A structured examination of the advantages and disadvantages of a belief, behavior or change. It is useful when ambivalence maintains avoidance or when a symptom has a function. The therapist helps the client see both short-term benefits and long-term costs.
Step-by-step guide
- Define the belief or behavior to examine.
- List its advantages.
- List its disadvantages.
- Separate short-term and long-term effects.
- Rate how important each item is.
- Decide what the analysis suggests about change.
When to use
- Ambivalence about change
- Avoidance that has short-term benefits
- Addictive or compulsive behavior patterns
- Rigid beliefs that feel protective
Key phrases
Let's not assume this pattern is only bad. What does it give you, and what does it cost you?
Follow-up questions
What is the short-term payoff?
What is the long-term cost?
If you keep this pattern for a year, what happens?
Alternative phrasings
Every strategy survives because it does something useful. We need to know what.
What would you lose if you changed?
Warnings
- ⚠️ Do not use the exercise to pressure the client into change.
- ⚠️ Respect the protective function of the behavior.
- ⚠️ Move from insight to a concrete next step.
Source: Miller & Rollnick, 1991; CBT decision balance adaptations
Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.