After you’ve self-harmed, maybe for the fifth time, maybe for the hundredth time, it’s true that there often comes a moment of relief from the emotional pain. But not long after, you’ll probably feel the urge to hide the marks and to avoid thinking about the emotions and thoughts that led to them. The cycle begins again.
Reflecting on what led to self-harm, and what purpose it served in the moment, can feel overwhelming. Without other coping tools in place, that reflection may bring up shame, fear, or even stronger urges to self-harm.
This lack of understanding keeps you stuck in a loop of trigger-harm-relief-shame, on and on. You repeat the cycle, reaching for self-harm again when you’re overwhelmed, but only getting temporary relief.
DBT can help you realize what triggers self-harm, and can support you in choosing alternative behaviors
For people who repetitively self-harm, understanding causality for the self-harm behaviors can be a powerful tool to breaking that cycle. When you realize what’s prompting your self-harm, what’s increasing your vulnerability to self-harm, and what you can choose next time, you can start to ease your emotional distress without relying on self-harm for relief.
Dialectical behavior therapy (DBT) includes a framework called “behavior chain analysis” to help you understand the why, how, and what’s next for repetitive self-harm behaviors. It’s a non-judgmental approach to pattern recognition, giving you a chance to take an honest and detailed look at what leads to self-harm for you and empowering you to choose other ways to cope.
How do you use DBT chain analysis for repetitive self-harm behaviors?
DBT considers all behaviors to come from a chain of events and internal experiences. When you consider all the links in the chain, you can pinpoint links where you can make changes, so you don’t end up resorting to self-harm again.
Vulnerability
Inner experiences and outer environmental factors can make you more vulnerable to self-harm, even if they don’t directly trigger urges. These vulnerabilities are similar to those listed in the ABC PLEASE skill, as they leave you more susceptible to emotional dysregulation and make it harder for you to reach for healthy coping tools.
Vulnerabilities can include:
- Physical illness or injury
- Poor eating, sleeping, or skipping medications
- Intense emotions you’re already going through
- Mind-altering substances like alcohol or drugs
- Stressful events in your life (could even be good experiences, but they trigger strong emotions)
- Recent stressful behaviors of your own
Prompting event
A detailed description of what happened right before you self-harmed (or felt the intense urge to self-harm). This should always be an external event, but it could be nearly anything, like an intense argument, or something very basic and seemingly boring like eating breakfast.
Links
A prompting event doesn’t lead directly to self-harm; there are steps in between, including physical actions you take, and thoughts and feelings you experience.
DBT uses an ABCEF mnemonic device to help you think through all the possible links that lead to repetitive self-harm, including:
- Actions (like isolating yourself, finding tools to self-harm)
- Bodily sensations and feelings (like anger, fear, tightness in your chest, a flushed face)
- Cognitions: thoughts and beliefs
- Events in the environment, like things people do
- Feelings and emotions you experience
Even if you don’t think a thought, feeling, or event is contributing to your repetitive self-harm, being detailed can help you see patterns you might not have recognized before, and can also create opportunities to choose different outcomes.
Problem behaviors
Be detailed about your self-harm behaviors; take note of where, when, and what you do. Remember, you are not the problem. The behavior is. You can change the behavior. You do not have to change who you are.
Consequences and Solutions
Consider the consequences of your problem behavior, both for yourself and for others. How do you feel right after the behavior, an hour later, a week later? How do others respond if they notice the repetitive self-harm behaviors, and how do you feel about that?
At each of these links, but especially after you’ve completed the whole behavior chain, you and your therapist can consider alternatives and solutions that can help you in the moment.
Life will throw difficult experiences your way, and you will experience intense emotions sometimes. DBT chain analysis can help you recognize, in detail, how these challenges lead to self-harm, and that detail can also show you places in the chain where you have the power to change the outcome.
Why use DBT chain analysis?
DBT behavior chain analysis can help you reduce vulnerability to self-harm triggers
When you know what’s leaving you vulnerable to self-harm, you can focus on prevention through prioritizing physical and mental wellbeing. Using a DBT skill like ABC PLEASE can give you a structured way to take care of your body and mind and reduce your vulnerability to self-harm urges.
Chain analysis can help you choose different responses other than repetitive self-harm
When you know what triggers repetitive self-harm, you can create a plan for those moments, so you have something to reach for, like sensory soothing with the DBT skill Self-Soothe, or working with your body chemistry through the TIPP skill, to manage your distress in the moment in ways that don’t lead to self-harm.
When you understand the links in the chain of your problem behaviors, you can also recognize them as you’re living them. Anywhere in the cycle, you can choose to do something that changes the outcome. If nothing else, you can use DBT skills like STOP or Opposite Action to give yourself some breathing room in the moment, cutting the self-harm cycle short.
DBT chain analysis isn’t easy, but it’s an important step in treating repetitive self-harm behaviors
It can feel scary, threatening, or even foolish to tell your therapist the whole truth about a self-harm episode and to look at what you’ve experienced in detail. You’ve spent a long time trying to hide the behaviors, and you’re not sure what life would look like without them as an outlet.
DBT chain analysis, as part of a comprehensive DBT program, can give you a mindful, non-judgmental frame for your repetitive self-harm behaviors. Nowhere in the chain is there a “What does this mean about you as a person?” link, nor is there a “Just stop, all on your own, without learning any other ways to cope” link.
The whole goal of chain analysis with the empathetic therapists at Suffolk DBT is to help you choose different behaviors that don’t hurt, but do help, by recognizing what triggers you; you deserve a life without self-harm, and behavior chain analysis can help you create that life.
If you’re ready to use understanding and compassion to break the repetitive self-harm cycle and choose behaviors that create a life that is filled with meaning instead of pain, contact us today to set up a free consultation.
Frequently Asked Questions About Repetitive Self-Harm Behaviors
Are people who repetitively self-harm suicidal?
No, self-harm is not a definite indication someone is suicidal. Self-harm and suicidal ideation can co-occur, but they are separate experiences. Non-suicidal self-harm behaviors are specifically defined as not associated with suicidal intent, though if they’re allowed to continue without treatment, they can eventually tie into suicidal ideation and escalate into suicidal behaviors.
What’s the difference between repetitive self-harm and body-focused repetitive behaviors (BFRBs)?
Self-harm behaviors, repetitive or one-off, are done with the intent to cause pain/damage/harm. They often involve actions like cutting, burning, scratching, or bruising oneself, usually in order to express or suppress some form of emotional upset. The harm is the goal for self-harm behaviors, and the person doing the behaviors may not want to stop, so as not to lose the outlet for their feelings.
BFRBs usually feel soothing in the moment, a way to calm an individual in response to internal discomfort, like difficult emotions or body sensations. They often take the form of hair pulling, nail picking or biting, skin picking, and lip biting/chewing. With BFRBs, the harm is incidental, not the goal, and the person experiencing them usually wants to stop the behavior so they can stop the harm.