Dialectical Behavior Therapy for Binge Eating and Bulimia (20 page)

APPENDIx
3.6

Sample Chain Analysis

Behavioral Chain Analysis of Problem Behavior: Page 1

Name:

Date flled out:

VULNERABILITY

PROMPTING

EVENT

LINKS

Date of problem behavior:

PROBLEM BEHAVIOR

CONSEQUENCES

WHAT EXACTLY IS THE MAJOR
PROBLEM BEHAVIOR
THAT I AM ANALYZING?
One-hour binge on a variety of junk foods from convenience store.

WHAT PROMPTING EVENT
PROBLEM BEHAVIOR? Start Day:

IN THE ENVIRONMENT

Monday

STARTED ME ON THE CHAIN TO MY

My husband and I got into an argument because he went against our agreement that his mother would
stay in a hotel during the holidays. Instead, he told his mother that she could stay at our house after all.

WHAT THINGS IN MYSELF AND MY ENVIRONMENT MADE ME

Start Day:

Saturday

VULNERABLE?

I felt stressed and overwhelmed at all I had included on my to-do list (grocery shopping, polishing
silverware, getting house in order, washing dog, washing car). I was irritated at my husband for not helping.
I had not gotten enough sleep and felt exhausted and irritable. Over the years, I have developed the

pattern of using binge eating when upset.

Adapted from Marsha M. Linehan. Copyright 1996–2009. Adapted with permission in Dialectical Behavior Ther—
apy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen (2009). Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for

details).

Date flled out:

Behavioral Chain Analysis of Problem Behavior: Page 2

OF BEHAVIOR (actions; body sensations; cognitions; feelings) and EVENTS

LINKS

sensations

Feelings

A – Actions

B – Body

C – Cognitions

E – Events

F –

Name:

Adapted from Marsha M. Linehan. Copyright 1996–2009. Adapted with permission in
Dialectical Behavior Therapy for Binge Eating and Bulimia
by Debra L. Safer, Christy

F. Telch, and Eunice Y. Chen (2009). Permission to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for details).

76

Behavioral Chain Analysis of Problem Behavior: Page 3

Name:

Date flled out:

WHAT EXACTLY WERE THE
CONSEQUENCESIN THE ENVIRONMENT?
1.
When I returned home it was harder to talk with my husband.

AND IN MYSELF?

1.
Immediately after all the food was gone, I felt exhausted yet relieved. The thoughts and feelings about
the fght felt a distant memory, not important. Just wanted to go home and sleep.

2.
Once I got home I felt guilty because I didn’t want to do anything but go to bed. My stomach was upset.
Felt sick and self-hating. Ashamed.

WAYS TO REDUCE MY
VULNERABILITYIN THE FUTURE

First, I can decrease my level of stress and tension by reducing the demands I place on myself. I can also
focus on the pleasure and satisfaction I derive from some of the “tasks” I set for myself. Second, I can ask
others for help and communicate my feelings rather than expect them to read my mind.

WAYS TO PREVENT
PRECIPITATING EVENT
FROM HAPPENING AGAIN

Discuss with my husband “rules” for talking about areas of confict and disagreement. For example, only
talking when we both agree on the timing, genuinely listening to each other’s position, agreeing to end the
discussion and return to it later if it is at an impasse or is escalating.

WHAT
HARM
DID MY PROBLEM BEHAVIOR CAUSE?

The greatest harm was to myself. I felt ashamed and worthless after the binge. Physically sick. I noticed I
withdrew from my husband and was less able to solve the real issues at hand.

PLANS TO
REPAIR, CORRECT,
AND
OVERCORRECT
THE HARM

I will apologize to myself and commit to never, ever binge eating again. I will make a promise from deep
within to stop, observe, describe, and use all of the skills I can next time the binge chain starts. Apologize
to my husband for my role in the fghting and suggest we do something we both enjoy. I will overcorrect by
donating canned food at the grocery store for the needy.

MY DEEPEST THOUGHTS AND FEELINGS ABOUT THIS (THAT I WANT TO SHARE)
In my heart of hearts, my wise self, I know that this is not how I want to behave or conduct my life. I am
reacting rather than taking the time to understand, explore, or examine the thoughts and feelings evoked.
I miss out on knowing my experience, knowing who I am. I blur my experience with binge eating. This deeply
saddens me. I want to stop binge eating.

Adapted from Marsha M. Linehan. Copyright 1996–2009. Adapted with permission in Dialectical Behavior Ther—
apy for Binge Eating and Bulimia
by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen (2009). Permission
to photocopy this appendix is granted to purchasers of this book for personal use only (see copyright page for
details).

77

APPENDIX 3.7

Guidelines for Filling Out a Behavioral Chain Analysis
of
a
Problem Behavior

1.
Problem behavior: Specify the problem behavior (e.g., not practicing skills, binge eating [large or small],
binge eating and purging, mindless eating) in the space provided on the frst page of the chain. Be specifc
and detailed in describing characteristics of the behavior.

2.
Prompting event: In the box on the frst page, fll in the specifc event that started the whole chain or sequence
of events leading to the problem behavior. Always start with an action or an event in your environment even if
it doesn’t seem to you that the environmental event “caused” the problem behavior. Examples of prompting
events might be weighing yourself, looking in the mirror, attending a buffet dinner, being asked to volunteer on
a committee, and so forth. The prompting can be anything or everything that was happening at the moment
you started off on the path to your problem behavior. Describe, as well, what was going on inside of you when
the prompting event started (e.g., what you were doing, thinking, feeling).

3.
Vulnerability factors: Identify in general what factors (both in yourself and in the environment) occurred
before the prompting event that made you more vulnerable to it. In other words, what gave the prompting
event such power? These factors might include those within you—such as physical illness, unbalanced eating
or sleeping, use of drugs or alcohol, emotions (e.g., sadness, anger, fear, loneliness), or behaviors (e.g.,
inactivity or procrastination). Or they might be factors in your environment—either positive or negative—such
as availability of tempting foods, being alone, increased demands at home or at work, and so forth.

4.
Links in the chain: On the second page of the chain, write out the main links in the chain that hooked the
prompting event to the problem behavior. Notice what comes frst: the sensation? Feeling? Thought? Describe
the links in the sequence they occur. Links might include actions or things that you did (e.g., yelled at your
child or partner, stopped at grocery store), body sensations (e.g., knot in stomach), cognitions or thoughts
(e.g., “I’m too fat,” “None of my clothes look good,” “I’ll never get this done,” “I can’t wait”), events (e.g., boss
asked me to stay late, invited to a pot-luck dinner), and feelings (e.g., angry, overwhelmed, lonely, scared).
5.
New skillful solutions: On the lines in the second column, describe the specifc skills that you could have
used to replace the link and break the chain of events leading to the problem behavior. Sometimes it is helpful
to fll these in with a different colored pen or pencil.

6.
Consequences: On p. 3 in the top box, describe the consequences of the problem behavior, both in the
environment and in yourself. The idea is to identify the consequences that reinforce
the problem behavior,

making it more likely to happen again. Describe both the immediate consequences (e.g., an increased sense
of power over others, deciding not to attend a party, feeling numb, no longer anxious about an argument), as
well as the longer-term consequences (e.g., depressed mood, physical discomfort, weight gain).

7.
Ways to reduce your vulnerability in the future: Describe in detail ways you can prevent the chain of events
from starting by reducing your vulnerability to the chain of events (e.g., improved sleep, not purchasing large
quantities of food, balancing work with relaxation).

8.
Ways to prevent precipitating event from happening again: Describe the things you can do to prevent the
prompting event from happening again. For example, one might make an agreement with a partner to take a
time out before an argument escalates. Then, follow through on this agreement.

9.
What harm did your problem behavior cause?
Describe in detail the damage or harm your problem behavior
caused for you and others. How did it affect your self-confdence? Your belief in your ability to maintain control
over yourself for your long-term best interests? Your relationships with others?

10.
Plan to repair: Describe what you will do to repair the harm that resulted from the problem behavior (e.g.,
what will you do to correct the blow to your self-confdence or the damage to relationships that the problem
behavior caused?).

11.
Deepest thoughts and feelings about this (that you want to share): Spend some time encouraging and
allowing your deepest thoughts and feelings to surface about this chain of events and problem behavior. Write
down the thoughts and feelings that you want to share.