Beauty and the Borderline

A Journey towards Integration

Distress Tolerance: Pros & Cons

Pros & Cons is one of my favourite skills, because it helps you to make it through crisis situations, and to focus on your long-term goals.  (I consider it the first of the Dialectical Skills, because it’s a wonderful introduction to looking at an issue from all sides, and it can be especially effective during a “splitting” crisis.)

Thinking of PROS & CONS

Make a list of the pros and cons of tolerating the distress.  Make another list of the pros and cons of not 256px-Light_on_door_at_the_end_of_tunneltolerating the distress — that is, of coping by hurting yourself, abusing alcohol or drugs, or doing something else impulsive.

Focus on long-term goals, the light at the end of the tunnel.  Remember times when pain has ended.

Think of the positive consequences of tolerating the distress.  Imagine in your mind how good you will feel if you achieve your goals, if you don’t act impulsively.

Think of all the negative consequences of not tolerating your current distress.  Remember what has happened in the past when you have acted impulsively to escape the moment.

Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan, p. 169

 

Here’s how the good people at Ontario Shores presented Pros & Cons to my group:

PROS AND CONS:  Think about the advantages and disadvantages of doing something AND not doing it.

  1. Figure out what behaviour is the problem
  2. The first time you use Pros & Cons, do it while NOT in crisis
  3. Keep the Pros & Cons written down, then reread when you’re in crisis
  4. Do the WISE thing

 

Beauty’s example:

PROS CONS
Use marijuana
  • Relax
  • Escape negative feelings
  • Temporary high
  • No significant short-term health effects
  • Avoid crisis
  • Avoid self-harm or harming relationships
  • Lack of judgment
  • Not learning or using healthier skills
  • Lack of focus, control
  • Potential long-term health effects
  • Possible addiction if abused
  • May harm relationships
  • Bad role model for child
  • Judge myself/feel shame
Don’t use marijuana
  • Pride in own strength of will
  • Using healthier skills
  • Retain focus and control
  • Better role model
  • Endure extreme emotions
  • May “act out” or have crisis
  • Feel and act irritable

 

 

When I first learned this skill, I used it for EVERYTHING.  What are the pros & cons of writing a nasty letter to my mother-in-law?  Of going out for a cigarette?  Of working on my taxes now or tomorrow?  Of smoking a joint or having a glass of wine?  Does it sound tedious?  Maybe not to us Borderlines, many of whom, like me, have decision-making problems.  In my own example, above, smoking a joint may be appropriate at times, like when my child isn’t around and when I don’t have anything else to accomplish (ah, LBK = life before kid, those were the "Bob Marley - Statue - Kingston - Jamaica" by Avda - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Bob_Marley_-_Statue_-_Kingston_-_Jamaica.jpg#/media/File:Bob_Marley_-_Statue_-_Kingston_-_Jamaica.jpgdays) but often I am just too busy, and have too much to lose, to smoke marijuana all day (though if I keep collecting AirMiles I’ll have enough for a one-way trip to Jamaica when I’m 80!).

After a week, I started to get quicker and using the Pros & Cons skill. Soon I could list and remember the pros & cons of various actions in my head, even in the middle of situations that formerly would have sent me into crisis!  But most importantly, I learned to start looking at everything from multiple points-of-view, and to get out of the black/white, all-or-nothing, extreme thinking that so often made my crises much worse.  Each situation is unique, and what is right one time may be inappropriate or harmful another time.

Pros and Cons and Behaviour Chain Analysis of Problem Behaviour from DBT Self Help

DBT Skills Handbook, pp. 64-66

How to Use the PROS AND CONS Skill by Life on the Borderline

DBT Distress Tolerance Skills by Kate Comtois, PhD, MPH, pp. 15-16

DBT: Pros and Cons Skill from My Dialectical Life

Worksheets for Pros and Cons 1 2 3 from DBT Peer Connections

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