Opposite Action Worksheet for Therapists

Authored by Dr. Hannah Lin, counseling psychologist trained in CBT, ACT, and IFS, with over a decade of clinical practice across anxiety and complex trauma.

Twelve minutes left. Priya has already named the feeling: shame at 80 after a progress note that took forty minutes. The urge is to hide the chart, skip the next note, and cancel Thursday. You could spend the rest of the hour reconstructing whether she is “bad at notes.” That is a different sheet. What she needs on paper is the emotion, the urge, a short mark on whether it fits, the opposite action done in the body, and an after-rating.

An opposite action worksheet is the record for that hour. You name one emotion and its action urge, write camera facts, mark fit, write the move that would follow the urge, then write a timed opposite and rate intensity after. The page is assigned paper. It is not a lecture on doing the opposite. If you wanted a full facts-check, you would already be in the wrong file.

This guide is for licensed therapists using DBT or DBT-informed work with adults who can stay with one emotion long enough to choose a response. It is not a self-help article and it is not a protocol for unsupervised use.

Educational content for licensed therapists, not clinical, legal, or emergency advice. Worksheet selection sits inside formulation, consent, and risk review. These sheets do not replace supervision, diagnosis, or a safety plan.

What this sheet is and is not

The parent DBT worksheets pack already covers diary card, chain analysis, crisis-skill planning, and DEAR MAN. This page fills one gap that pack leaves open: a six-row opposite-action record. Keep diary-card review on that pack. Keep this sheet for one emotion-to-opposite trial.

This sheet is	This sheet is not
One named emotion, intensity 0-100, and the action urge	A slogan to do the opposite of whatever they feel
A short yes / partial / no on whether the emotion fits	A full facts-check reconstruction
A timed opposite action in posture, face, voice, and move	Thinking the opposite while the body still hides
An after-rating of the same emotion	A crisis plan, diary card, or DEAR MAN rehearsal
Paper under a DBT or DBT-informed formulation	Unsupervised self-help or a skills-manual reprint

Behavioral Tech trainer Sara Schmidt describes opposite action as the move used when emotions do not fit the facts of the situation or acting on the emotion is not effective, done all the way in body language, vocal tone, and actions (Behavioral Tech Institute). This page does not reprint a publisher handout. It hands you a record that follows those moves for one assigned trial.

When the assignment fits

Use an opposite action worksheet when three things are true at once.

1. One emotion can be named, with an intensity and an action urge.
2. The emotion does not fit the camera facts, or acting on the urge would make the next hour worse.
3. The client can stay with the feeling long enough to choose a response, rather than needing a crisis-survival skill first.

Priya’s shame after a finished, on-time note fits. Fear while a car is coming does not. Anger at a delayed email that is not an attack can fit. Anger at ongoing coercion does not. Grief after a death is usually the wrong job for this page.

Fassbinder, Schweiger, Martius, Brand-de Wilde, and Arntz write that every emotion comes with an action urge, that acting on the urge is often effective, and that opposite action is indicated when the emotion-driven behavior is not in accordance with the facts or the values of the patient (Frontiers in Psychology, 2016). If the emotion fits and the urge would help, follow the urge. Do not stretch this worksheet to cover that hour.

Skip or pause when:

• acute risk, intoxication, or dissociation is in the room
• the emotion fits the facts and acting on it would help (leave a dangerous alley, report harm, keep a real boundary)
• the page would be used to talk someone out of warranted anger, grief, or repair
• the client cannot stay with the feeling long enough to describe it (use distress tolerance first, including a TIPP skill worksheet when the first ten minutes need a body-led sequence)
• the indicated tool is a diary card, a chain, a crisis plan, or a facts-check

The record you assign

Keep the opposite action worksheet on one page. Six rows. No extra columns for evidence lists, thought records, or a full facts reconstruction. Those belong on other sheets.

Do not add a seven-column evidence grid. That quietly turns the page into a facts-check. Do not add a prediction / actual pair. That quietly turns it into an experiment. If you need those, assign those sheets instead.

How to walk it in session

Start by naming the emotion before anyone invents the opposite. “I should just push through” is not an emotion. Shame at 80 with an urge to hide is.

Then write camera facts in one or two lines. You are not running a full facts-check in this row. You need enough to mark yes, partial, or no. If the mark is “I still cannot tell,” stop and use a facts-check sheet rather than padding this one.

Only then write the opposite. Fassbinder and colleagues note that changing action tendencies includes the overt action and also body language, facial expression, or tone of voice, and that opposite action does not intend to suppress an emotion (Frontiers in Psychology, 2016). Keep that on the row: posture, face, voice, timed move.

Stay on the opposite row until it includes:

• a clock time and a place
• what the body does (stand, approach, stay, speak)
• what the face and voice do
• how long they stay in the move
• what would count as halfway (so you can see it)

A qualitative study of 23 patients in DBT found that performing opposite action was perceived as exhausting, and that intense emotion and high distress were reported as barriers, even when people understood the skill (PubMed, 34881928). Budget for that. A five-minute trial that is done fully beats a heroic plan that never leaves the chair.

A worked example

Notice what the example does not do. It does not reconstruct every past late note. It does not rate the thought “I am a fraud.” It does not schedule a week of mastery activities. Those are other worksheets. This page only has to produce one trial done in the body and one after-rating.

A laboratory alternating-treatment study in people with borderline personality disorder found that acting opposite, versus acting consistent with an induced emotion, led to greater drops in intensity for sadness and guilt/shame, and did not show that short-term advantage for anxiety or anger (Sauer-Zavala et al., PMC6467696). Use that as a caution, not as a reason to skip anger or fear trials. It means you still check fit, you still do the move all the way, and you do not promise that every after-rating will drop in ten minutes.

Between sessions and the next-hour review

Assign one trial on the opposite action worksheet. If you send two emotions, you will get a slogan.

Write the dose on the sheet: complete name through opposite before leaving the room when you can. Between sessions, the client only runs the opposite row and brings back the after-rating. Fully, halfway, or not are all data. A perfectly filled page with no body move is also data. It usually means the opposite was still a thought.

Reopen with the after-rating, not with “did you do your homework.” Ask what was tried, whether it was all the way, and whether the fit mark still holds. If they approached and the rating dropped, keep the same emotion and shrink the next trial or repeat it. If they thought about approaching and stayed home, the row was not behavioral. If the session turns into a debate about whether they are allowed to feel shame, you have left this sheet.

The pack’s last page is a next-session review with chart stems. Use it so the worksheet does not get pasted into the note.

What goes in the note

Do not dump the grid into the chart. Capture the clinical signal:

• emotion named, intensity, and the action urge
• fit mark (yes, partial, no) in one clause
• opposite action as a timed, observable move
• after-rating, and whether the trial was full, half, or skipped
• next step, or the reason you switched tools

A sufficient line: “Assigned opposite action worksheet for shame 80 after an on-time note; urge to hide and skip Thursday. Fit: no. Opposite: stay at desk 10 minutes and start the next note. Returned shame 55 with first line written. Not a facts-check target.”

That shows modality fit, a specific intervention, and continuity. It does not store the client’s self-attack in a place that is easier to subpoena than it is to use.

For presentation-specific selection around emotion regulation versus crisis survival, DBT techniques for borderline personality disorder maps the highest active target to one skill family. Stay on this opposite action worksheet when the task is already a six-row emotion-to-opposite record.

Where Emosapien fits

The clinical work is the name, the fit mark, the all-the-way move, and the after-rating. The admin work is remembering that a sheet went home and turning the return into a line in the note. Emosapien can hold the assignment, collect a short return (full / half / blank), and draft a stem you still have to edit. It does not choose the opposite and it does not decide that a blank page is resistance.

If you want that loop connected to the next appointment, start for free and keep the worksheet inside the session where it belongs.

Related worksheets

Use the therapy worksheets guide when you are still choosing a form by clinical task. Stay on this opposite action worksheet when the task is already a structured emotion-to-opposite record.

References

• Schmidt, S. (n.d.). The Role of Emotion Regulation in DBT (Part 2). Behavioral Tech Institute.
• Fassbinder, E., Schweiger, U., Martius, D., Brand-de Wilde, O., & Arntz, A. (2016). Emotion regulation in schema therapy and dialectical behavior therapy. Frontiers in Psychology, 7, 1373.
• Rogg, M., et al. (2021). How patients with borderline personality disorder experience the skill opposite action in the context of dialectical behavior therapy. Psychotherapy, 58(4), 544–556.
• Sauer-Zavala, S., Wilner, J. G., Cassiello-Robbins, C., Saraff, P., & Pagan, D. (2019). Isolating the effect of opposite action in borderline personality disorder. Behav. Res. Ther., 117, 79–86.