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Fundamental to problem solving in DBT is the behavioral analysis, which is the collaborative process of identifying and reevaluating over time the sequence of internal and external events that are associated with the problem behavior. Behavioral analysis includes the assessment of multiple chain analyses. Small units (links) of behavior are analyzed with the goal of defining the beginning of the chain, or the antecedents; the middle of the chain, or the problem behavior itself; and the end of the chain, or the consequences of the behavior. Attention is paid to all behaviors, including emotions, bodily sensations, thoughts (explicitly and implicitly as in expectations and assumptions), urges, and overt behaviors. Environmental factors (e.g., a conflictful visit with a relative) and vulnerability factors (e.g., lack of sleep or physical illness) that may affect the behavior are important to ascertain. It is essential to define the problem specifically. Rather than asking questions about causality (e.g., "Why do you think that happened?"), the therapist should ask questions aimed at specifying the antecedents and consequences of the behavior (e.g., "At what point in the day did the thought of suicide enter your mind? What was happening in that moment?"). This information facilitates understanding of typical response patterns to specific stimuli that are germane to the particular behavior.

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Table Reference Number
Table 27–5. Levels of therapist validation in dialectical behavioral therapy

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