DBT Skills: Chain Analysis

Who doesn’t want freedom from rapidly spiraling and/or out-of-control cognitive and emotional cycles? I know I do. A couple of months ago, after a particularly grueling weekend during which my emotional and cognitive processes completely derailed, leaving me feeling like an empty trainwreck, I spoke with one of my counselors and he suggested we do a DBT Chain Analysis. He cautioned me that it was stuff that I wouldn’t have covered yet in my DBT group, as I was still (and am still) on a break between the mindfulness and skills-based blocks of the therapy program. But he thought it might help me begin to break down my breakdowns, understand why I’m having them, and ostensibly avoid spiraling in the future, or at least be able to get a handle on it more quickly.

I have to say I was skeptical. This is something I’ve been struggling with my entire life: gaining control over my thoughts and emotions. So often it happens before I really even know what’s going on and then I’m picking up the pieces of my dignity and self-respect, wondering what the hell happened. I just always assumed there was something so wrong with me that I deserved the pain, isolation and misery. So I suppose the first thing that the chain analysis teaches is that that’s not the case. There’s nothing wrong with me; I simply evolved to do things a certain way to protect myself and get my needs met. It just so happens that that way no longer serves me.

There are two sides to a DBT Chain Analysis. The first step is to identify what happened to set off the episode. It helps to identify the actual trigger, and then to go back before that and see if something else was already happen: a more-sensitive-than-usual mood, hunger, fatigue, and overstimulation being a few examples, as they are things that can set us up to be triggered more easily. Then the progression is entered in, line by line, broken down as much as humanly possible. The idea is to be able to recognize each thought or action as an event in and of itself, so that we can address them all individually and take some of the power out of them. There are six different kinds of links on the chain: A – actions; B – body sensations; C – cognitions; E – events; and F – feelings. It is important to be able to separate them from each other, as it helps identify how to address them.

As an example, I will use one of my own analyses.

Chain analysis*:

Things in my environment that made me uncomfortable: racing thoughts, disturbing dreams, interrupted sleep, trigger – leaving in the morning (leaving my partner in the morning sometimes triggers feelings of loneliness, abandonment, sadness, etc, as it did on this particular morning).

Prompting event: waking up (within the first hour) – tension, feeling of being “down”, feeling of heaviness.

Actual behaviors and events: hard to get going/feel motivated; noticing negative thoughts and self doubts; increase in depression, hopelessness as the thoughts gain momentum; increased anxiousness over the hopelessness and depression; increased negative thoughts; withdrawal/avoiding roommates/friends/partner, staying in my room; distracted; having negative conversations with people who cross my path; obsessing about hurting myself.

Consequences in the environment?: impacts relationships, work.

Consequences in myself?: worsened mood; passive aggressiveness; hard on self/beating self up; urges/acting on urges of self harm.

Solution analysis*:

Ways to reduce vulnerability in the future: address lack of energy, and overcommitting.

Ways to prevent prompting event in the future: same as above.

Skillful alternative behaviors: acknowledgement; notice “3 in 1” exercise (awareness exercise to bring my attention back to my immediate surroundings); not isolating; calling someone.

My counselor and I spent a great deal of time discussing what some alternatives were to following the thought patterns. Probably two of the most useful were mindfulness techniques, and labelling distorted thinking. For example, if I’m having a particularly distressing thought, I can slip into mindfulness, be aware that I’m having a disturbing thought, notice it, and let it pass. It works when I remember to try it, which unfortunately isn’t nearly as often as the disturbing thoughts occur but it’s a start. Then there’s labeling distorted thoughts. Often when a thought disturbs me it is distorted in some way: either I am comparing myself to someone else and coming up short, or I am using black and white/wrong or right thinking, or I am catastrophizing, mind-reading, fortune-telling…the list goes on and on. It was suggested to me that even if I don’t know all the types of distorted thinking, I can simply label it a distorted thought and move on. The purpose of this, of course, is not to judge ourselves for having a distorted thought, but simply to be aware that the thought is distorted and to help take some of the power out of it.

This is as far as I’ve gotten. I still have meltdowns. I still get carried away by negative thought and emotion cycles. I still feel like an emotional invalid at times. But more and more I am able to practice the skills I’ve just mentioned and see immediate relief (even if the relief only lasts momentarily), which leads me to believe that there is hope in recovery, regardless of how slow and ‘imperfect’ it is.

*Adapted from Marsha Linehan’s Chain Analysis Worksheet by Seth Axelrod, PhD 2/13/04

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