Okay, so we've covered the history of behaviorism, the basics of how behavior works, examining whether one is ready to change, motivational interviewing to support change. Using a behavioral activation approach as a way to treat depression and the smart approach to goal setting, so that behavioral goals are more likely to be successful. The next natural questions are, one, how do we troubleshoot any problems that occur? And two, how do we maintain the changes that have been made? So first, how are problems and behavior change plans assessed? Behavior change is not a one and done thing, it takes a lot of observation and experimentation. Functional analysis or chain analysis is the tool used in cognitive behavioral therapies like dialectical behavior therapy, DBT, and acceptance and commitment therapy, ACT. To understand and deconstruct how a behavior came to occur, what's reinforcing its future occurrences, and what we can do differently. Chain analysis or functional analysis can be used in many different ways during therapy. It might be as simple as a guided conversation between a therapist and the client to understand what came before and after a behavior. It might be a worksheet that the patient uses to keep notes on their behavior, the circumstances under which it occurred and the consequences that happened after. Or it might be a more of an in-depth analysis to put together as many elements as possible. To understand what led up to the behavior and how it played out. The purpose of a chain analysis is to examine the chain of events that leads to an ineffective behavior. As well as the consequences of those behaviors that may be making it hard to change again. Remember reinforcement, what happens after matters. Let's break down the steps of a full chain analysis now. The first step is to identify a problem behavior. This was like what you did in picking your target behavior you've been working on. Maybe it was staying up too late or getting exercise in a therapy session. It might be something like losing your temper, drinking or self harm. As we work through this chain analysis, let's use the example of road rage. The client is working on changing their behavior when someone cuts them off in traffic from yelling, swearing and accelerating to breathing deeply and calmly and maintaining their same normal speed. So the next step is then to choose a specific instance of the behavior and this is key and a common mistake. People will try to do a chain analysis of a general or average example and it just doesn't work. So the therapist or the patient needs to bring a specific example to think about and to diagram out. This could be the most recent instance of the behavior, the most severe, the most confusing, whatever makes sense. But we're going to be talking a lot about details, so we need a specific instance. So if I was thinking of the example of losing my temper on the road, I'd want to do a chain analysis on a specific example of that. For example, losing my temper yesterday when a black pickup truck cut me off in traffic when I was driving home from work in the afternoon. All right, now that I have that in mind, the next step is to make sure that you've clearly defined the behavior. So if I was again using this example of losing my temper, I'd want to behaviorally define that. What is the behavior of losing my temper? It might be yelling, cussing and speeding. Next I need to look for the prompting event. What was the event that set this chain off? And it might not have occurred directly before the behavior. So questions to get to this prompting event might be, what set that off or what was going in the moment before the problems started. And this example we're using, it might be clear when the pickup truck cut me off. Other times, the prompting event might be a little harder to find or identify, but it's really worth looking for. For example, if you're analyzing a time when you had a drink, when you weren't planning on it, you might need to look earlier in the day or think harder about what really set off that episode of drinking. The next step then is to look for vulnerability factors. What were the conditions at work that may have made this particular series of events more likely? For example, perhaps I remember that, that afternoon at my job, I had had a performance review with my boss that had really stressed me out and I was already on edge and anxious when I got into the car. Or maybe I remember that I was running late to get home for dinner and was really anxious and stressed. Or perhaps it was raining out and the driving conditions were poor. I would note any of these factors down as vulnerability factors. You can think of these kind of like the operating conditions of the environment. Had I been heading out from work on a normal day without a performance review, without a need to get home early, in good weather. Perhaps the chain would have unfolded very differently even with that same prompting event, a truck cutting me off. Our next step then is to break down that chain, moment by moment. And here we want to think about the five types of experiences we might be having. What were my behaviors or actions? So in this example, I slammed on my brakes, I rolled down the window, I started yelling at the truck. I also want to notice what I'm feeling in my body, what are my sensations? So in this example, I felt my heart rate go up and I got hot and flushed, and my muscles tightened. I also want to know what cognition or thoughts I was having. Maybe I remember having the thought, that guy has no respect for me or the thought, we could have had a crash. And then finally, what was I feeling? Perhaps feeling emotions of anger or fear. And then also, additionally, I want to know whether some other events are happening around me in the environment. Perhaps another driver looked at me when I was yelling. Next, I want to describe the consequences. What happened after? How did people react? How did I feel? What impact did the problem behavior have? And this is going to help us identify the reinforcement patterns that may be keeping this behavior in place. This is key to understanding the function of the behavior. Remember what happens after is what is reinforcing the behavior and increasing the likelihood that it happens again. So looking at the consequences will also help you see points of damage that could be repaired if the behavior impacted others. So in my example, maybe I felt like I had more control after I started yelling. If that was the case, this is probably the thing that's reinforcing my response. And I also reflect that when I got home I was on edge, and I snapped at my child at dinner. This is a consequence I may need to repair as it impacted someone else. The next step is then to use all this data you collected to think through where you could break the chain in the future. Or if you're working with a therapist or if you're a therapist working with a client, where are places that they could break the chain? What more skillful behaviors could you teach that would keep that chain from running through again. So in our road rage example, I could have used a deep breathing technique when I first felt that anger rising up. I could have used some cognitive restructuring to challenge the thought that the other driver was out to get me. Or maybe I could have just put on some good music to distract myself. Now this step usually takes ample time, as it's where the brainstorming and problem solving and thinking through skills really comes in. Finally, we also might want to think about how to reduce these vulnerability factors we identified earlier. The vulnerability factors we really want to spend time on are those that are within an individual's control. So common vulnerability factors like this are things like being tired, being hungry, having missed a medication dose. It isn't as helpful to focus on vulnerability factors that we don't have control over like weather or traffic, as these are just environmental conditions that we're going to have to get used to dealing with. For example, if I knew tiredness was a common vulnerability factor for me, maybe working on sleep would help. Or in this instance if my road rage was worse because I was in a hurry, I could try making it a habit to leave work 10 minutes earlier to build in some buffer time and reduce the amount of anxiety and arousal I was starting off with. So that then is a complete chain analysis. You can use this as a tool to troubleshoot what's going on with your behave
