Sunday, February 27, 2011

Feb 27-March 6th, 2011: Skill of the week - Take (2)

Clearly I was not awake during my skills post last week because I dated for this week and not until I went to write this weeks skills post did I realize that I buggered it up...so, we shall have a second go of a skills post for the dates of February 27th - March 6th, 2011.

I wanted to take a bit of time today and discuss, in detail, how one would fill out their chain analysis worksheet. It really doesn't matter much what "form" you use, rather the importance comes in the information you provide for yourself. 

First-of-all, what is the purpose of a Chain Analysis Worksheet? 

One of the telling signs of a mental illness is that a person engages in behavior that is harmful and possibly life threatening, on a regular basis. This behavior (generally many behaviors) tends to get in the way of living a life that is worth living. It gets in the way of effective relationships, happiness, feelings of fulfillment in life and in general destroys a persons life...eventually. 


The idea is to attack the mental illness by addressing the symptoms first. Lessening the immediate pain (distress tolerance) so that you can have a clear look at the larger problems, your destructive behaviors or "target behavior". Part of the process of discovering your larger problems comes in the way of assessing your tendencies. Evaluating what it is that you notice about yourself. This process generally tends to come in the following order:
  1. Awareness of a problem (no longer denying that you have a mental illness)
  2. Commitment to recovery
  3. Plan of attack
  4. Education of your plan (for those that choose DBT) - Learning the A, B, C's of DBT. 
  5. Implementing those A, B, C's - Core Mindfulness (observing and describing yourself and your environment)
  6. Knowing the enemy - what are your target behaviors? -  *This is the step where a chain analysis is introduced.*
Alright, I have a sample Chain Analysis in "Helpful Forms and Worksheets" you may want to check-out. But I am going to give you the meat and guts of what information you really are gathering in a chain analysis so that you can generate whatever sort of form that works best for you. 


Let's get started:

Describe the specific problem behavior - i.e. throwing a chair, hearing voices, dissociating, not going to therapy appointments, etc. 
  • Be very specific and detailed. No vague terms. 
  • Identify exactly what you did, said, thought, or felt (if feelings are the targeted problem behavior).
  • Describe the intensity of the behavior and other characteristics of the behavior that are important.
  • Describe problem behavior in enough detail that an actor in a play or movie could recreate the behavior exactly. 
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 environment event "caused" the problem behavior. Possible questions to get at this are:

  • What exact event precipitated the start of the chain reaction?
  • When did the sequence of events that led to the problem behavior begin? When did the problem start?
  • What was going on the moment the problem started?
  • What were you doing, thinking, feeling, imagining at that time?
  • Why did the problem behavior happen on that day instead of the day before?
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:

  • Physical illness; unbalanced eating or sleeping, injury
  • Use of drugs of alcohol; misuse of prescription drugs
  • Stressful events in the environment (either positive or negative)
  • Intense emotions, such as sadness, anger, fear, loneliness
  • Previous behaviors of your own that you found stressful
Describe in excruciating detail the links in the chain of events that hooked the prompting event to the problem behavior.

  • Links in the chain can be: Actions or things you do; Body sensations or feelings; Cognitions, e.g. beliefs, expectations or thoughts; Events in the environment or things others do; Feelings and emotions that you experience.
  • 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 of events, no matter how small. Be very specific, as if you are writing a script for a play: What exact thought (or belief), feeling, or action followed the precipitating event? What thought, feeling, action came next? Then next? ~ Scrutinize your work, look back at the chain, was there any thought or feelings that may 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. ~ For each link in the chain, ask yourself if there is a smaller link you could describe.
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. 

  • How did other people react immediately and later? 
  • How did you feel immediately following the behavior? Later? 
  • What effect did the behavior have on you and your environment immediately and later?
Describe in detail different more skillful solutions to the problem.

  • Go back to the chain of your behaviors following the prompting event. Circle each point of link where if you had done something different you would have avoided the problem behavior.
  • 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?
Describe in detail preventing strategy for how you could have kept the chain from starting by reducing your vulnerability to the chain.


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

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.

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 over-correct the harm. 

Finally, record whatever reflects your deepest thoughts and feelings about the episode. Just start writing and continue for five or so minutes 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. 

~

This should be read over, practiced and practiced. The idea is that you are getting down to the bones of what sets off the target behavior. The more you know about what happens to you and your environment during this time the better chance you will have at anticipating the prompting event even, and that opens up so much more that can be done in the way of healing. 

Let's hear some thoughts on chain analysis, how has it been working? What doesn't work about it? How do you feel about? Please share.

MJ