DBT - Behavior Chain Analysis

Hey guys, how are you? Today, this is a companion video to the diary card video that I posted.

So I just suggest watching that first if you haven't, because it kind of gives you some background info that'll help inform your understanding of this video. Alright, so this one's all about behavior chain analyses, which is a tool that's used in individual therapy to help understand why you do what you do when you engage in a target behavior.

And it also gives you some clues as to where you could intervene along the chain of events. In order to prevent the target behavior from happening. It's especially important because a lot of times people feel that they go from zero to 100. And it happens so fast, and they have no idea where to step in. So this will kind of slow things down for you, and help you figure out where the intervention can take place the next time.

Behavior chain analyses. So we're literally going to use a metaphor of a chain to see how different thoughts feelings, events, body sensations and urges are linked together and how they lead up to that target. Bader event.

The first thing you need to do is to make sure you're filling out your diary card, because this is really helpful in understanding all the components that kind of went into the target behavior event. The diary card is a tool you could use in individual therapy, to note the urges you've been having any self injury you've done, or any kind of target behaviors you've done over the week, the emotions you were feeling any noteworthy events, which may have impacted that, and any coping skills you tried.

So the combination of all those things helps us figure out why you did what you did. Okay. All right. So anyway, just getting back to the chain analysis part.

Let's look at the metaphor of a chain. So before the target behavior happens, which is somewhere in the middle of the chain here sees this problem behavior. There's a series of things that happened first, even if it doesn't feel like it. But if we really look back, we'll notice that there actually is.

First is vulnerability factors. And if you look at my please video, by the end, the ABC video, ABC please talks about how we could reduce vulnerability to negative emotions. A vulnerability to negative emotions is, you know, a series of things that might be building up for us, so that when a stressful things happens, we're more likely to react to it in unskillful way. So it might be like, physically, I'm not taking care of myself as well. Maybe there's extra stressors, building up interpersonal problems building up. And so that makes me more vulnerable to whatever the prompting event is, which is the next circle here.

So then, after the prompting event happens, there's a series of thoughts, feelings, body sensations and action urges that we experience. And that may not exactly happen in a linear way, they kind of might overlap. But it's important to kind of think back and remember, what were those chain links that were going on for you. Okay, so then the problem behavior happens here.

Then after you engage in the target behavior, there's a series of consequences. So first might be the immediate consequence. And sometimes that may not even feel that bad, like maybe you get relief at first, maybe it seems like it helped. But then perhaps down the road, if you really think it through, you might have some regrets, or some other negative things followed.

So it's important to like so to say this, so they say, play the tape all the way through to the end. So you can re fully recognize all of those outcomes, don't just stop at the height of the, it made me feel better, and stop the tape there. Because you'll be more likely to repeat the problem the next time, you really have to internalize, what were those negative consequences that were problematic for me. All right. So usually, I started in a session by asking the person just to tell me the story of what happened. And sometimes a story kind of goes all over the place as back and forth. And I remember a detail and go back in time. And you know, it's not always that linear.

So I'll have the person tell it however, they can tell it. And then we'll try to go back in order the best we can and piece together that chain.

And that can be done verbally. But it also can be done in writing. If you're able to write it, that could be a really helpful tool. There's actually a bunch of different types of worksheets for this and you could easily find them if you do a google image search. There's also something I believe in the manual, or you could just do it on a piece of paper. So it's just like writing down.

You know the series of events in the chain one by one so that it's really clear and in front of you, so you don't have to spend too much energy, trying to keep it fresh in your mind. You just Kind of get it out there, okay. And if you're not in therapy, you can still do this on your own just to build insight into your own stuff.

If you do a bunch of these, it's also important to note that if you do a lot of them and you save them, you could start to see some patterns emerging. So maybe it's there's always like some kind of similar vulnerabilities that are building up, or a similar type of prompting event.

And then, you know, similar types of reactions, and you could kind of see like, how this pattern keeps reemerging in different ways in your life. And in that case, it actually, you know, it's helpful to know that, because then you'll be clear about exactly where to intervene in the future, in a skillful way to stop the chain.

Alright, so check this out. So let's say, you know, you have similar vulnerabilities and triggers, but you start to add coping skills in there. So instead of it being a reactive target behavior, which is on top, which can lead to negative consequences symbolized by the rain cloud, right, we could maybe change the chain of events, and have what they call responsive behaviors, which is maybe more wise mine thoughtful, skillful behaviors.

And that can lead to the sunshine, which is a more positive outcome, right? So even if you're not sure it's possible, you actually could probably figure out where you could intervene earlier on, to make things different, okay. And that's a great way to feel empowered, because that actually is in your power.

I want to give you an example, just so you see how this works. I got this from the internet. So this is a publicly available example. Not from anybody I know.

Okay, so for this person, vulnerability factors, which happened before the prompting event, was this person drank alcohol the night before, restricted eating, and sleep disturbance. So if you know the please skill, this taps on three major things in the please skill, because part of it is avoiding mood altering drugs, which is the a balancing eating, which is one of the ease and you know, getting good sleep, which is the s right. So if you're taking care of those things using please, the vulnerability factors are under better control, and maybe you're less likely likely to react to the property event. So prompting event saw my ex boyfriend with another woman. O

So as a result, this person had a series of thoughts and feelings. So felt sad sadness, and loneliness, thought, I'm so lonely, I miss him, felt shame, and then thought, I'm just not lovable.

Felt guilt and thought, no wonder that he left me I screwed up, felt self hatred and thought, how could one be so stupid, I am awful. Then she experienced high physical arousal, right. So this is a body sensation that's coming on, and thought I can't stand it anymore.

Just sort of like a giving up thought, you know, when you start to throw the consequences out the window and stop caring that's really, you know, one of those things that can kind of lead you to the tipping point of a problem behavior.

So problem behavior, went home cut myself three times deeply with a razor blade, right. So that's the main thing we're looking at. So we probably would have seen that on the diary card, and would have wanted to have a conversation about the stuff that led up to it. And also the emotions and urges would be on the diary card as well.

So consequences, so I so right after right, felt relief, and the emotions were in the background.

So that's why the cutting gets reinforcing. Because at first, sometimes it feels pretty good. Right? But then had to go the emergency room felt like a freak, it felt shame.

Then the long term consequence, felt sad, guilt and shame, you know, worrying about the scars, you know, all that other kind of stuff piles on. All right. So, I want you to pause the tape, and you think about where would you intervene?

If you were this person, where along this chain, could you have done something different? Okay, so that's, you know, if you notice, there's a lot of little areas where something possibly could be changed. Alright, I'm going to give you my take on this with a bunch of skills.

But before you get to mine, maybe just try some of yours, see how well you can do. Okay, so vulnerability factors, like I mentioned before, please or ABC, please. Okay, I put please here because they're focused more on the body mind stuff and pleases the physical aspect of reducing vulnerability to negative emotions, right. So practicing the police skill could help prompting events so my ex boyfriend with another woman, so maybe if the person has a hard time letting go, they could use opposite to motion action for love. So maybe she's still really in love with him. But it doesn't make sense to feel loved because he's with another woman. And they broke up, right?

So opposite emotion can help with that. Also, radical acceptance. Sometimes it's hard to accept the ending of a relationship and you're still nurturing hopes that it'll be rekindled. But then maybe those hopes are dashed when you see your ex boyfriend with another woman. Right. So radical acceptance is something you practice, it's something you have to bring back again and again, you know, as time goes on, so she has to renew her radical acceptance of the fact that relationship and Okay, so now she's feeling a lot of emotions, right emotions and bad thoughts and negative spiral thinking and stuff. So one thing she could do is probably distract herself from those thoughts by engaging in other kinds of activities.

So getting some ideas from the distract with accept or wise mind accept skill could be really helpful here, right? Especially since she can't fix a situation right away, she can just make him you know, not be with that girl, I just fixed the whole problem, he might just be with that girl now. So she has to deal with her stress that's coming from her distress. All right, she could also choose to be mindful of her emotions, and just watch them be mindful of the fact that she's having these thoughts without buying into them and taking too seriously, she could validate herself, right?

It must be pretty painful to feel these things, you know, and to be to feel like you've lost your love, you know, to give yourself some validation, or if not seek support with us, you know, a person you trust, and maybe that person could also help validate you. It's hard to be in your head and along with all these things. Fast skill, right?

Especially for shame based thoughts, like I'm just not lovable. So fast has to do with self respect effectiveness, right. So sometimes relationships still still work, it doesn't mean there's something wrong with you, right? So you don't have to go down that road necessarily.

You could still have self respect, and be broken up with somebody, there's plenty of nice people out there that have broken up relationships, right. Okay, another thing is, she's clearly an emotional line. So she's got to maybe check the facts or put in some more reasonable line so she can get back to a wise mind way of seeing the situation.

So that's something she could work on to, and to think a little more dialectically because she's very stuck on being the victim being rejected, you know, feeling is something wrong with her. But there's other stuff being left out, but you probably have to consider in order to have a more balanced view. So both of them are kind of hand in hand wise mind and thinking dialectically, she might also try to improve skills, improve the moment skills from distress tolerance, right, because she's having a rough moment. And there's probably something she can do within that skill that can make the moment a little bit better, right. So I would open the manual and look at that.

High physical arousal, right. And so sometimes that's an important part of the urge, right? You feel physically you feel the emotions physically. So self soothe skill is great for that has to do with using your five senses and soothing them with different kinds of, you know, actions, you can take the tip skill, tipping your temperature, intensely exercise, pacing, your breathing, pairing, your breathing, with Muscle, Muscle tensing, and relaxing, all those things could help your physiology under a high stress situation like this for sure.

And issues close to the urge to the problem behavior, you could always start with a stop skill to stop in your tracks and just don't do anything. Right, or the urge surfing, notice the urge, rather than acting on the urge. Okay, so see how this works.

There's so many areas where skills could come in. And she may not even have to do all of them, it could be possible that she could do some of them toward the beginning. And it would be enough to you know, make the emotions go down and make the urges go down so that she could survive and get through this difficult situation without making it worse.

And you could see how she made it worse, because now you know, he's going to the emergency room, she has a cut on her arm, she might get another scar. She's feeling all these, you know, shame based feelings, right?

So see how an added on to the original problem, right? So that's the whole goal of distress tolerance, try to get through it using your skills without making it worse.

Okay, so I hope that helped. And I hope that when you go to therapy, and they do behavior chain analysis with you, that you keep this example in mind and think of like, how could I do it even better for myself when I do my behavior change analysis so that it can really work for me, right?

How can I better understand my patterns and know how to skillfully intervene so that my life can change for the better?

Thanks for listening. And stay tuned for more stuff soon. And have a great day, guys. Take care now.

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