This document discusses the dialectical behavior therapy (DBT) technique of "Opposite Action". Opposite Action involves conjuring thoughts, enacting stances, and performing behaviors that are opposite to what would usually match an emotion. It is used to regulate strong negative emotions and prohibit acting on urges. Studies have found it can significantly decrease emotional intensity, especially for sadness, shame and guilt when participants acted opposite to their induced emotional state. However, more research is still needed to isolate the effects of Opposite Action.
2. What is
‘Opposite
Action’?
9/3/20XX Presentation Title 2
Conjuring thoughts that are the
opposite of what would usually match
an emotion
Enacting stances and physical
gestures that are the opposite of
what would usually match an emotion
Performing behaviours that are the
opposite of what would usually match
an emotion
4. Why do we use
opposite
action?
To prohibit acting on the urges that
strong negative emotions give rise to.
5. When do we use
‘opposite action’?
• After the development other of other DBT-based skills such as
distress tolerance, mindfulness and wise mind
• When an emotional experience has been identified as too high,
or too low
10. Evidence supportive of ‘Opposite Action’
10
The Treatment of Maladaptive Shame in Borderline Personality Disorder: A Pilot Study of "Opposite
Action” Rizvi & Linehan, 2005
Intervention • Five adult women with a BPD diagnosis participated in a 6-month DBT
program with an ‘Opposite action’ intervention embedded within
• Shameful memories conjured, repeated exposure to shame and a
collaborative development of suite of ‘Opposite Actions’ to counteract
shame
Findings • Shame ratings at conclusion were significantly lower than at baseline, and
throughout the intervention.
Limitations • ‘Opposite Action’ intervention embedded within broader DBT-intervention
makes it difficult to determine whether ‘Opposite Action’ was responsible for
reduction in shame intensity
• No control group utilised
11. Evidence supportive of ‘Opposite Action’
11
Isolating the Effect of Opposite Action in Borderline Personality Disorder: A Laboratory-based
Alternating Treatment Design, Saur-Zavala, et., al., 2019
Intervention • 16 participants (13 = F, 2= M, 1= Transgender) induced into emotional states,
either anxiety, sadness, anger, or shame/guilt via a 10-minute writing task
• Asked to act either ‘consistent with’ emotion, or ‘opposite to’ emotion
Findings • Acting opposite significantly decreased the emotional intensity of sadness
and guilt/shame conditions, but anxiety and anger
Limitations • Some behaviours in the suite of ‘Opposite Actions’ were more like
distractions, so its unclear which emotional regulation technique caused the
shift in emotional intensity
16. References
9/3/20XX Presentation Title 16
Ben-Porath, D. D. (2010). Dialectical behavior therapy applied to parent skills training: Adjunctive
treatment for parents with difficulties in affect regulation. Cognitive and Behavioral Practice, 17(4), 458-465.
Dunkley, C. (2020). The theory of ‘opposite action’. In Regulating Emotion the DBT Way (pp. 27-37).
Routledge. https://doi.org/10.1016/S1077-7229(05)80071-9
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Rizvi, S., & Linehan, M. M. (2005). The treatment of maladaptive shame in borderline personality
disorder: A pilot study of “Opposite Action”. Cognitive and Behavioral Practice, 12(4), 437-447.
http://dx.doi.org/10.1016/S1077-7229(05)80071-9
Rogg, M., Braakmann, D., Schaich, A., Ambrosch, J., Meine, C., Assmann, N., ... & Fassbinder, E.
(2021). How patients with borderline personality disorder experience the skill opposite action in the context of
dialectical behavior therapy–A qualitative study. Psychotherapy, 58(4), 544.
https://doi.org/10.4324/9780429290534
17. References continued
9/3/20XX Presentation Title 17
Sauer-Zavala, S., Wilner, J. G., Cassiello-Robbins, C., Saraff, P., & Pagan, D. (2019). Isolating the effect
of opposite action in borderline personality disorder: A laboratory-based alternating treatment design. Behaviour
research and therapy, 117, 79–86. https://doi.org/10.1016/j.brat.2018.10.006
Soler, J., Casellas‐Pujol, E., Fernández‐Felipe, I., Martín‐Blanco, A., Almenta, D., & Pascual, J. C.
(2022). “Skills for pills”: The dialectical‐behavioural therapy skills training reduces polypharmacy in borderline
personality disorder. Acta Psychiatrica Scandinavica, 145(4), 332-342. https://doi.org/10.1111/acps.13403
Editor's Notes
Opposite action is one of many DBT emotion regulation techniques.
As the name implies, and as has been previously outlined, opposite action is the conjuring of thoughts, the enactment of stances and physical gestures, and the performance of behaviours that are the opposite of what would usually match an emotion.
The primary goal of opposite action is to prevent acting upon the urges that strong negative emotions give rise to. It’s a way of halting the trajectory towards lashing out or breaking down, or halting the trajectory towards numbing out with substance use or dissociation.
Opposite action assumes a certain level of emotional literacy and adeptness with other DBT skills such as distress tolerance, mindfulness, and wise mind, for example,
which is to say that opposite action it is not an introductory DBT technique.
It also important not to use opposite action to stymie the expression of valid negative emotions.
Opposite action isn’t used to prevent the experience of sadness when there has been a loss. Rather, opposite action is used when that sadness has become overwhelming or all consuming, or, when sadness is inappropriately low.
Opposite action used to up-regulate as well as down-regulate emotions, depending on the circumstance.
I found this flow-chart particularly helpful in understanding the application of opposite action, and I am going to talk us through it.
The first step is to identify the emotion
Step two is to ‘check the facts’ – this is the process of determining if an emotion is too high, too low, or just right to match the situation.
I find this image is a helpful visualize ‘checking the facts’
The middle column represents the full extent that an emotion can be expressed – 100%, down to the absence of all emotion at 0%.
We see down this side that when the amount of emotion is too high, we need to down-regulate the emotion with opposite action.
Down the bottom, we see that when the amount of emotion is too low, we need to up-regulate the emotion with opposite action.
And, in the middle, when the amount of emotion is appropriate, we listen to what it’s trying to tell us, and act accordingly.
So, let’s assume that we’re talking about an emotion that is up too high, here are a list of some of the opposite actions we can take to try and down-regulate
Anger: “in a soft tone of voice, describe the ‘other side’ of the story”
Anxiety: “take deep breaths”
Guilt/shame: “get into a dignified and alert posture”
Sadness: “get moving – so, behavioural activation”
So, that was a brief overview of opposite action, now I am going to talk you through some research about this technique.
The first study on opposite action that I am going to talk about was co-authored in 2005 by Linehan herself!
In this study, five female participants with a borderline personality disorder diagnosis took part in a 24-session DBT program.
Embedded within this program was an ‘Opposite Action’ intervention aimed at mitigating intense feelings of shame.
During each session, participants discussed intensely shameful events that had happened in their lives, and brainstormed ‘opposite actions’ to perform when experiencing the shame associated with those events.
Findings
After the ‘Opposite Action’ intervention, the five participants reported significantly lower levels of shame.
Limitations
However, because the ‘Opposite Action’ intervention was embedded within a broader DBT-intervention, it is difficult to assess whether the decrease in the intensity of shame was actually a result of ‘Opposite Action’ itself, or whether this technique used in conjunction with all of the other DBT techniques the participants learnt accounted for this effect.
And, this problem of not being able to single out the effect of ‘Opposite Action’ was exacerbated by the fact that there was no control group used in this study.
These two limitations were seemingly overcome in the next study that I am going to talk about, published in 2019.
In this study, 16 participants (13 females, 2 males and 1 transgender person) with a diagnosis of borderline personality disorder were induced into feelings of either anxiety, sadness, anger, or shame/guilt via a 10-minute writing task and then instructed to either act in a way that is consistent with that emotion, or to act in an opposite way to that emotion. Here is the tabled used in that study that shows consistent and opposite acting.
Findings
Acting opposite was found to significantly decrease the emotional intensity for those in the sadness and guilt/shame conditions, but not on the anxiety and anger conditions.
Limitations
Some of the behaviours in the acting opposite conditions had more of a flavour of distracting from the emotion, rather than consciously working to turn it around. For example, ‘play a game on your phone’ ‘Listen to your favorite song’ ‘text a friend’.
Distraction is a highly effective emotion regulation technique but embedding distractions within an opposite action intervention makes it a little unclear about what technique actually had the effect of shifting the intensity of the emotion.
Nonetheless, both of the studies I have spoken about go some way towards building empirical support for the application of the Opposite action technique.
