Dialectical Behavior Therapy Problem Solving

BEHAVIORAL ANALYSIS
What it is:
1) In Behavior Therapy: a step-by-step assessment of a problematic behavior or target, focusing on all
aspects and circumstances of the behavior, including the antecedents and consequences

2) In DBT specifically: the first part of the general Problem Solving Strategies in DBT; most sessions in
Stage One of DBT consist largely of behavioral analyses (when dealing with parasuicide, therapy
interfering behaviors, quality of life interfering behaviors, etc).
(Problem Solving consists of: behavioral analysis -- insight -- didactic strategies -- solution analysis)

3) Goal: Figure out what the problem is, what is eliciting it, what is interfering with resolution of the problem,
what aides are or are not available to help solve the problem

4) Functions of behavioral analysis in therapy: provides insight into factors that elicit and maintain the
behavior, elucidates places where solutions and changes can occur, punishes dysfunctional behavior (an
aversive consequence, i.e., clients dislike these, feel shame, etc), functions as therapy (especially as
exposure technique)

Steps in BA:
1) Define the problem. Things to Remember:
2) Orient client. 1) Obtain cooperation
3) Conduct chain analysis. 2) Weave validation throughout
4) Generate hypotheses. 3) Elicit emotions during BA (for exposure effects)

Behavioral Analysis Steps in Detail

st
1 , Define the problem in terms of behavior.
1) Choose a focus (use diary cards for highest priority behavior; also pay attention for in-session, target-
relevant behavior, this can provide an excellent opportunity for BA).

2) Formulate the problem in terms of behavior, i.e., feelings, thoughts, or actions (not on the situation itself)
3) Get information on the problem specifically including
a) frequency of behavior
b) duration of behavior
c) intensity of behavior
d) topography of behavior

Never assume anything, get as specific as possible (“what do you mean by that, exactly?” “how many
times did that happen?” “on a scale from 1-100, how intense was the feeling?” etc).

**Orient client, explain what you’re going to do and why (e.g., I’d like to spend the bulk of this session
trying to understand exactly what happened here; this behavior has GOT to stop, and the only way that will
happen is if we understand why it’s occurring in the first place; so let’s start at the beginning...)

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 Dialectical Behavior Therapy Problem Solving

Behavioral Analysis Steps in Detail (continued)

2 , Conduct a chain analysis (an exhaustive step-by-step description of the chain of events leading up to
nd

and following the behavior).

1) Where to start: can ask client where problem began--you want to locate, in the environment, the event
that precipitated the chain of behaviors

2) What to ask about:

a) Get very detailed information about what was going on, both in the environment and behaviorally with
the client (remember, this includes feelings, thoughts, assumptions, behaviors); again, assume
nothing, be a “naive observer”
b) Find out consequences of behavior (i.e., what happened in the environment afterwards, how client felt
afterwards, what thoughts client had, etc)
c) Find out events leading to event that started the chain; what set of prior event or current state of being
made client vulnerable to prompting event; why did it have an effect at this moment and not before?

3) What you’re looking for:

a) events that may automatically elicit responses (remember classical conditioning)
b) behavioral/skill deficits
c) things in the environment that may have strengthened problem behavior (remember reinforcement)
d) responses of the client that may have interfered with more appropriate behavior, e.g., beliefs, fears
(remember behavioral hierarchies)

4) Possible questions:
a) what set that off?, what was going on at the moment the problem started?
b) what were you feeling then? what thoughts were you having?
c) what did you feel like doing?
d) when did the thought/urge of (problem behavior) first come into your mind?
e) how strong was the feeling then on a scale of 1-100?
f) how strong was the urge afterwards?
g) what happened next?
h) how did you feel immediately after you problem behavior?
i) what did your boyfriend do right after that? ETC.

VULNERABILITY
PROBLEM BEHAVIOR

PROMPTING
EVENT
LINKS
CONSEQUENCES
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3 , Generate hypothesis (and with the client, come up with ideas about what is eliciting and maintaining
rd

behavior).

1) Remember to use DBT and behavioral theory to guide your hypotheses (possibilities are skills deficits,
contingencies in the environment, thoughts, emotions--pay particular attention to emotion dysregulation and
“secondary targets” like self-invalidation, inhibited grieving, apparent competency)

2) Always be willing to modify or abandon hypotheses if they don’t fit

3) Use previous BAs to guide hypotheses

DBT Hypotheses for BPD

1) Ineffective behaviors are being reinforced or effective behaviors are being punished
2) Person doesn’t know what would be more effective or
how to do a more effective behavior
3) Other client responses inhibit or interfere with effective behaviors, such as:
emotions, such as fear, shame, guilt
beliefs or assumptions that interfere with more effective behavior
secondary targeted behaviors:
emotionality, emotional vulnerability
self-invalidation (perfectionism, self-hate, inhibiting self-initiated behaviors)
crisis generating behaviors
inhibited grieving, emotional avoidance (dissociation)
active-passivity
apparent competence

th
4 , Weave solution analyses into chain analysis.

1) Highlight other possible roads that could have been taken along the way.
or
2) Brain-storm solutions at each faulty link--these should be elicited from client as much as possible, but
therapist is generally more active at beginning of therapy.

3) Do quick evaluation solutions generated.

a) assess client’s expectancies
b) assess how realistic solutions are
c) look for potential obstacles

4) Recommend (or agree on) a solution for next time.

5) Go back to chain analysis.

5th Summarize (over and over throughout and at end) sequence of links in chain and highlight
important links and patterns.

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 Dialectical Behavior Therapy Problem Solving

BEHAVIOR CHAIN ANALYSIS & SOLUTIONS

Instructions and Worksheet
1. Describe the specific PROBLEM BEHAVIOR – e.g., throwing a chair, cutting, hearing voices,
dissociating, not coming to a therapy appointment, etc. (Behaviors that are targeted in the
treatment plan, or diary card.)
A. Be very specific and detailed. No vague terms.
B. Identify exactly what you did, said, thought, or felt (if feelings are the targeted problem
behavior).
C. Describe the intensity of the behavior and other characteristics of the behavior that are
important.
D. Describe problem behavior in enough detail that an actor in a play or movie could recreate the
behavior exactly.

2. Describe the specific PROMPTING EVENT that started the whole chain of behavior. Start
with the environmental event that started the chain. A prompting event is an event
outside the person that triggers the chain of events leading to the problem behavior.
Always start with some event in your environment, even if it doesn’t seem to you that the
environmental event “caused” the problem behavior. Possible questions to get at this are:
A. What exact event precipitated the start of the chain reaction?
B. When did the sequence of events that led to the problem behavior begin? When did the
problem start?
C. What was going on the moment the problem started?
D. What were you doing, thinking, feeling, imagining at that time?
E. Why did the problem behavior happen on that day instead of the day before?

3. Describe in general what things (both in yourself and in the environment) made you
VULNERABLE to the prompting event. What factors or events made you more vulnerable to
a problematic chain? What gave the prompting event such power? Areas to examine are:

A. Physical illness; unbalanced eating or sleeping; injury

B. Use of drugs or alcohol; misuse of prescription drugs
C. Stressful events in the environment (either positive or negative)
D. Intense emotions, such as sadness, anger, fear, loneliness
E. Previous behaviors of your own that you found stressful

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4. Describe in excruciating detail THE LINKS IN THE CHAIN OF EVENTS that hooked the
prompting event to the problem behavior.
A. Links in the chain can be: Actions or things you do;
Body sensations or feelings;
Cognitions, e.g., beliefs, expectations or thoughts;
- (the dash is here for D)
Events in the environment or things others do;
Feelings and emotions that you experience.
B. Imagine that your problem behavior is chained to the prompting event in the environment. How
long is the chain? Where does it go? What are the links? Write out all links in the chain of
events, no matter how small. Be very specific, as if you are writing a script for a play.
1. What exact thought (or belief), feeling, or action followed the precipitating event? What thought,
feeling, or action followed that? What next? What next? etc.
2. Look at each link in the chain after you write it. Was there another thought, feeling, or action that
could have occurred? Could someone else have thought, felt, or acted differently at that point? If so,
explain how that specific thought, feeling, or action came to be.
3. For each link in the chain, ask is there a smaller link you could describe.

5. What are the CONSEQUENCES of this behavior? Be specific. Examine both the immediate
(in just seconds) effects and the delayed or longer term effects. Figure out the reinforcers
for the behavior.
A. How did other people react immediately and later?
B. How did you feel immediately following the behavior? Later?
C. What effect did the behavior have on you and your environment immediately and later?

6. Describe in detail different more skillful SOLUTIONS to the problem.

A. Go back to the chain of your behaviors following the prompting event.? Circle each point or link
(or fill in link with your pencil) where if you had done something different you would have
avoided the problem behavior.
B. What could you have done differently at each link in the chain of events to avoid the problem
behavior? What coping behaviors or skillful behaviors could you have used?

7. Describe in detail PREVENTION STRATEGY for how you could have kept the chain from
starting by reducing your vulnerability to the chain.

8. Describe a plan for SOLVING the prompting event (if it were to happen again) or keeping it
from happening again.

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 Dialectical Behavior Therapy Problem Solving

9. Think through the HARMFUL consequences of your behavior. Figure out what is harmed
so you can figure out what you need to repair or correct. Look at yourself, at your
environment, and at people in your environment to see if there are any harmful
consequences.

10. Describe what you are going to do to REPAIR important or significant consequences of the
problem behavior? Describe what you will do to CORRECT the harm that resulted from your
problem behavior. Describe how you will make things just a little bit better than they were
before, that is, how you will OVERCORRECT the harm.

11. In this space, you can write whatever reflects your DEEPEST THOUGHTS AND FEELINGS
about this episode. Just start writing and continue for five minutes or so without stopping.
If the topic gets upsetting to you, shift topics and keep writing. Or, you can write out any
comments that you have about the analysis.

Miscellaneous Notes:

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 Dialectical Behavior Therapy Problem Solving

Page 1
Name: Date Filled Out: Date of Problem Behavior:

PROBLEM BEHAVIOR
VULNERABILITY

PROMPTING
EVENT
CONSEQUENCES
LINKS

WHAT EXACTLY IS THE MAJOR PROBLEM BEHAVIOR THAT I AM ANALYZING?

WHAT PROMPTING EVENT IN THE ENVIRONMENT STARTED ME ON THE CHAIN

TO MY PROBLEM BEHAVIOR? Start day: ____________

WHAT THINGS IN MYSELF AND MY ENVIRONMENT MADE ME VULNERABLE?

Start day:

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Name: Date Filled Out: Page 2

LINKS OF BEHAVIOR: Actions, Body sensations, Cognitions (thoughts), Events, Feelings)

INSTRUCTIONS: first circle the letter (ABCE or F) that corresponds to each behavior link starting In order from the Po ss ible Ty pe s o f Li nks
 A = Actions
prompting event. (See legend pictured right.) Then in the left column, describe the lettered behavior link. Lastly, In the
right column list more skillful behaviors you can use in the future to break the problematic behavior chain.
B = Body sensations
C = Cognitions
E = Events
F = Feelings
LINKS List Behavior Links In Order From Prompting Event List More Skillful Behaviors To Use In The Future
ABCEF
1st
2nd
ABCEF

ABCEF 3rd
ABCEF 4th
ABCEF 5th
ABCEF 6th
ABCEF 7th
ABCEF 8th
ABCEF 9th
10th
ABCEF

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 Dialectical Behavior Therapy Problem Solving

Name: Date Filled Out: Page 3

WHAT EXACTLY WERE THE CONSEQUENCES IN THE ENVIRONMENT?
Immediate:
Delayed:
and IN MYSELF?
Immediate:
Delayed:

WAYS TO REDUCE MY VULNERABILITY IN THE FUTURE:

WAYS TO PREVENT PROMPTING EVENT FROM HAPPENING AGAIN:

WHAT HARM DID MY PROBLEM BEHAVIOR CAUSE?

PLANS TO REPAIR, CORRECT, AND OVER-CORRECT THE HARM:

MY DEEPEST THOUGHTS AND FEELINGS ABOUT THIS (THAT I WANT TO SHARE):

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