Posted on by khumbard87

Crash Course: DBT Pros and Cons Grid + FREE PRINTABLE

Does anyone else struggle with decisions? I often joke that I have “decision fatigue.” As is typical with anxiety, it’s the “what if” questions that get to me. What if I make the wrong choice and regret it? What if there’s something I’m not considering? What if someone judges me for making this choice?

Sometimes it seems less uncomfortable to consult a magic 8 ball or flip a coin! Let something or someone else make the decision! You know why, right? Because then the responsibility is off our shoulders and we have someone else to blame if it all goes wrong.

As someone who is resistant to making decisions, I love a good pros and cons list. I love hand writing out advantages and disadvantages to something, and being able to look at which list is longer and seems more meaningful/impactful.

I recently took a Dialectical Behavior Therapy certification class and learned how to level up my pros and cons list. Instead of just one row of two columns, one for “PROS” and one for “CONS,” the DBT pros and cons list has two columns AND two rows. It’s a two by two grid. So you’re able to put the pros and cons of two actions (completing the urge and not completing the urge).

The DBT pros and cons list was designed to challenge urges (specifically unhealthy urges such as self-harm behavior and substance use). So you’ll see “complete urge bx” (“bx” = behavior in clinical writing) above the left column and “don’t complete urge bx” above the right column. Then top row is for PROs and bottom row is for CONs.

For example, someone with a history of addiction and substance use who is feeling the urge to drink alcohol, would use this grid to look at both the pros and cons of drinking, and the pros and cons of not drinking. Take a couple of minutes to think about what the pros and cons would be for both behaviors.

Using the pros and cons list for these behaviors can be less about determining what the “best” course of action is, and more about prompting your brain to remember the WHY. When considering self-harm behavior or engaging in substances, the short-term pros of the urges may not be worth the long-term consequences, but it can be hard to remember that sometimes! Making this pros and cons grid helps someone look at the big picture and can increase motivation to resist urges and impulses that you may regret later.

I think this form of a pros and cons list can be generalized to other things as well to help make informative decisions.

Do I confront a friend about something hurtful they said? What are the pros and cons or confronting them and the pros and cons of not confronting them.

Do I begin anxiety medication? Obviously talk to a prescribing physician about this, but if you’re on the fence maybe looking at the pros and cons of starting meds and the pros and cons of not starting meds will help.

Do I pick ________ or ________? Maybe you’re deciding between two jobs, two colleges, two cities to move to. You could look at the pros and cons of options you’re considering.

  • Some questions to help you fill out the pros and cons grid:
  • What are some of the immediate benefits of this choice?
  • What are some of the long-term benefits of this choice?
  • What are some immediate negatives of this choice?
  • What are some of the long-term negatives of this choice?
  • What will these choices cost me?
  • What about each of these choices will feel good (or not good)?

I absolutely do not mean to detract from using the DBT pros and cons list as a way to assess urges for self-harm or substance abuse. This is obviously a very helpful tool for that.

However, I think it can be helpful for other choices as well. I walked a client through a pros and cons list about confronting his mother about a comment she made that he found hurtful. We looked at the short term and negative terms benefits and downsides of confronting her, and he was able to come to a decision that he felt good about.

If you find yourself struggling with an urge or decision, consider using the DBT pros and cons grid to help you consider all aspects of the decision. It might help!

Below is a free printable pros and cons grid for your use. Note that, unlike the grid example above, the choices are rows, with the pros being on the right column and the cons being on the left column.

 

You can click here to access the document.

Thanks for reading!

Disclaimer: I am a licensed independent mental health practitioner and certified professional counselor, but I am not your therapist. The information in this article is for general informational purposes only. This article does not create a therapist-client relationship. If you need specific recommendations based on your individual circumstances, please consult with a mental health practitioner near you.

Posted on by khumbard87 · 1 Comment

What I’ve Been Reading: The Let Them Theory by Mel Robbins

I finally read The Let Them Theory, by Mel Robbins. It had been on my TBR (To Be Read) shelf for a while, so I was excited to get a copy and dive in.

When I first starting reading, I shared with a colleague that I had started it, and she rolled her eyes and said, “she’s just telling everyone what CBT therapists have been trying to say for years.” I suppose I can somewhat see her point, but I think The Let Them Theory has resonated with a lot of people, some who haven’t been to therapy (CBT specifically) or some who tried therapy, but it just didn’t click for them.

The Let Them Theory is all about how we respond to things that trigger us, especially the actions of other peoples. It’s almost a way to shrug it off; you just say “let them” and go on with your day. This is CBT thought challenging in a nutshell. Something triggers a thought, which then triggers a behavior, which then triggers an emotion. The Let Them Theory is catching that thought (often unpleasant and unhelpful), and using “Let Them” as a replacement thought and a reminder that you can’t control other people, but you can choose not to let it bother you. It’s been helpful for a lot of people, and I’ll admit that I’ve used “let them” on some situations I’ve encountered since reading the book!

I also appreciate that Mel Robbins doesn’t just stop at “Let Them,” but goes on to say “Let Me.” It’s the other part of the equation we can control, right? I can control my reaction to other people, and but I can also control my own actions. It’s moving on from “let them” and using what happened to inspire your own behavior. Let them be successful, and let me take the steps I need to take to also be successful.

I will say that I think people often forget about the “let me” part. Mel Robbins emphasizes it in the book, so it’s not for lack of effort on the authors part! I’ve heard many clients use “let them” in a way that almost sounds like code for “eff them,” and that’s not what it’s about. That’s anger. The impression I got, is “let them” comes from a place of indifference or “good for them, now watch me.”

Another portion of the book I found especially helpful was Chapter 13, titled How to Create the Best Friendships of Your Life. I think just about everyone has felt, at some point in their life, a desire for deeper friendships. Or just a friend in general. It’s very common for a client to tell me that they feel alone and isolated. Maybe they began working remotely and don’t see coworkers in person any more. Maybe they just moved and haven’t made any friends. Maybe they got divorced and lost all their friends in the process.

In The Let Them Theory, Mel normalizes difficulty in meeting people and building friendships, and I truly appreciated that. She also normalizes the amount of effort and time it can take to make friends and build meaningful relationships. It’s hard! In this book, she offers some great tips for putting yourself out there, but maintains that it takes consistent effort.

I’d recommend giving it a read! I think there are some helpful tidbits for just about anyone in this book, and I appreciate Mel Robbin’s style and using personal examples. Maybe this is CBT in a book, but she’s done a fantastic job of writing a book that resonates with a multitude of people!

Disclaimer: I am a licensed independent mental health practitioner and certified professional counselor, but I am not your therapist. The information in this article is for general informational purposes only. This article does not create a therapist-client relationship. If you need specific recommendations based on your individual circumstances, please consult with a mental health practitioner near you.

Posted on by khumbard87

In Times of High Anxiety: Controlling What You Can Control

You may not control all the events that happen to you, but you can decide not to be reduced by them.” — Maya Angelou

Everywhere you turn, there seems to be possible sources of anxiety. Recent clients have brought up anxiety related to politics, weather events, family conflict, job-related stressors, acts of public violence, and so on. If you are looking for a reason to be anxious, you don’t need to look far.

It can be incredibly easy to get sucked into an anxiety spiral when our focus is on all the things we worry about. And once we’re in that spiral, it can be incredibly difficult to get out of it. I have added and will continue adding ideas for avoiding the anxiety spiral, and getting out of it (see here). One idea is to focus on what you CAN control.

First, let’s look at just a small sample of things that are outside of our control:

I cannot who is president. I cannot control what difficult task my manager assigns to me. I cannot control the never-ending heat or tornados. I cannot control my spouse’s words when we are arguing. I cannot control if my neighbor gives me a dirty look when she sees me outside.

I could go on and on and on, but you get the idea: there is SO much in our lives that we are unable to control, no matter how hard we might try.

When we focus on those things, it’s easy to feel anxious, stressed, worried, frustrated, and hopeless. However, if we can switch our focus to what we CAN control, it’s likely that we’ll begin to feel less dysregulated, more positive, and more like ourselves.

So what CAN we control? I’ll be honest, when you make a list of what you CAN control and a list of what you CANNOT control, sometimes the latter feels very overwhelming. BUT there ARE things we can control.

I can control who I spend time with.

I can control how I speak to others and about others.

I can control how I speak to myself and about myself.

I can control what I spend my time doing.

I can control my thoughts (though this may be difficult sometimes).

I can control the amount of water I drink.

I can control what foods I choose to eat to fuel my body.

I can control the amount of sleep I get.

I can control the amount of time I look at a screen.

I can control the amount of exposure I get to the news.

I can control what coping skills I use.

I can control the amount of time I spend on social media.

I can control who I follow on social media.

I can control how much physical activity I get each day.

I can control what boundaries I set with other people.

Back in 2020, I saw the below image making the rounds on social media (source is at the bottom of the image). What a time to be alive, right? COVID hit, and so many things that were outside of our control changed.

Those things outside of our control could feel SO big, SO heavy, SO overwhelming. Many people, though, found comfort in focusing on what they COULD control. It’s a tactic that can work well in lots of different situation. And see at the top where it says “So, I can LET GO of these things” in parentheses? First of all, easier said than done, right? BUT TRUE.

I believe self-talk is one of the greatest tools we have to tackle negative thinking and anxiety. It can be monumentally helpful to have a script to help you focus on what you can control. Maybe it will sound like this:

“Self, you cannot control ______. That’s a fact. So Iet’s choose to focus on _____ instead, because that is something you can control.”

Make it your own, and use it as a script to pull your focus back to what is within your control. If you’re struggling, reaching out to a family member or a friend who may help you identify what is within your control can help. Of course, a mental health provider can also help with this strategy.

Drop a comment with your script, or something within your control that you’re choosing to focus on!

Disclaimer: I am a licensed independent mental health practitioner and certified professional counselor, but I am not your therapist. The information in this article is for general informational purposes only. This article does not create a therapist-client relationship. If you need specific recommendations based on your individual circumstances, please consult with a mental health practitioner near you.