The primary topics were designed for therapists to review and learn the steps of creating chain analyses and solution analyses. This was not limited to therapists who use dialectical behavior therapy. Some of the terms used below have roots in other disciplines and theoretical orientations. These terms will be presented using standard DBT terminology.
Chain analysis is the DBT term for behavior analysis. One of the goals in creating chains is "to understand fully all events that led to the antecedents and consequences," said Shireen Rizvi.
One of the differences between the solution analysis is DBT and other therapies is the emphasis on DBT solutions and skills, rather than focusing only on the consequences of the problem behavior.
The chains presented used the visual model of DBT chains: starting with the vulnerability factors, determining the prompting event, following the links in the chain, creating alternative responses, targeting problem behaviors, and considering the consequences.
The content in the chain analysis might not be presented in this order. Dr. Marsha Linehan's manual for Cognitive-Behavioral Treatment for the Treatment of Borderline Personality Disorder begins with defining the problem behavior. This might not be the first round of information presented by the client.
The treatment hierarchy will determine which problem behavior will be analyzed first. In order, the treatment hierarchy is life-threatening behaviors, therapy-interfering behaviors, and quality of life behaviors. These will be discussed in greater detail in a future post.
There can be multiple problem behaviors. In sifting through a set of life-threatening behaviors, assess if the behavior is an action, urge, or ideation.
The action is the trump card and will be discussed first, followed by urge, and ideation in the hierarchy.
"Vulnerability factors provide context" for precipitating events and what led up to the straw that broke the camel's back (Koerner, 2012, p. 37-38). Vulnerability factors can be thoughts, behaviors, actions, and emotions. I would imagine that there are often multiple vulnerability factors that created the setting that led to the problem behavior.
In looking at the links in the chain, there needs to be a high level of detail. Shari Manning described this as writing a movie script that is so specific that it could be directed and viewed by others. Look for emotions, thoughts, sensations, and events. Be concise, specific, and precise.
Physiological sensations: "What were you feeling in your body when you saw the email from your ex-boyfriend?"
Thoughts: "What were you thinking about when you looked at your iPhone after your ex-boyfriend emailed you?"
Emotions: "What was your emotion when you read the email from your ex-boyfriend?"
The last part of the DBT chain analysis is clarifying the consequences. DBT describes consequences as "immediate or delayed reactions of the client and others that followed the problem behavior" (Koerner, 2012, p. 42). These can be distal and proximal.
The process of clarifying the consequences can be very dysregulating and may trigger strong emotions, such as shame and anger. Therapists may be sure to orient the client to explain that dysregulation may arise from a thorough discussion of the problem behavior.
Shireen Rizvi discussed this as a possibility that the therapist may not want to hold the cue, which can result in changing the topic and reinforcing emotional avoidance. She said this process is hard for the therapist and client. Sometimes the therapist might not want to hold the cue, noticing the client's pain and tears. She pointed back to the function of chain analyses as a way to understand behaviors so that they can work together to prevent them from coming back.
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