#23: Pros and Cons
Today’s show covers the DBT skill called Pros and Cons. While most of us have already done informal pro and con lists in our heads when facing a tough decision, the DBT take on Pros and Cons is a little different.
Pros and Cons is great to use in anticipation of problem behaviors like avoiding, lashing out, shutting down, self-harm, or any kind of addictive behavior. Just make sure that you’re in your Wise Mind when you write out your Pros and Cons list, rather than Emotion Mind.
We review states of mind during this episode as well, in case you’re unfamiliar with the concepts of Wise Mind, Emotion Mind, and Reasonable Mind. We also review the SUDs scale, or Subjective Units of Distress, to help you become familiar with what different distress levels feel like for you.
Pros and Cons is part of the Distress Tolerance module and all the skills in Distress Tolerance are designed to help you get through a crisis or stressful situation without making things worse.
Towards the end of the podcast, Marielle guides Ed through a Pros and Cons list for procrastination. You might be surprised at what is discovered!
Show Highlights:
- Pros and Cons skill helps you map out advantages and disadvantages of different courses of action
- Pros and Cons is the opposite of acting impulsively or without thinking
- Consider both long and short term goals when using Pros and Cons
- Identify crisis behaviors or urges that don’t serve you and that you would like to change
- Make a list of the pros and the cons of acting on the urge
- Also, identify the pros and cons of resisting the crisis urge
- Often the downside of resisting the urge is that you feel bad, or perhaps even miserable, in the moment
- Usually, the major benefit of acting on the crisis urge is immediate relief
- Sometimes there is resistance to using Pros and Cons because those crisis urges give you something you need that you don’t know how to get otherwise
- Keep your Pros and Cons list somewhere handy: in your wallet or on your fridge so you can see it when you need it
- Ed runs through pros and cons around procrastination
- Avoiding brings him relief in the short-term but there is a constant sense of dread, too, and building anxiety
Links & Resources
DBT Skills Training Handouts and Worksheets, Second Edition
SUDs (Subjective Units of Distress) scale
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#23: Pros and Cons
Transcript
Marielle Berg
Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center. So today, Ed and I are going to be diving into the distress tolerance skill called Pros and Cons. And so, similarly to many of the other skills like the skill is in the name. I’m sure many listeners have informally used pros and cons lists when they have difficult decisions to make in their minds. The skill is a bit more involved, and we have some things to unpack a little bit about the skill that will help really make it useful when you are facing a tough decision.
Ed Fowler
And I think this skill is definitely helpful to do in moments where our distress level is lower, to use to remind ourselves of our goals when our distress level is higher. So we’ll get into how to do this in a moment of lower stress in order to pull it back as a reminder in moments of higher stress.
Marielle Berg
And on that note to get us started. Let’s review states of mind because it’s been a little while since we talked about this concept, although I know we refer to the idea of wise mind, often.
Ed Fowler
Basically, wise mind the concept we’ve talked about before, is a state where we are balancing what we all have, which is our emotion mind and our reasonable mind. And so we spend a lot of time in DBT trying to mindfully notice what state of mind am I in right now? Am I in really strong emotion mind, where emotions are driving the car? And like really that’s the predominant experience, is what I’m feeling emotionally? Am I more in a reasonable mind state which is more factual, getting into just the facts of the situation without much attention to emotion? Or do I have a balance between the two where I’m bringing in my emotional awareness as well as facts, which gets me to this place that we call wise mind.
Marielle Berg
And ideally, we’re making as many decisions as we can from this wise mind place. And sometimes people feel like I don’t have wise mind, I just, I was just born without one. And I would say that I think we might say that we all have the potential to access that wise place in ourselves. It just might take a little bit of practice. And some synonyms for wise minds that might be useful to think about our intuition. Or sometimes people talk about like a gut sense of just kind of knowing that something is right or wrong.
Ed Fowler
And I find the differentiation in DBT between wise mind and emotion mind to be helpful. Because so often when, when people are talking about “oh, my intuition told me” very often what we’re talking about is our emotion mind told us like I was feeling extremely angry. And my intuition told me that that person was doing me wrong. And we’ve had those experiences where it’s like, Oh, I was actually really misinterpreting the situation. And my anger was not necessarily based on what was really happening. And in DBT, we recognize that sometimes we are in that emotion mind place where it’s like, oh, my emotions are so strong, it’s coloring all of my thoughts. And other times we’re able to recognize I’m really feeling pretty balanced right now. And like, Yeah, I’m noticing my anger, I’m also noticing that this other person did X, Y, and Z. And that was really harmful. Like my my intuition is telling me that this is somebody I need to maybe stay away from. So that’s the difference between emotion mind intuition, quote, unquote, and I’m making quotation marks with my fingers as if anyone can see me. So emotion mind versus wise mind, intuition.
Marielle Berg
That’s such a good point. Because so often, especially for folks who feel strong emotions, I think particularly with anger, that–and I’ve been in this place myself where it feels like so right, I feel so justified. And in that moment, I would probably say yes, this is my wise mind, and I need to tell you off, you know, in the most cautious way possible, and only in retrospect, do I realize like, oh my subjective units of distress or SUDs, which we’ll talk about in a moment. We’ll review again, that that was through the roof and I’m full on in emotion mind. And that doesn’t mean that when I sort of calm down and I access my wise mind, I’m not still angry, but as you said, it comes out or gets expressed very differently, right.
Ed Fowler
And again, like with most things in DBT, we’re looking for that dialectical balance between two things that may seem opposite. So the balanced wise mind is this balance between emotion and reason. We need both, we cannot just have one or the other. And so what we’re looking for is, am I in that balanced place?
Marielle Berg
And the whole reason why we decided to review states of mind and wise mind in particular before we dive into the Pros and Cons skill, is that we do the skill when we are in wise mind. And we’re doing a pros and cons very often have patterns of behavior that we engage in when we’re an emotion mind. So it’s a way of kind of communicating between the two states of mind because when you’re in high emotion mind, it’s really easy to lose sight of long term goals or values. Emotion mind often wants to get us to act really quickly to just relieve distress, which we’ll we’ll talk about in a little bit. Let’s move on and talk about distress tolerance, kind of the whole idea of it in general, just as a quick review, before we dive into the skill. So in distress tolerance, we’re learning a whole bunch of ways to get through what DBT calls a crisis situation. And you can really think of that broadly, it’s basically any situation where your emotional distress is super high. And you’re in danger of doing or saying something that you’re going to later to regret. And that can also include avoiding doing something that you might need to do. And if you avoid that thing, it can create additional problems. And the overarching goal isn’t necessarily to make you feel better, although that’s great if that happens. But you have been successful in using your distress tolerance skills, if you get through that crisis time. Without making things worse for yourself.
Ed Fowler
Right. I really find that to be a helpful framework. People will often say when I’m talking to them about distress tolerance skills, oh, it didn’t work, because I didn’t feel better. And again, the goal with distress tolerance isn’t to feel better. The goal is to not feel worse, especially to not feel worse, because I did something reactive in a moment of high stress than I regret. So distress tolerance is about just getting through without doing anything that you will regret in the long run.
Marielle Berg
Another tool that’s useful to think about, and we will attach this in the show notes is our subjective units of distress, or SUDs that we call it for short, which is a way of gauging how how much emotional distress you’re in.
Ed Fowler
So the subjective units of distress scale, SUDs, is a zero to 10 scale rating, what level of distress do I have from zero, which is no distress at all, total peace, to 10, which is absolute maximum, worst ever amount of distress? And it’s subjective because each of us has our own definition of what does it mean to be at no distress? What does it mean to be at maximum? What does it mean to be at a suds level of five, like kind of in between the two. And so it’s not that this is not objective in the sense of like, there’s a universal scale that fits everyone, it’s subjective for each of us. And we each come up with our own scale that helps us to identify a little bit more objectively, then, oh, I feel horrible, which doesn’t give us a lot of helpful information to like, where am I on the scale? Am I at a 6, am I at an eight? Where am I at and my stress level?
Marielle Berg
And if people can spend some time familiarizing themselves with this SUDs scale, it can be very helpful in getting to the know the nuances of your own shifting emotional state. Because I was just thinking about this when you said a moment ago, and when people say, oh, I feel horrible or terrible, that there’s a whole bunch of different levels or gradations in between feeling maybe a little mildly upset to freaking out and being at, you’re in your worst possible state. And so I think looking at the subscales can help you get to know your emotional world a little bit more thoroughly. Because a lot of times we may not notice it might feel like we’ve gone from zero to 60 or in our case because we’re using the scale from like zero to 10 in a minute when my hunch is is that there have been like steps or markers along the way. Maybe your breath got shallow, you started to not think very clearly that there’s been little things along the way that have let you know, like I’m not doing okay. And I think when we can become familiar with some of those for ourselves. Because every one, for everyone, it’s a little bit different. I know for me, I’ll start clenching my teeth. And then I’m like, oh god, why do I have like a pain in this headache. And that, to me is a sign that like my that dial on my distress is being turned up. And so for, you know, it’s, these are as unique as every individual what it might be for you. But this is a way to also help you with some emotional control. If you can learn some of the signals for yourself that can alert you to rising distress, I think it can be really helpful.
Ed Fowler
And one of the things when we talk about SUDs in our skills group around distress tolerance, one of the things that we identify is that when we are feeling strong distress when our emotions are really high, and it’s making it hard for us to act in a way that would be wise, taking a moment to check and rate our distress level brings in some of that reasonable mind to balance out the strong emotion. Instead of saying, oh, I feel horrible, being able to say, oh, what’s my SUDs, right now? I am at a seven, I think a seven out of 10, we’re bringing in that more reasonable mind factual side to strike a little bit more of a balance and just that checking our suds can be helpful in bringing down the intensity of the emotion.
Marielle Berg
And so we use the skill Pros and Cons when what would you say Ed, when we’re sort of like a five or below.
Ed Fowler
I mean, I think you have five or six really, because when we when we talk about our SUDs scale in skills group, we say like eight, nine, ten we literally can’t think we just really can’t think clearly. So six, five, six at the max where, you know, like, we’re really we’re aware of distress, but we’re not really at any risk of acting on it.
Marielle Berg
The pros and cons skill is really helpful to kind of map out the advantages and the disadvantages of different options. And so we want to do this when we have some access to wise mind. So that five or six or below place on your SUDs scale, helps us figure out how to make wise choices. And it’s really kind of the opposite of acting automatically, or habitually, which so many of us do without thinking about, like long term consequences, both negative and positive. And so it’s super helpful to use a skill to help you resist like impulsive or kind of destructive urges that might come up. Because usually, when you have those kinds of urges, you’re in high suds high emotion mind, and you’re not thinking very clearly and acting on your urge feels like the smartest thing you can do in that moment.
Ed Fowler
So, like, examples of more kind of destructive urge would be like when our emotions are really high, we want to turn to substances or other kinds of compulsive behaviors. We want to turn to suicidal thinking, and really nurture that type of thinking, we have an urge to lash out. So I’m angry, and I just want to lash out, we have an urge to shut down. And so I withdraw; I don’t attend to the things that need to be done in my life. All of those are examples of urges that we might go with in a moment of high distress that are going to cause longer term consequences.
Marielle Berg
Yeah, they provide this immediate relief. But then down the road, there’s problems. So they might be kind of more like overt things like you lose a friendship because of something you said or did. But sometimes the negative long term consequences have to do more with like our self respect and our self esteem, like our sense of how we view ourselves gets damaged.
Ed Fowler
Right, totally.
Marielle Berg
And I would say the overarching also goal of this skill is a lot around accepting reality, like as it is, and tolerating distress.
Ed Fowler
Being able to recognize that we are going to have distress, there’s going to be times when we are going to feel emotionally overwhelmed, it happens. Being able to know ourselves enough to know that in those moments, I might want to do something that I really don’t want to do. And so using a pros and cons list ahead of time, helps us think through what are my long term goals versus just my short term goals.
Marielle Berg
And let’s dive now into kind of the meat of the skill because it’s unique. If you’ve been listening to us talk about pros and cons or refer to it, you might think okay, yeah, I know what a pros and cons list is. I’ve done it. I know what that’s about. But this there’s a twist to it.
Ed Fowler
So in DBT, the way that we would apply pros and cons is that you identify crisis behavior and or urge that you have in crisis situations or high distressed situations that you that doesn’t serve you and that you would like to change. And you sit down and you make a list of the pros of acting on that crisis urge, as well as the cons of acting on that crisis surge. And then you also identify the pros of resisting the crisis urge, and the cons of resisting the crisis surge. So pros and cons in DBT is kind of a four box approach of the pros and cons of both acting on the urge as well as the pros and cons of resisting the urge. So you get a really broad picture of what is going into this crisis urge.
Marielle Berg
And sometimes, there’s overlap, or often there is, but it can be surprising some of the things that come up when you do both the pros and cons of acting on the urge and resisting the urge. When we’re in wise mind, or we have a low, a lower SUDs level, it can be very obvious to us as to why we would want to resist acting on a crisis urge. So why we’d want to resist doing some kind of behavior that might make things worse in the long run. But we might forget that there are also cons, there are disadvantages, or downsides to resisting those crisis urges. And a lot of times, I think the and it will vary depending on what the issue is. The downside of the disadvantages is that you’re gonna feel not very good, you’re gonna feel maybe really angry or really uncomfortable, or some sort of very distressing state.
Ed Fowler
So when when people are doing pros and cons of a crisis urge, invariably, one of the pros of acting on the crisis urge is immediate relief, which is a huge motivator. And that’s why we all have these behaviors, that when we’re feeling overwhelmed in one way or another, we just want immediate relief, and we know this behavior will bring relief. So I think it’s helpful to identify that it’s not just oh, I’m a bad person who has no self control, and I always act on these crisis urges. It’s like no, I, when I’m overwhelmed, I want relief. It feels miserable, to feel those feelings that are driving this urge. And so it is a pro of acting on that crisis urge to get that relief. On the other hand, very often a con, of resisting the urge is I have to sit with whatever those feelings are I’m trying to avoid.
Marielle Berg
Yeah and sometimes I think the way we teach this in group is we kind of teach the pros and cons at the beginning of our distress tolerance module. But sometimes I think maybe it’s better to teach it towards the end. Because if your only option is if you resist your crisis urge, the only option is to feel like crap. But that’s not going to be very appealing or motivating. So if you have other tools or other skills at your disposal, you can feel a sense of like, okay, I don’t just have to suffer, there’s something I can do; self soothing, or some other kind of distracting skill to help me get through this really uncomfortable period. And I want to add just another piece because sometimes there’s a resistance to doing pros and cons of especially more habitual crisis urges. So maybe, as you said, like thinking, suicidal thoughts, any kind of self harm any sort of addictive or compulsive or impulsive behaviors, because those behaviors or urges, give us something, it might be important to honor and respect the wisdom in some of the crisis urges that you struggle with, repeatedly that there’s a part of you that’s trying to give yourself some relief, some out, some period of checking out some kind of break. And if you don’t have any other tools or things at your disposal, then it makes sense that you’ve learned over time to turn to the things you turn to.
Ed Fowler
And in DBT, we’re always seeking that balance between acceptance and change, recognizing that we need both. So so often we can be unsuccessful in trying to change compulsive, impulsive behaviors, because we we don’t accept, I’ve needed this. This was adaptive for me to develop a way to take a break from overwhelming emotion. And starting with some acceptance of like, yeah, for whatever reason, it may have caused me a lot of problems, but I needed this behavior to get by. And I would like to work on changing that so that I have more options so that I don’t need it. In the same way when I’m feeling strong emotions. Yeah.
Marielle Berg
And on that note, let’s, let’s go through it. Pros and cons are you up for that?
Ed Fowler
Sure.
Marielle Berg
So I know you’ve, not to put you on the spot too much, but you’ve talked about your struggles with procrastination, and I’m wondering what it would be like for us to do a pros and cons together. Right now.
Ed Fowler
It will probably be very helpful and also uncomfortable.
Marielle Berg
There’s the dialectic.
Ed Fowler
There it is.
Marielle Berg
Why don’t you begin by describing because you, you know your procrastination, obviously, much better than I do. And I feel like for everyone, procrastination can look a little bit differently. So what, what’s the problem behavior that you have with procrastination or set the scene for us?
Ed Fowler
Where this becomes difficult for me is when I have discomfort around some tasks that I need to do, I want to avoid it. Which, avoidance is a very natural response to anxiety or worry, or that kind of thing. It can really become a habit for me. So my, my approach, for instance, if I have work stuff that I need to do, I want to do everything else first, and then get to the most important thing, the thing that’s causing me the most stress, last, which means sometimes, oh, no, I have to put that off until tomorrow, and that can drag on and cause a lot of discomfort because I’m avoiding a task that I don’t want to do.
Marielle Berg
Okay, so what are the pros of acting on the urge, like, what are the pros of procrastinating?
Ed Fowler
I get a sense of immediate relief of like, there’s something that I don’t want to do, and I don’t have to do it right now.
Marielle Berg
Any other pros or advantages to their procrastination?
Ed Fowler
I mean, that’s really the biggest one is that immediate relief, that sense of like, I don’t want to do this, and I don’t have to.
Marielle Berg
Is freedom like with that kind of feeling? Would that go along with it as another pro? Like, do you feel a sense of that?
Ed Fowler
Yeah. Like freedom and, and a sense of power and a way of like, I don’t want to do this, and I choose not to, even though very often, it’s more impulsive than that. But that’s a part of it.
Marielle Berg
So immediate relief, freedom, power. Those are the pros. Those are the positives of why you procrastinate. Anything else?
Ed Fowler
No that that covers it.
Marielle Berg
Okay, what are what are the cons? What are the disadvantages of your procrastination?
Ed Fowler
Basically, postponing the discomfort of doing the task I want to avoid? So the task to still has to be done, I’m just postponing the discomfort, feeling a sense of having something hanging over my head. So yes, I have immediate relief. And then until I do the task, in the back of my mind is I have to do that task.
Marielle Berg
So you sort of have this like, nagging worry, that doesn’t go away? That’s a downside. Yeah, fascinating. What about your sense of self? Like, suppose you have a, you know, an afternoon set aside to take care of them work tasks, and you procrastinate on the most important, and maybe the most challenging thing? How do you feel after those hours have passed about yourself?
Ed Fowler
Yeah, I usually feel relief, as well as shame. And a sense of like, oh, other people don’t struggle with this. Other people don’t do this. If anyone knew that I was procrastinating, quote, unquote, for no good reason, they would be so dismissive of me. So yeah, it kind of flares up that sense of like, oh, this is a bad thing. I shouldn’t be doing this.
Marielle Berg
So that shame or there’s like, there’s something kind of wrong with me and other people don’t struggle this way. It sounds like it’s an isolating kind of place to be.
Ed Fowler
Yep, definitely.
Marielle Berg
And then if we move on to the pros, of resisting the urge to procrastinate, so there again, there might be some overlap with what we’ve already talked about. So what are the advantages of resisting the urge to procrastinate?
Ed Fowler
So I, instead of feeling that combination of–when I am procrastinating, feeling that combination of relief, as well as kind of dread that’s in the background, when I just do the task, I get the relief without the dread. So I do get relief. And I don’t have something hanging over my head, my sense of shame is much less. And in fact, when I actually do the task that I might want to avoid, I feel proud of myself, for building mastery, to use another DBT skill, in doing something that I struggle with.
Marielle Berg
Okay, so there’s relief without the dread; shame goes way down if it’s even there at all. And then this really important piece where you feel a sense of pride. You built some mastery, you did the hard thing. Mm hmm. So a lot of advantages are pros to not procrastinating. What are the cons are the disadvantages to resisting procrastination?
Ed Fowler
The immediate sense of like, oh, I have to do this thing now. And so that that kind of desire to avoid something that causes discomfort or causes anxiety. I’m not avoiding it. It’s right there.
Marielle Berg
So the downside of resisting the procrastination is you might feel like overwhelmed or anxious or confused, or depending on what the task is like, it just might be uncomfortable for a while.
Ed Fowler
Yeah, yeah.
Marielle Berg
And so as we’ve laid this out anything new or surprising, come up for you?
Ed Fowler
I again, so this isn’t the first time I’ve done this. And actually, as I’m reflecting on it, I have definitely made some progress in it. And it still comes up, especially when I am not mindful. So when I’m not conscientious about working on procrastination, procrastination can easily slip in. This is a very well worn habit for me since childhood. So doing this again, like I what I recognize is that like, the discomfort of actually doing the task, and getting it over with is definitely uncomfortable short term, without any long term discomfort, whereas avoiding does bring relief, but it also brings that sense of dread of I’m going to have to do this eventually. So while it may feel like a relief to procrastinate, and actually has like this, paired quality of like, oh, the dread is going to carry on. So it’s actually not that great, I don’t get that much relief from procrastinating.
Marielle Berg
And, you know, you may be struggling with procrastination in one way or another for much of your life. This is sort of how you’ve been for a long period of time. But it sounds like you are moving towards less of it, with the goal of not being a perfect human being, because we’re never going to achieve that. And that actually sounds a bit boring, but just to create more ease in your life. And to decrease some of these more painful emotions, like shame are what’s wrong with me or right, other people would judge me if they knew about this. Exactly. Yep. And so we invite listeners to try this out for themselves. And to do this again, while you your Suds is low while you can access wise mind, and then the key is to carry it with you and have it you know, even review it on a regular basis, because it kind of reinforces it. Because when your emotion is really high, so when you have a really kind of unappealing task to do, Ed like if you can pull out your pros and cons list for procrastination, it will likely serve as a reminder, because you might not be able to access wise minds in that moment to be like, Oh, yes, this is why I want to not procrastinate now.
Ed Fowler
That’s what I find helpful about a pros and cons list when I’ve used it in and with clients that I’m working with have used it that it is really just right there concrete in your face, countering all of that strong emotion that says Get rid of the discomfort, there is something that can help anchor me to, here’s what I really want. Here’s the actual more accurate picture of what’s happening here. So having that pros and cons list to review, in moments of distress is really concrete help.
Marielle Berg
Yes. And one last thing, you know, I realized we didn’t really go into this much. But when you’re doing your pros and cons, think about short term advantages and disadvantages. And also long term. So we didn’t use procrastination. But if we were going to think about long term, short term consequences, if you have a life where procrastination is your main go to, you’re probably not going to build the life you want.
Ed Fowler
I do think that’s like an important factor to consider is not just the short term pros and cons of acting on the crisis urge, but also the long term. So for instance, like, yeah, like, I carry this shame with me, and this dread with me throughout my life. And it does make it harder and it drains energy from doing other things that are important to me. That’s a significant long term con of acting on my procrastination that’s very different than the short term pros and cons.
Marielle Berg
Yeah, and a lot we might say a long term pro of resisting procrastination is that it will build over time like this building mastery skill, that it will increase your sense of self confidence and self esteem over time. And so that’s a long term positive consequence. And I feel like the pros and cons list if you bring in both short term and long term consequences, it’s kind of like a message or communication with your future self. So if I act on this crisis behavior, and I do this every time something’s done So comes up, who am I going to be in 10 years? And do I want to be that person? Definitely.
Ed Fowler
Yeah, I think that, you know, ideally, the pros and cons is this activity that we do when we’re in wise mind. That reminds us when a motion mind is really strong of what our short term and long term goals are, so that we are continuing to build the life that we want, and that we’re not letting strong emotion or strong distress, get in our way of building that life.
Marielle Berg
Thank you, Ed. Thanks for listening to today’s episode. To learn more, or if you’re in the Bay Area and want to get started with therapy, you can find us online at bayareadbtcc.com. That’s bayareadbtcc.com.