An important tenet of DBT is that behaviours and emotional outbursts, including unhealthy ones, have different kinds of causes. The causes aren’t just (conscious and unconscious) beliefs and desires; nor are they just electrical signals carried by chemicals in the brain.
In addition, these varying causes form a chain:
Vulnerability → Prompting event → Interpretation and other intermediate links → Problematic reaction → Consequences
In my own case, the “problematic reactions” aren’t things like abusing alcohol or drugs, angry explosions, etc. Mine are inner feelings – especially overblown fear and sadness – and the outer expression of those feelings – such as freezing up and sobbing uncontrollably.
Part of DBT therapy is analysing these chains. “Chain analysis” has a descriptive and a prescriptive part: not just identifying the links in the chain, but therapeutically breaking the maladaptive chains and replacing them.
A recent example. The vulnerability: I was alone, with too many tasks to complete, on a grey and cold afternoon. The prompting event: I saw an East Indian girl in a pink jacket with short dark hair. The problematic behavior: I started sobbing, repeatedly clenching my hands and toes, lowered my chin to my neck, closed my eyes; and I felt dreadful grief and hopelessness. The consequence: the young girl and her grandfather noticed me with shock and became frightened.
As for the interpretation, I thought:
- “That girl looks like Moon and Saima when they were young”
- “My little girls are gone”
- “They loved me back when they were that age, but do they love me now?”
- “My life is full of loss”
- “Everything around me ages and dies”.
This amplification of the prompting event – via the intermediate links – is what yielded an outsized physical and emotional reaction, the sobbing, etc. Then there was a subsequent chain. (Cue a downward spiral.)
The vulnerabilities came to include my present state of desperately grieving, of being even more emotionally fragile. A new prompting event on the scene was the very fact that I reacted so strongly to the initial one, and that this hurt others. A resulting “meta-chain” went:
- “I am a bad person because I’ve upset this poor family”
- “That I reacted this way shows that I am sick and won’t get better”.
As you can tell from this example, I’ve become pretty astute when it comes to recognizing the varying causes and the chains. My present homework is to focus on the prescriptive bit. I’m working on four aspects right now.
1) Checking the facts. Is my interpretation complete and accurate?
(In the example, checking the facts would involve asking: “Have I really ‘lost’ my girls?” “Am I truly getting worse?” “Did I do so much harm that I’m an awful person?” The facts were: No, no and no.)
2) Identifying more effective links. Where could I have replaced a problematic link? Which links are such that, had I conceived things differently, the consequence would have been avoided?
(I might have interpreted the scene as: “It’s nice that that girl is happy”; “Her coat reminds me of wonderful Winter outings with Moon and Saima”; “Change and loss are constant and universal, they aren’t specific to me”.)
3) Recalling DBT skills during a prompting event. Which techniques would have forestalled the chain?
(I could have paused, mindfully, to focus on and describe the initial sensations in the body when I first saw the girl.)
4) Strategizing about how to prevent such a chain next time.
(But not by avoidance of, e.g., seeing happy children outdoors! Nor by quashing the feelings entirely. That’s aversion rather than prevention.)