Manage BPD Using the Pros Cons Tool

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Using the Pros and Cons is a skill taught in Dialectical Behavior Therapy (DBT), a cognitive behavior approach to borderline personality disorder (BPD). During DBT, this tool is used to help you evaluate whether or not to engage in impulsive behaviors or aggressive actions. But this tool can help you think through other kinds of decisions too. By thinking through the consequences of what may happen and by evaluating what your goal is for your behavior, you can help manage your symptoms.

If you are struggling to decide what to do in a given situation, give the Pros and Cons Tool a try. 

Getting Ready 

Get a piece of paper and draw one horizontal and one vertical line to divide it into quarters. At the top of the upper left-hand corner write “pros of BLANK.” Fill in the blank by writing in whatever behavior you are thinking of doing. For example, if you are thinking of fighting with someone who hurt you, write in “hitting.” If you are thinking of quitting therapy, write in “pros of quitting therapy.” At the top of the upper right-hand corner write “cons of BLANK” and fill in the blank with whatever you wrote in the upper left-hand corner (i.e., cons of hitting, cons of quitting therapy).

Next, at the top of the lower left-hand corner write “pros of BLANK.” Fill in the blank with the behavior that is the opposite of whatever you are thinking of doing. So, if you are thinking of fighting, write in “pros of not fighting." For the quitting therapy example, write in “pros of staying in therapy.” At the top of the lower right-hand corner right “cons of BLANK” and again fill in the blank with the behavior that is the opposite of the one you are thinking of doing.

Listing the Pros and Cons

Now that you have your sheet set up, fill in the squares with all the positive consequences (“pros”) and negative consequences (“cons”) that you can think of for each scenario. Feel free to use extra paper if you need it.

For example, for “pros of fighting you might write: “Get rid of the emotional pain instantly.” For “pros of not hitting” you might write, “Not getting in trouble at work or school.”

Or, for “pros” of quitting therapy you might write: “An extra hour each week to devote to other things.” For “cons” of quitting therapy you might write: “Have to try to find ways to reduce my symptoms on my own.”

How to Evaluate the Pros and Cons

Once you have completed the form with every consequence you can think of, take a look at it again, and see if anything stands out to you. Any patterns that you notice? Any quadrants that are empty, or full? After completing this exercise, does it change what you want to do?

Carefully evaluate the pros and cons, and compare them to what your purpose is. If for instance, your goal is to eventually recover from borderline personality disorder and have a strong relationship, there are steps you need to take to get there. Quitting therapy, while it may free up some time, will make it harder for you to reach your end goal. By looking at both sides of the situation and their repercussions, you can make more appropriate and measured decisions about how to act. 

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  • Linehan MM. Skills Manual for Treating Borderline Personality Disorder. New York: Guilford, 1993.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.