Pros and Cons can function as a beneficial distress tolerance skill in DBT. As with other distress
tolerance skills, Pros and Cons are often used in crisis situations. It can aid in helping us avoid
acting impulsively while weighing the pros and cons of the impulsive decision at hand. Instead
of acting impulsively, making the pros and cons list can help us act skillfully. It shows us that
better results pan out by making a skillful decision with our pain, rather than an impulsive
decision with our pain. It’s most common to use pros and cons when we have to participate in
something that we really don’t want to do.
The most common way to use the pros and cons skill is to make a pros and cons list. Most
people, at one point in their life, have made a pros and cons list about a decision. In DBT, we can
make a pros and cons list of our impulsive decisions and maladaptive behaviors.
In order to make this list, we can pick a maladaptive or impulsive behavior that we typically
engage in. First, we would make a pros and cons list of specifically engaging in the behavior. We
may ask ourselves, what good can come out of engaging in the behavior, and what negative
consequences can result as a part of engaging in the behavior? Then, we would make an
additional pros and cons list. This list will be for the same behavior, but we would evaluate the
pros and cons of not participating in the impulsive behavior.
While making the list, we can also consider both the short and long-term consequences of
engaging vs. not engaging in impulsive behavior. A way to do this on this list would be to signify
“ST” for short term, and “LT” for long term next to specific statements on the list. This shows us
that our behaviors can provide short-term relief, but may cause long-term conflict. By labeling
behaviors as short-term or long-term, we can also identify maladaptive patterns within our
behaviors, and learn to challenge them. Once we identify these patterns, we can skillfully find
ways to integrate new coping strategies in replacement of maladaptive and impulsive behaviors.
Pros and cons lists are often created before a behavior occurs, likely in therapy with a DBT
therapist. The list can then be used in a moment of distress, when there is an impulsive urge to
act upon a behavior. We can refer to the list that we made in a time of clear-minded thinking,
instead of using an emotional mind to make a decision.

​

Just as adults tend to talk about their feelings and emotions, children act them out in play! Play is
a child’s natural way of communication. Children use toys to express themselves including their
needs, wishes and wants. They use toys as a medium to make sense of their life experiences. For
children, what seems unmanageable in reality, becomes manageable in play! Children externalize
their emotions and thoughts with the help of toys and hence experience a sense of relief through
play.


Play therapy is an evidence based approach with solid research to support its effectiveness for
many populations and concerns. Children experiencing social, emotional or behavioral
difficulties use the playroom as a safe space to comprehend their struggles, express their
emotions and explore possible solutions. The children use the toys in the playroom as a form of
communication with the clinician. These toys include real life and nurturing toys such as doll
family, doll house, puppets, cars, money, medical kit, food; Aggressive toys such as toy soldiers,
plastic guns, animals and aggressive puppets; and finally expressive toys such as sandtray, paint,
clay, musical instruments and, dress up clothes.


Play therapy helps children to facilitate communication, enhance social relationships, foster
emotional wellness and increase personal strengths. The clinician in the playroom strives to
provide the child with a warm, safe and supporting environment. The clinician provides the child
with unconditional positive regard while building a friendly and warm relationship. The clinician
maintains a deep respect for the child’s ability to solve his/her problems and gives the child the
opportunity to do so. A collaborative approach is taken with an aim to empower both the child
and the caregiver and the clinician conducts regular sessions with parents and guardians to
monitor the child’s progress.
​

Contact office@taproottherapynyc.com to know more/ schedule an appointment!

Guest Writer: Revna Ozdamar
Accumulating positives is a DBT skill that reduces vulnerability to difficult emotions and creates a barrier between you and feeling overwhelmed. Increase your pleasant experiences by building positives. Building positives refers to increasing positive emotions. 

Do one pleasant event per day. Positive events can be anything of your choice examples include reading, gardening, taking a bubble bath. Create a list of things that bring you joy and practice these activities for 25-30 days. While accumulating positives, be present, and immerse yourself fully in a chosen activity. If you get distracted and worry starts to take over your experience refocus.

Refocus your attention on pleasant events and participate fully. Be present with what you are doing. Be unmindful of worrying; do not destroy positive experiences by thinking about when they will end? Acknowledge and release these thoughts.

Another way to accumulate positives is to focus on something good that happens every day. Be mindful of your positive experiences. Journaling and keeping a gratitude journal is a great practice. Accumulating positives, in the long run, requires a different skill set.

Accumulating Positives: Long-Term

Avoid-avoiding. There is a natural tendency to procrastinate on tasks that do not spark joy. Avoiding problems builds up stress and activates your emotional mind. Practice makes perfect, the more you flex your mindfulness skills and address agenda items the better you will feel. Another way to build positives in the long-term is to live a life in alignment with your values, goals, and aspirations. 

Identify your goals, aspirations, and values and build a life around them. Examples include improving relationships, ending destructive ones, and spending time working on your goals and dreams. 

Accumulating positives takes time and practice. Building a life worth living is a journey and experiencing positive events daily is a component of it. Baby steps pave the way for greater self-awareness and self-discovery. Creating a working list of positive activities takes time and patience. I invite anyone who is embarking on this journey to also practice gentleness. It takes time to build a life that matches your values.

An important Interpersonal Effectiveness DBT skill involves learning how to balance goals and priorities when we are dealing with a conflict. This skill teaches us to be mindful about our relationships and the conflicts within them, and subsequently decide how to make effective, gratifying compromises.


Generally, within an interpersonal conflict, there are three factors we must decide how to prioritize and balance: our desire to get what we want, our desire to maintain a good relationship with the other person, and our desire to maintain our own self-respect. 


Let’s discuss these factors in greater detail:


The objective: this refers to our goal, or what we want to get out of the conflict. We might want to request something effectively, to deny a request effectively, to stand up for ourselves, or for our opinion or viewpoint to be taken seriously.


(It’s important to note that, no matter how skilled we are at interpersonal communication, sometimes we simply cannot attain our objective. That’s when radical acceptance and distress tolerance come into the mix.) 


The relationship: this refers to the importance of preserving the relationship despite the conflict within it. We might preserve the relationship by balancing our immediate goals with the good of the long-term relationship, or by choosing a way to communicate that does not erode respect and trust within the relationship.


Our self-respect: this refers to the importance of maintaining our positive feelings towards ourselves, and our adherence to our beliefs and values while dealing with a conflict. We might preserve our self-respect by remaining true to our morals, or by acting in a way that makes us feel competent, as opposed to lying, manipulating, or giving in for the sake of approval.


These three factors will be prioritized differently depending on the particular situation.


For example, let’s say your boss assigns you work that is far outside the purview of your job description and does not offer compensation. You don’t want to do the work, it is not fair that you have to do the work, but you are concerned with maintaining a good relationship with your boss. Ultimately, you might choose to ask for what you want, prioritizing getting what you want while communicating skillfully.


But let’s say your significant other asks you to stay home with him instead of attending a party you wanted to go to, because he had a difficult day. You might consider your own goal—to attend the party—and your sense of self-respect, which entails independence. But ultimately, you would likely choose to prioritize the relationship here.


Now, let’s say your friend asks you to help him cheat on a test. In this situation, you may be concerned about preserving the relationship, but you would ultimately prioritize self-respect and adhere to your morals, and deny the request using skilled communication.


Of course, these examples are simplified, and real life conflicts are often more complicated and involve more context. Nonetheless, remembering these factors can help us organize our priorities and make better decisions in moments of conflict with others.

Radical Acceptance is a distress tolerance skill in Dialectical Behavior Therapy (DBT). It teaches us to accept things as they are, completely and fully. It means not resisting, or not attempting to change. Rather it means seeing things as they are.
 
This can be a challenging skill in DBT! It can be hard to look at our problems and say “I accept it for exactly what it is.” We want to change things that are unfair, painful, or problematic. But radical acceptance forces us to look at something and say, “it is what it is.”
 
It’s important to clarify with this skill that it doesn’t necessarily mean that we are approving of something. Acceptance does not mean approval. It does not mean we have to like something. It simply means we recognize the facts of the situations.
 
Acceptance also doesn’t mean agreeing. I can accept that something is happening without agreeing with it. For example, let’s say you’ve asked your boss for a raise, and your boss says no. Despite the fact that you’ve worked late, taken on extra projects, and have definitely earned your raise. You might completely disagree with this decision, and you can still radically accept that this is the final decision.
 
Radical Acceptance does not mean that we tolerate abusive behavior. Radical Acceptance does allow us to recognize abusive behavior, however, and help us decide how to respond to it. Once I recognize that something is happening, once I radically accept it, I can then decide how to respond to it. Moreover, by accepting our pain, we reduce our suffering. As the famous saying goes, “Pain is inevitable. Suffering is optional.” Radical Acceptance helps us reduce suffering.
 
As with all of our DBT skills, Radical Acceptance takes a lot of practice. It is not easy to accept things as they are. To practice, start first by practicing small things. If it’s raining out and you were hoping to go on a hike, radically accept the weather. If you wanted to pick up a bottle of olive oil and the grocery store is already closed, radically accept that you’ll go to the store the next day. As you feel comfortable practicing these smaller instances, you’ll be able to start practicing radical acceptance with bigger issues that come up for you.

IMPROVE the moment is a distress tolerance skill in Dialectical Behavior Therapy (DBT). It is a skill to help us in the midst of challenging times. It doesn’t necessarily mean that we automatically feel better, but it can help us from feeling worse.
 
I: Imagery
Use imagery to help you cope. You can imagine yourself in a safe place. You can imagine yourself coping with the difficult situation you’re experiencing in an effective way. You can imagine a place that makes you feel happy. Any images that help you feel safe and calm.
 
M: Meaning
Make meaning out of your pain. This can be a challenging skill, because at times, we aren’t ready to make meaning. There are times, however, when we can look at a painful experience, and see what we can learn from that experience or how we can grow. We can also make meaning by finding moments of gratitude within our pain. For example, we can express gratitude for a friend or loved one who supports us in our pain.
 
P: Prayer
Prayer can mean many different things! It can be praying to God, or it can be praying to a higher power. Prayer can be connecting with Wise Mind, meditating, or setting intentions. It can be going on a hike and taking in nature. It can be volunteering and connecting with your larger community. Prayer can be anything that allows you to connect with a higher power.
 
R: Relax
Engage in relaxing activities. Take a gentle yoga class or practice deep belly breathing. Try a half-smile meditation. Take a hot bath or shower. Drink a cup of your favorite tea. Hug a friend or family member. Watch your favorite movie snuggled up in your favorite blanket.
 
O: One Thing in the Moment
Similar to the DBT mindfulness skill, One-Mindful, be mindful of what you are doing, and only do one thing at a time. So often, we multitask. Instead, put down your cell phone, stop scrolling through social media, turn off the television, and just do one thing in the moment.
 
V: Vacation
Give yourself a vacation! This can be a week-long European destination trip, or it can be a brief 10-minute vacation in your mind. It could be imagining yourself going on a dream vacation, or it can even be giving yourself a few hours, removed from work, and watching your favorite TV show.
 
E: Encouragement
Be your own cheerleader! Talk to yourself the way you would your best friend who might be struggling. While this can be challenging to do, tell yourself all of the ways you are coping well. Encouraging statements like, “you got this!”, or “you’re doing a great job,” can help us in challenging times.