Taking an "Opposite Action" to Prevent Relapse

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Dialectical Behavior Therapy and Opposite Action

In the past, addiction treatment focused mainly on preventing relapse once someone left rehab.³ Today, many professionals instead emphasize skill-building, giving people practical tools and coping strategies to maintain the positive changes that were made in rehabilitation and to support long-term recovery.

Therapists use behavioral therapies and skills training to help you handle symptoms of substance use disorders, such as cravings or urges. These approaches also strengthen your ability to protect and improve your overall mental health and well-being.

Therapists who use dialectical behavior therapy (DBT) work to foster a mindful “here-and-now” approach to overcoming personal challenges, mental health disorders, and addiction. DBT introduces mindfulness-based skills, like the concept of the opposite action, that you can use to stay focused on your recovery.

Researchers suggest that DBT, which was developed in the 1970s, and other behavioral therapies that use mindfulness “have breathed new life into” addiction treatment.⁴

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Opposite Action in Theory

As the name suggests, the opposite action technique encourages you to engage in actions that represent the opposite of what your emotions urge you to do.⁶ Emotions, even the painful ones, are triggered by real and valid experiences.

Some experts suggest that experiencing strong emotions that potentially trigger a reaction can be part of a learned response pattern

Strong emotional reactions may come from learned response patterns or from processing painful or traumatic experiences without using alcohol to dull the feelings. Opposite action means acknowledging your emotions while taking steps to lessen their intensity or shift them toward a more helpful state.⁶

Many people say they began misusing substances as a way to cope with stress or to avoid painful emotions. Substance use may also develop as an attempt to manage symptoms of underlying conditions like anxiety or to dull emotional pain. DBT and other behavioral therapies focus on recognizing these patterns and responding to them mindfully, helping you build healthier habits that support lasting recovery.³

Opposite action focuses on changing how you respond to unhelpful thoughts and feelings.⁵ For example, the term “avoiding relapse” may trigger obsessive thoughts about how much you need to stay sober, which can lead to you spending more time thinking about drinking alcohol.

By placing a strong emphasis on “relapse prevention,” these strategies may trigger the thoughts and memories you want to avoid. For someone who does not want to use alcohol or other substances, these thoughts might create anxiety, fear, or self-doubt.

Instead of focusing on “avoiding relapse,” opposite action prompts you to consider something different, like “maintaining recovery-focused changes.” ^{3, 6} Focusing on the opposite actions in these situations means acknowledging the way you feel and focusing your attention on choices that can help you maintain your addiction recovery goals. ^{3, 6}

In this example, when you feel you are “white knuckling” alcohol relapse prevention, the emotion that comes up—such as anxiety—may make you feel like you should do things like:

Exert a hyper-level of control over your behavior
Avoid going out to reduce exposure to potential triggers
Stop consuming media in case you encounter images of alcohol

But strict control and isolation, like these examples, trigger instinctive responses that may sacrifice your personal care, social interactions, and personal interest activities.

To use opposite action, start by identifying what your emotions urge you to do and then choose to act in the opposite way. A DBT therapist can guide you in selecting the most helpful opposite actions.

When you feel intense anxiety about the possibility of relapse, start by acknowledging and naming the feeling. Notice the urge the anxiety creates—perhaps isolating, canceling plans, or trying to control everything around you. Instead of acting on that urge, choose an opposite action, such as calling a supportive friend, spending time on an enjoyable activity, or engaging in self-care. This helps reduce the power of the anxiety and keeps your behavior aligned with recovery. Other opposite actions you might consider could be:

Reaching out to a friend to talk about something you both love
Going out with a sober friend or loved one to a place where you feel safe
Holding a sober activity at home, such as a game night

Opposite Action in Practice

Taking a step-by-step approach to opposite action can help you apply this technique in a structured, mindful manner.⁶

Emotional Check-In

You can begin by acknowledging your emotions. Feelings are different from thoughts and include experiences like:

Happy
Sad
Afraid
Resentful
Angry

Working on opposite action with your therapist can help you better identify emotions that feel unclear or hard to name. For example, if you grew up in an environment where showing feelings was discouraged, you might struggle to recognize emotions like anger. Instead, anger could be mistaken for a different feeling—or it might not feel like an emotion at all.

When you put these emotions into words, you can better acknowledge how you feel. Maybe you have more than one feeling at a time. That’s okay too! Just put those different emotions into words and recognize that they exist.⁶

Once you take some time to describe your feelings, consider how strongly you feel them.⁶ Intense feelings may offer important information and guidance on how to act.¹Consider how well the feelings and their intensity fit the situation you face. The intensity of your emotions, strong or weak, can give you clues about how they impact your behavior.

Disproportionate emotions may not be caused directly by the current situation, but by something the situation reminds you of. These extremely intense emotions may become overwhelming and motivate you to act in ways that could interfere with your recovery.

Actions and Opposite Action

At this point in learning how to use opposite action, you can start to connect your feelings to the actions you take.⁶ What do you notice in your body, your face, and how do you relate to others? Do your emotions match your behavior^?1 Does your behavior match the situation you are in? Notice how your emotions influence the way you act and begin to consider whether you need to take opposite action.

Next, consider your potential opposite actions. Imagine, as an example, that a situation at home or at work has become stressful and in response, you begin to feel angry or upset. Perhaps you’ve notice that your face has begun to tighten. In the past, you may have engaged in an argument, yelled, or had a drink when you became upset in similar situations.

Opposite actions might include intentionally loosening your facial muscles, speaking calmly, taking a time out, or taking care of your body in a different way without using substances. Get specific, both about what your emotion drives you to do and the opposite action of that behavior, to commit to this new plan of action. Get specific about the:

Emotions you feel
Behaviors you want to change
Opposite, recovery-focused choices you want to make

Your therapist can help you work through issues you may encounter, such as difficulty linking a behavior to an emotion or deciding on an appropriate opposite action for a specific urge.

Commitment and Self-Reflection

Commitment takes consistent practice and self-reflection. When you remember how emotion-driven behavior affected you in the past, it can remind you of the importance of practicing opposite actions. When you set time aside to practice opposite actions, consider how emotional self-regulation can help you interact with others, progress in recovery, and enjoy activities. Consider the consequences of your past actions and the result you would like to see with your opposite actions.⁶

Continue to check in with how you feel. Your therapist may prompt official check-ins during sessions, but you can check in with yourself as it feels useful. Take note of changes you observe in your emotions. Consider how well your opposite actions are working and whether there are other opposite actions that you want to take.

Using a journal, guided daily reflections, or another type of log to keep track of changes to your feelings and behavior helps you to identify the opposite actions that are most useful.⁶ This log can help identify aspects of the opposite action skill you would like to work on with your therapist.

DBT in Addiction Treatment

Opposite action and other DBT interventions are commonly used in combination with other addiction treatment approaches.³ Using multiple approaches to recovery can help you get the support you need to heal in several areas of your life.

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Resources

Musch, S. The Magic of Opposite Action. University of Oregon, University Health Services Counseling Services.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals, 2nd ed. The Guilford Press.
Stotts, A. L., & Northrup, T. F. (2015). The promise of third-wave behavioral therapies in the treatment of substance use disorders. Current opinion in psychology, 2, 75–81.
Freedman, P. A. (2018). The Addiction Recovery Workbook: Powerful skills for Preventing Relapse Every Day. Althea Press.
Mckay, M., Wood, J. C., & Brantley, J. (2007). The Dialectical Behavior Therapy Skills Workbook.. New Harbinger.
National Institute on Alcohol Abuse and Alcoholism. (2020, November 23). Step 2 – Ask 10 recommended questions. U.S. National Institute of Health.

By Gayle Morris

Gayle Morris, BSN, MSN has over two decades of nursing practice with a clinical focus on rehabilitation medicine. She has published and lectured throughout her nursing and writing career. In the last 15 years, she has directed her energy and passion to create content that informs and educates readers with the goal of improving overall physical and mental health.

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