The DBT Pros and Cons Skill: Four-Quadrant Tool for Crisis Urges

What the Pros and Cons Skill Is

Pros and Cons is a distress tolerance skill from Dialectical Behavior Therapy (DBT). It is used in moments when an emotion-mind urge is loud — the urge to use, to self-harm, to quit, to fight, to flee, to text the ex at 2 a.m., to walk out of the meeting, to send the email you will regret. The skill gives you a structured way to weigh acting on the urge against tolerating it, so you can choose your values over the impulse when it matters most.

It was developed by Marsha Linehan as part of the distress tolerance module of standard DBT. In the official DBT skills training framework, it sits alongside other crisis-survival tools like TIPP, ACCEPTS, self-soothe, and IMPROVE. Where TIPP is for bringing your physiology down when the wave is at a 9 or 10, Pros and Cons is for the moment after — when the intensity has dropped enough that you can think, but the urge is still there and still convincing.

The defining feature of the skill is not what most people assume. It is not a list of reasons to do the thing and reasons not to do the thing. That is what almost everyone already does, and it is exactly why most people lose to their urges. The DBT version is a four-quadrant grid — and the four-quadrant structure is the entire point.

Why It Differs From Regular Pros and Cons

Most people, when they try to talk themselves out of a crisis urge, do a two-column list in their head: reasons to act on the urge, reasons not to act on the urge. Sometimes they write it down. Sometimes they just rehearse it.

This works poorly. It works poorly for a specific reason.

When you are in emotional mind, the pros of acting on the urge feel enormous and the cons of acting on the urge feel small or distant. Of course they do — that is what an urge is. So a two-column list, weighted by how things feel in the moment, almost always tilts toward acting. The urge wins, and you wonder afterward why your "reasoning" failed you.

The DBT skill is a four-quadrant grid:

1. Pros of acting on the urge. What you get if you give in.
2. Cons of acting on the urge. What you lose if you give in.
3. Pros of tolerating the urge (not acting on it). What you get if you ride it out.
4. Cons of tolerating the urge (not acting on it). What you lose by riding it out.

The fourth quadrant is the one that almost nobody fills in on their own, and it is the most important one. It validates that tolerating the urge has a real cost. It is hard. It is uncomfortable. You miss out on the relief or the rush or the answer you wanted. Naming that cost — putting it in writing — is what allows you to compare honestly. You are no longer pretending tolerance is free. You are choosing it knowing what it costs you.

The other quadrant most people skip is the second one — the cons of acting on the urge — written in detail, in your own handwriting, when you are not in crisis. Generic cons ("it's bad for me") will not survive contact with emotion mind. Specific cons ("I will not be able to look my daughter in the eye on Saturday") might.

Where It Sits in the Distress Tolerance Module

Linehan's distress tolerance module is the part of DBT that teaches you what to do when you cannot fix the situation and cannot make the feeling go away — when the only option is to get through this moment without making things worse. The module is split into crisis-survival skills and reality-acceptance skills.

Pros and Cons is a crisis-survival skill. The other crisis-survival skills are:

• TIPP — Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. The fastest way to bring extreme emotional arousal down.
• ACCEPTS — Activities, Contributing, Comparisons, Emotions (opposite), Pushing away, Thoughts, Sensations. A menu of distraction strategies.
• Self-soothe with the five senses — using sight, sound, smell, taste, and touch to comfort yourself.
• IMPROVE the moment — imagery, meaning, prayer, relaxation, one thing in the moment, vacation, encouragement.

The reality-acceptance skills include radical acceptance, turning the mind, willingness, half-smiling, and mindfulness of current thoughts.

Pros and Cons is the most cognitive of the crisis-survival skills. It does not change your physiology like TIPP does, and it does not redirect your attention like ACCEPTS does. It works at the level of decision-making — slowing the moment down enough that you can choose, rather than react.

How to Use It: Step-by-Step

Linehan's worksheet pattern is precise, and the precision matters. The skill has two phases, and most people only do the second one. That is a mistake.

Phase 1: Build the Grid in Advance

The single most important rule of this skill is that you build the grid before the next crisis hits, not during it. When you are in emotion mind, your access to nuance is gone. You cannot reliably generate four honest quadrants in the middle of a panic spike, a rage flare, or a craving. You build the grid when you are calm, when wise mind is online, and you save it.

1. Identify a recurring crisis urge. Pick one. Not a category — a specific urge. "Texting my ex when I am lonely at night." "Skipping the meeting and pretending I forgot." "Cutting when the numbness gets too big." "Drinking after a fight with my partner." Be concrete. The skill is sharper when the target is sharper.

2. Draw or print a 2x2 grid. Four quadrants. Label them: "Pros of acting on the urge," "Cons of acting on the urge," "Pros of tolerating the urge," "Cons of tolerating the urge."

3. Fill in all four quadrants. Honestly. The pros of acting are real — name them. Relief. Rush. Connection. Numbness. Power. If you skip them or write them dismissively, the grid will fail you when you need it. The cons of acting are equally real — name those in detail, with specific consequences in your specific life. Then do the same for tolerating: the pros (intact relationships, self-respect, building tolerance, future you thanks past you) and the cons (the urge does not go away quickly, you feel uncomfortable, you do not get the thing you wanted).

4. Review when calm and revise. Read it back to yourself a day later. Does it feel honest? Are the cons of acting specific enough that they will land in emotion mind? Add to it.

5. Make it portable. Put the grid somewhere you can actually access during a crisis. Photo on your phone. Note app. Folded in your wallet. On your refrigerator if the urges happen at home. This step is non-negotiable. A grid you cannot find in the moment is a grid that does not exist.

Phase 2: Use the Grid When the Urge Hits

When the urge arrives, the goal is not to think your way out of it. The goal is to read your way out of it — to let your wise-mind self, the one who built the grid, talk to your emotion-mind self, the one currently in crisis.

1. Pause. Even three seconds is enough. If the intensity is too high to think at all, run TIPP first — cold water, intense exercise, paced breathing — to bring the wave down to a level where words can land.

2. Pull out the grid. Read it. Read all four quadrants out loud if you can. Reading aloud changes the cognitive register and makes the words harder to ignore.

3. Sit with the comparison. Do not rush to a conclusion. Notice what you actually want, given everything in the four quadrants — not just what the urge wants.

4. Decide. Most of the time, when the grid is well-built, the decision becomes clearer. If the decision is to tolerate, the next move is usually opposite action, distraction, or self-soothe to ride out the remaining intensity.

The skill does not eliminate the urge. It gives you a structured way to choose against it.

A Worked Example

Let's walk through a concrete one. The urge: texting an ex during a panic spike at night, after no contact for three months.

Pros of acting on the urge (texting):

• Immediate relief from the panic and loneliness
• Hope of reconnection or reassurance
• Distraction from the worse feeling underneath
• The familiar comfort of their voice or words
• Something to do with the energy in my body

Cons of acting on the urge (texting):

• Restarts the cycle I worked three months to break
• I will not sleep tonight either way, but tomorrow I will hate myself
• They might not respond, which will feel worse than the original panic
• They might respond warmly, which will pull me back into a relationship that ended for good reasons
• I lose the streak — the part of me that is proving I can do this gets quieter
• My therapist and I will spend our next session on this instead of moving forward
• I will tell my best friend, or I will lie to her, and either feels bad

Pros of tolerating the urge (not texting):

• The streak holds. Future me has another night under their belt.
• I prove to myself that I can survive a panic spike without using the relationship as a coping tool
• I sleep better than if I had texted, even if I sleep badly
• I keep the trust of the version of me that decided this breakup was right
• The intensity will pass — it always does, usually within an hour
• I get to start tomorrow without a hangover of regret

Cons of tolerating the urge (not texting):

• The next hour is going to be uncomfortable. Very uncomfortable.
• I do not get the relief I want right now
• I do not get to know what they would have said
• I have to find another way to manage this panic — and I am tired
• It feels lonelier in the short term

Notice what the fourth quadrant did. It validated that tolerating is hard and costly. It did not pretend the right answer is free. That honesty is what allows the comparison to actually work — because emotion mind cannot accuse the grid of lying about how bad this feels.

When this person reads the grid at 11 p.m. on a panic night, they are not being talked out of their feelings. They are being shown the trade. And the trade — when it is laid out honestly — usually favors tolerating. Not always. But usually.

When to Use the Skill

The skill is useful in three windows.

Before urges arrive (proactive use). This is the most underrated application. Building the grid for an urge you know is coming — Friday night, the anniversary of the loss, the trip home — gives you a tool ready when the moment arrives. This is also how Pros and Cons pairs with cope ahead, where you mentally rehearse using the skill before the situation happens.

Between sessions when emotion is loud but not at peak intensity. When you can tell an urge is building but you can still think, this is the sweet spot for actually using the grid. Pull it out, read it, and decide.

During a crisis urge, after physiological down-regulation. If you are at a 9 or 10, words will not work. Run TIPP first. Once you are at a 6 or 7, the grid becomes usable.

The skill is not primarily a tool for everyday decisions ("should I take the job offer?"). The standard pros-and-cons approach is fine for those. The four-quadrant DBT version is calibrated for the specific problem of crisis urges — moments when emotion mind is loud and the pros of acting feel much bigger than they actually are.

Troubleshooting

"I forget about the grid in the moment"

This is the most common failure. The fix is mechanical, not motivational. Put the grid where you cannot avoid it. Lock-screen photo. The first note in your notes app. A printed copy taped to the bathroom mirror if that is where the urge tends to surface. Some people set a phone reminder for the predictable trigger times ("9 p.m. — read the grid"). The skill cannot help you if you cannot find it.

"The pros of acting on the urge still feel true even when I read it"

That is fine. They are true. The grid is not designed to invalidate the urge. It is designed to put the urge in context against the rest of the picture. If you have read all four quadrants and the pros of acting still outweigh everything else for you, that is information. Bring it to your therapist. Often, what looks like a failure of the skill is actually a signal that something underneath the urge — unmet need, unresolved trauma, missing support — needs direct attention rather than tolerance.

"Emotion mind says 'this time is different'"

It will. Every time. The grid was built for exactly this — for the version of you that, in the moment, is convinced that this situation is the exception. Trust the past version of you who built it more than the present version who wants to discard it. If "this time is different" is genuinely true, you can revise the grid tomorrow when calm. Tonight, follow what is written.

"I freeze and cannot decide"

Pair the skill with another. Radical acceptance of the discomfort. Self-soothe with one of the five senses. ACCEPTS distraction. The skill does not have to do the entire job alone. Pros and Cons is often the front end of a chain: read the grid, decide to tolerate, then use a different skill to ride out the remaining intensity.

"I keep skipping the fourth quadrant"

Almost everyone does. Force yourself to fill it in. The cons of tolerating are real, and naming them — boredom, loneliness, missing out, feeling weak, not getting the thing — is what makes the rest of the grid honest. A grid without the fourth quadrant is a sermon. A grid with all four is a tool.

Pairing With Other DBT Skills

Pros and Cons rarely works alone. It works as part of a sequence.

TIPP first, then Pros and Cons. When the urge arrives at full intensity, run TIPP — cold water on the face, paced breathing, intense exercise — until you are at a level where reading is possible. Then pull out the grid.

Pros and Cons, then opposite action. Once the grid has helped you decide to tolerate, the next move is often opposite action — doing the thing the urge does not want you to do. If the urge wants you to isolate, you reach out to a safe person. If the urge wants you to lash out, you back away.

Cope ahead and Pros and Cons. Cope ahead is the practice of mentally rehearsing a difficult upcoming situation. Building the grid for the urges you anticipate is a natural extension of cope ahead — you are pre-loading the tool you will need.

Pros and Cons and wise mind. The grid is, in effect, a way of asking what wise mind says — but in writing, with structure, when wise mind is hard to access directly. The grid is the artifact your wise-mind self leaves for your emotion-mind self.

Pros and Cons and radical acceptance. Sometimes the grid clarifies that the urge is pointing at something you cannot fix. The next move then is acceptance of the underlying reality, not just tolerance of the urge.

Worksheet Template

Here is the simplest replicable version of the skill. You can write this out on a sheet of paper, in a notes app, or in your DBT diary card.

1. The urge: Write the specific behavior you are tempted to do. One sentence. Concrete.
2. Pros of acting on the urge: What I get if I do it. Be honest.
3. Cons of acting on the urge: What I lose if I do it. Be specific to my actual life.
4. Pros of tolerating the urge: What I get if I do not act on it.
5. Cons of tolerating the urge: What it costs me to ride this out.
6. The decision: What I am choosing, today, given what is in the grid.
7. Backup skill: What I will use to get through the next hour after I decide.

Build one for each recurring urge. Review weekly. Revise as your life changes — what was a con three months ago may not be one now, and new ones will emerge.

When to Use This With a Therapist

Pros and Cons is one of the foundational skills in standard DBT, and it is taught in DBT skills groups and individual therapy alongside the rest of the distress tolerance module. If you are working with a therapist trained in DBT — whether for borderline personality disorder, emotional dysregulation, self-harm urges, suicidality, or substance use — the grid is something you can build together. Your therapist can help you sharpen the cons of acting until they are specific enough to land in emotion mind, and can help you fill in the fourth quadrant honestly without sliding into self-attack.

For adolescents, the skill is taught in DBT-A and adapted with developmentally appropriate examples. The four-quadrant structure is the same.

If you are practicing on your own from a workbook, the skill still works — but the most common failure point is generic cons of acting. A therapist can press you on specificity in a way self-practice usually cannot.

Frequently Asked Questions