Trauma Informed Care – Avoidance Process
Although more and more clinicians are learning about and using principles/practices of Trauma Informed Care, too few understand the behavioral dynamics of negative reinforcement in the avoidance of trauma-related cues (people, places, things, internal sensations, emotions and images). This post will give a very brief description of negative reinforcement via habitual avoidance. Psychologist B. F. 
Skinner in his explanation of operant conditioning explained negative reinforcement as a behavioral response being strengthened by avoiding or removing a negative (in this case emotional) consequence or aversive stimulus. Behaviors are negatively reinforced when they enhance escape from aversive stimuli. Here the behavior of avoidance is reinforced; such conditioning leads to habitual avoidance of trauma-related cues and stimuli. This conditioned behavior is adaptive in that it reduces painful emotional suffering. In a sense, it is a form of emotional self-medication: short-term emotional relief by avoidance behavior but long-term suffering continues. The removal of a punishing experience is a highly reinforced, conditioned outcome. Therefore, a person suffering from psychological trauma learns that avoiding trauma-related stimuli leads to less suffering. Thus avoiding traumatic stimuli reduces emotional suffering activated by those same stimuli. Avoidance is learned as an adaptive coping response to 
traumatic fear of suffering on-going traumatic symptoms and reactions. In behavioral chain analysis, the person suffering from trauma learns avoidance improves their emotion state because it reduces consequential emotional suffering. The positive consequence is often immediate, making the reinforced conditioning stronger; habit formation occurs quickly. The behavior becomes stronger over time. As avoidance becomes habitual, the person cannot benefit from successive approximations – the slow, safe. steady approach behaviors related to facing and being with traumatic cues and stimuli. Longer-term, slow and safe exposure to these traumatic cues and stimuli improves emotional coping as it reduces negative physiological and emotional reactivity. The consequence of learning the avoidance cycle implies little progress will occur in recovering from powerful traumatic experience/s.
In the current scientific treatment of trauma, slowly weakening the habit of the learned avoidance cycle helps the person to approach and cope with traumatic cues and stimuli with less emotional reactivity and fear. Therapeutically supported cognitive restructuring, slow and safe behavioral exposure to cues and stimuli, and the application of mind body coping skills (use of the therapeutic alliance, supportive self-talk, cognitive and behavioral rehearsal, breathing retraining, mindfulness, meditation/yoga, etc.) will eventually improve coping, emotion 
regulation, and recovery process. People suffering from trauma can get well, but only if their therapists and medical providers understand how to treat psychological trauma. It is not just prescribing another medication. Co-occurring conditions (depression, other forms of anxiety, substance abuse) often mean that the treatment of trauma is NOT unidimensional in nature.
For more information refer to Skinner, B. F. (1953). Science of Human Behavior. New York: Macmillan. See also Kanazawa, S. (2010). Common misconceptions about science: Negative Reinforcement. Psychology Today. Retrieved 9-20-16.
By Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont
Author of Mindful Happiness
problems in Vermont and the nation. The final picture is a very sad one. Trauma Informed Care, better training of clinical and medical personnel, required documentation of better clinical outcomes are all part of an improving picture of better biopsychosocial-spiritual development for children and youth.