickly run through the pros and cons (that’s why pros and cons of hitting the snooze bar–again–is great practice!!!)

So if you are in a confrontation with someone at work, or school or in your family, and they say something insulting or invalidating, the tendency to want to escalate with verbal retaliation may be high (depending on the situation and relationships).

Here is an example of how you might complete the pros and cons chart:

HOMEWORK

Think of a situation where you have a decision to make.

Perhaps something big like looking for a new job, or breaking up with a boyfriend. Or something small like whether or not to order take out or make dinner at home. Then write down the pros and cons. Make the list comprehensive.

Then go through the cons and be creative about solutions.

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Diana is a licensed professional counselor based in Nashville. She has been teaching DBT skills for the last ten years after writing her master's thesis about making DBT skills training interesting and engaging. She loves using story telling to help illustrate how skills can be used.

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