I have been doing Dialectical Behavior Therapy (DBT), a cognitive-behavior skills based treatment, for years with my clients. I know the modules inside and out. Some say I eat, sleep, and breathe them. I get excited when I teach the skills of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness in my groups. I love it when someone has a light bulb moment and the skills work in a crisis and really see change in someone’s ability to regulate their emotions and behaviors more effectively. 

Recently I was re-introduced to a DBT skill that I completely forgot about! I imagine we have heard of the Behavioral Chain Analysis, and do it often with our clients to analyze problem behaviors, but what about the missing links analysis? Yes, the missing links analysis! 

The missing links analysis skill allows us to analyze what got in the way of engaging in effective behavior. Perhaps you have identified with your therapist that you are going to meditate five minutes a day, but it slips your mind. What if you know that grocery shopping is part of your treatment plan with your eating disorder treatment team , but week after week you do not go? It helps us to review why we did not do what was needed, what was agreed upon, or what others expected us to do. The four main questions are:

1. Did I know what effective behavior was needed or expected? If No, what got in the way? How can you problem solve?
2. Am I willing to do what was needed or expected? If No, what got in the way? How can you problem solve.
3. Did the thought of doping what was needed or expected enter my mind? If no, what got in the way? How can you problem solve?
4. What got in the way of doing what was needed or expected in a timely fashion? If no, what got in the way? How can you problem solve.

Here is an example:

Missing Behavior: Taking afternoon psychotropic medications.

1. Yes, I did know that I was supposed to take my medications every afternoon to manage my anxiety but due to my schedule I got busy and put it off. One way to problem solve is to put it in my calendar or planner.
2. I was not willing to take my medications because I did not understand the benefits of it so I spoke to my psychiatrist about the ways the medication can reduce stress at our last session. After the discussion I was more willing.
3. Some days the thought of taking my medications did not enter my mind so I set a specific alarm for 2pm for a reminder.
4. In order to take my medications right away, I put a glass of water and the prescription bottle on my desk as a cue/reminder.

Think about an effective behavior that you keep missing out on. Use the missing link analysis worksheet to answer some questions and to problem solve. Hopefully the skill will help you increase behaviors that improve the quality of your life.

Warmly,

Meredith O