Cost Benefit Analysis (CBA)

One of the ways to increase motivation is to do something called a “Decisional Balance”. SMART Recovery prefers the term "Cost Benefit Analysis".

Here is what it looks like:

Example 1

Pros of watching	Cons of watching
Pros of change	Cons of no change:

Or:

Example 2

	Pros	Cons
Continuing with Porn & Masturbation
Stop Porn & Masturbation

This seems like a simple tool, but it’s actually incredibly powerful, and it could help you in many ways. So it’s worth investing a little bit of time in doing this exercise.

When you’ve finished these boxes, go through item by item and write down “short term”, or “long term” near each item. That’s it.  

Hopefully, this exercise will give you clarity of what you really want to do for yourself, the power of this exercise, is that it puts everything on one piece of paper.

Some days when you’re inspired, you’re thinking how great it can be to change. On days that you’re not inspired you think about why you want to continue and you forget about why you want to stop.  

Over here, when you’re putting them side by side on one piece of paper, it sort of makes things click. You start realizing, hey one second -  hey this is everything. These are all my feelings about the topic on this piece of paper, now what makes sense for me to do?

Am I ready to let go of the pros that are listed in the first box, all those great benefits of continuing what I’m doing? Am I ready to let go? Is it worth it for me?

Again, there are no right or wrong answers. And if you decide that you want to continue doing what you’re doing, there’s no one that could tell you differently. It’s not a mussar kind of thing, it’s something done between you and yourself to come to more clarity about what you really want. 

Research

• "Decision making was conceptualized by Janis and Mann (1977) as a decisional “balance sheet” of comparative potential gains and losses. Two decisional balance measures, the pros and the cons, have become critical constructs in the Transtheoretical model. The pros and cons combine to form a decisional “balance sheet” of comparative potential gains and losses. The balance between the pros and cons varies depending on which stage of change the individual is in." Link to sheet.
• "Decisional Balance Exercise (DBE): This task asks clients to evaluate the perceived costs and benefits of continuing to engage in their addictive behaviors versus changing. The exercise is intended to make more salient the pros and cons of changing their current behaviors, which then will allow them to identify obstacles to change (Sobell & Sobell, 1998; Sobell, Sobell, Leo, Agrawal, Johnson-Young, & Cunningham, 2002; Sobell, Sobell, Toneatto, & Leo, 1993). Copies of the Decisional Balance Exercise can be found in a recent publication on motivational interviewing (Substance Abuse and Mental Health Administration, 2002) and can be freely accessed through <http://www.nova.edu/gsc> and then by clicking on the link to Online forms." Klingemann, H., & Sobell, L. C. (Eds.). (2007). Promoting Self-Change From Addictive Behaviors. Boston, MA: Springer US. https://doi.org/10.1007/978-0-387-71287-1
  • That form is unique. It has a list of preset options with checkboxes (with a space for "Other"), and it has the following instructions on top: "In making a decision to change, it can be helpful to think about the good things and less good things about changing. Check the TOP 2 or 3 things that apply to YOU."
• "To help you think through the issues, experts recommend doing an informal cost-benefit analysis, such as the one in Table 1 (page 12). The example in the table addresses the issue of compulsive gambling, but it could be repurposed for any addiction. Make a chart using your own addiction and your own costs and benefits. When you fill it out, write as many items as you can think of to go under each heading. Weigh the importance of each answer. Do the benefits of con­tinued use or participation outweigh the costs? If not, you may decide you want to change your behavior. Shaffer, H. J. (2017)." Overcoming Addiction - Finding an effective path toward recovery. Harvard Health Publishing. (The chart in that publication both benefits on row 1 (Benefits of Not Gambling, Benefits of Gambling), and both cons on row 2 (Cost of Not Gambling, Costs of Gambling)).
• "Many people who have successfully changed their alcohol or other drug use report that this process was very important for them when they were considering change. It is a process that we often use in thinking about changing jobs, buying cars or cell phones, and so forth." P/ C/ P Session 10 Tipping the Balance of Change Velasquez, Mary M. Group Treatment for Substance Abuse, Second Edition (Page 122). The Guilford Press. Kindle Edition.

Notes

• The goal of the short term vs long term step is to deal with The Problem of Instant Gratification (PIG).
• In SMART Recovery this worksheet is followed by a discussion of short term and long term benefits, and how this sheet shows that most benefits of the addictive behavior are short term.
• "Instruct them to first write their pros and then their cons for using and then write the cons and pros for changing. The rationale for this ordering of the activity is that clients will end on thinking about the not so good things about using and the benefits of changing." P/ C/ P Session 10 Tipping the Balance of Change Velasquez, Mary M. Group Treatment for Substance Abuse, Second Edition (Page 122). The Guilford Press. Kindle Edition. See worksheet here page 27-28 - note the order there.
• Reference: The ideas in the Porn Myth can be useful in adding cons. We can recommend the book.
• "Sometimes emphasizing all the benefits of the current addictive behavior may contribute to ambivalence (Miller & Rose, 2015), increase what is essentially “sustain talk” (DiClemente, Kofeldt, & Gemmell, 2011), and lead to chronic Contemplation. This is true both in individual and group treatments. In motivational interviewing terms, focusing on the “sustain talk” or arguments against change can prolong ambivalence and, in group settings, can trigger a “sustain talk downward spiral,” where group members reinforce the difficulty and impossibility of making a change. To avoid enhancing ambivalence and instead support reasons for change, decisional balance interventions must focus on increasing the personal meaning and importance that would promote change." Addiction and Change (The Exploring Values exercise can help with this)
• Challenging myths related to positive outcome expectancies and discussing the psychological components of substance use (e.g., placebo effects) provide the client with opportunities to make more informed choices in high-risk situations. Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors (Kindle Locations 273-275). Guilford Publications. Kindle Edition.

Further Reading

• Decisional Balance on Wikipedia
• The CBA worksheet - 4 Questions on SMART Recovery. A list of questions to help you fill out each of the 4 boxes.
• WILLPOWER EXPERIMENT: LOWER YOUR DISCOUNT RATE (how to perceive short term benefits) McGonigal Ph.D., Kelly. The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do to Get More of It (p. 164). Penguin Publishing Group. Kindle Edition.

Torah Sources

• אבות פרק ב משנה א: והוי מחשב הפסד מצוה כנגד שכרה ושכר עבירה כנגד הפסדה.
• כלה רבתי פרק ד: אם חפץ אתה להרחיק מן החטא הוי מחשב לאין סופו, דכתיב החכם עיניו בראשו, ועיני כסיל בקצה ארץ, מסתכל למה שיש לפניו ומשכח בסופו.
• אבות פרק ב: איזוהי דרך ישרה שידבק בה האדם... רבי שמעון אומר הרואה את הנולד.
• מסילות ישרים פרק ט"ו: הנה הדרך המובחר לקנות את הפרישות הוא שיסתכל האדם בגריעות תענוגות העולם הזה ופחיתותם מצד עצמם, והרעות הגדולות שקרובות להולד מהם. כי הנה מה שמטה הטבע אל התענוגות האלה עד שיצטרך כל כך כח ותחבולות להפרישו מהם הוא פיתוי העינים הנפתים במראה הדברים אשר הוא טוב וערב לכאורה, הוא הפיתוי שגרם לחטא הראשון שיעשה, כעדות הכתוב (בראשית ג, ו): ותרא האשה כי טוב העץ למאכל וכי תאוה הוא לעינים וגו' ותקח מפריו ותאכל, אבל כשיתברר אל האדם היות הטוב ההוא כוזב לגמרי מדומה ובלי שום התמדה נכונה, והרע בו אמיתי או קרוב להולד ממנו באמת, ודאי שימאס בו ולא ירצהו כלל, על כן זהו כל הלימוד שצריך שילמד האדם את שכלו להכיר בחולשת התענוגים האלה ושקרם עד שמאליו ימאס בם ולא יקשה בעיניו לשלחם מאתו. הנה תענוג המאכל הוא היותר מוחש ומורגש, היש דבר אבד ונפסד יותר ממנו? שהרי אין שיעורו אלא כשיעור בית הבליעה, כיון שיצא ממנה וירד בבני המעים אבד זכרו ונשכח כאילו לא היה, וכך יהיה שבע אם אכל ברבורים אבוסים כמו אם אכל לחם קיבר אם אכל ממנו כדי שביעה, כל שכן אם ישים אל לבו החלאים הרבים שיכולים לבוא עליו מחמת אכילתו, ולפחות הכובד שמגיעהו אחר האכילה והעשנים המהבילים את שכלו. הנה על כל אלה ודאי שלא יחפוץ אדם בדבר הזה, כיון שטובתו אינה טובה ורעתו רעה. ושאר כל ההנאות שבעולם כמו כן, אילו יתבונן בהם יראה שאפילו הטוב המדומה שבהם איננו אלא לזמן מועט והרע שיכול להולד מהם קשה וארוך עד שלא יאות לשום בעל שכל לשום עצמו בסכנות הרעות על רוח הטוב המועט ההוא. וזה פשוט. וכשירגיל את עצמו ויתמיד בעיונו על האמת הזאת, הנה מעט מעט יצא חפשי ממאסר הסכלות אשר החומר אוסר אותו בו ולא יתפתה מפתויי ההנאות הכוזבות כלל, אז ימאס בהן וידע שאין לו לקחת מן העולם אלא ההכרחי, וכמו שכתבתי.

From GYE Members

• You wrote a very good reason, that it makes you feel unhappy in addition to knowing its assur. Unfortunately, as we know knowing its assur sometimes isn't enough. What you should do is sit down with a pen and a paper and list all the reasons why you want to break this habit, why it makes you unhappy. Then in another column write all the reasons why you want to continue. Weigh the pros and cons. What you will find is that technically you are sacrificing greater happiness and longlasting pleasure for short term small bursts of enjoyment with long aftereffects of unhappiness. Surely you will feel on an intellectual AND emotional levels that technically the pleasure of sin isn't all you made it out to be in the past. With this nice neat already made decision in your pocket, when you are confronted with desire it will seem easier to say no because it's not anymore a fight of deliciousness vs. religion, enjoyment vs. what you know is wrong, but rather a short few minute animalistic pleasure vs. much longer term pleasure. Now, that's a pretty simple decision. Of course it will be hard but this will definitely make it easier. (It changed everything for me). #Grant400
• Just to build upon what grant400 was saying, the mishna in Avos says:  וֶהֱוֵי מְחַשֵּׁב הֶפְסֵד מִצְוָה כְּנֶגֶד שְׂכָרָהּ, וּשְׂכַר עֲבֵרָה כְנֶגֶד הֶפְסֵדָהּ. I think that this exercise is most effective when one actually considers that maybe he should choose to continue with the aveira. If it is forgone conclusion, it doesn't really help as much because the decision comes from a place of guilt rather than strength and resolve. #Jj123