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Anthony Quintiliani, Ph.D, LADC

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November 7, 2016 By Admin

Trauma Informed Care – The Avoidance Process

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. scienceandhumanbehavior_mindfulhappinessSkinner 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 tic-mindfulness_mindfulhappinesstraumatic 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 traumainformedcare_mindfulhappinessregulation, 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, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Behavior, Featured, Science, Therapist, Trauma, Trauma Informed Care Tagged With: ANTHONY QUINTILIANI, BEHAVIORAL, BF SKINNER, SCIENCE, THERAPY., TRAUMA INFORMED CARE

September 28, 2016 By Admin

Absolute Basics of Trauma Informed Care

Trauma Informed Care – The Absolute Basics

This post aims at providing a very basic introduction to Trauma Informed Care.  Advanced versions of this information are available from the author.  So what is Trauma Informed Care (hereafter TIC)?  Below I have listed rationales of need and core characteristics of TIC in organizations.mindfulhappiness-tic

Why We Need Trauma Informed Care?

The 2012 (revised 2016) National Survey of Children’s Health (Vermont Sample) documented significant levels of Adverse Childhood Experiences (ages 1 to 17)  and Adverse Family Experiences. This data is supported by ongoing assessment of ACEs in Vermont and in the nation. Some information paints a picture of serious psychological and physical needs in Vermont.  Such data include a 25% divorce/separation rate; a 25% family financial hardship rate; 10 to 15% rate of children living in a family of substance use or mental health disorders; 43% of children experiencing depression and/or anxiety; and, 33% experiencing behavioral/conduct problems. Vermont has a significant percentage of its children suffering from three-four or more ACEs.  Add all this to the out-of-control substance abuse/dependence nationalsurveyofchildrenshealthproblems 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.

Some Core Principles and Practices of Trauma Informed Care:

  1. Personal healing, resilience, and happiness are all possible over time.
  2. Staff must recognize and respond effectively to personal trauma histories and various, complex developmental consequences.
  3. Powerful self-safety in the environment and relationships is an absolute requirement of care.
  4. Trust and transparency go hand-in-hand with systemic trauma recovery.
  5. Advanced, effective trauma therapy requires more than conducive constructivist and systemic variables. Trauma therapy requires an expanded skills set within the same trusting relationship.
  6. All parties and their unique contributions are valued and respected in TIC.
  7. Strong compassion skills and processes work together with improved executive and limbic brain functioning. Concrete skills practice is part of the healing process.
  8. The science of prevention and the science of treatment are integrated in TIC.traumainformedcare_mindfulhappiness
  9. Assessment is continuous and includes both primary and secondary trauma realities.
  10. On-going staff training and an emphasis on staff self-care are necessary for TIC to work well. Typical “burn-out” practices are not part of this picture.
  11. Protective factors are enhanced, and health promotion and risk reduction are always implemented.
  12. Within relational interactions object constancy, the realities of nature and nurture, and powerful alliance patterns all exist.
  13. Mindfulness practices, breathing retraining, and trauma-informed yoga may be added interventions. Much trauma treatment is moving into the body, beyond simply talking and thinking.
  14. Awareness of and responsiveness to ACEs (Adverse Childhood Experiences) and AFE (Adverse Family Experiences) are on-going.
  15. Ultimately, TIC is part of psychosocial and clinical process that hopes to repair the dearth of healthy early life attachment. Improved object relations goes a long way toward healing.
  16. Healthy power-sharing reduces marginalization and hopelessness. Hope and empowerment are “musts” for client/consumer populations in recovery.
  17. In some cases, my premise that “we all are in recovery from something” may be part of this process.  This reality make us more like our clients/consumers – not “above” them.
  18. Needs are projected; needs are met; arousal is reduced; and, relaxed relationships continue.
  19. In the best outcomes safety, security, trust, self-regulation, hope, and healing will occur over time.
  20. In some ways D.W. Winnicott, the famous British pediatrician turned psychoanalyst, would be very, very happy with the core “intersubjective” holding environment of TIC.

For more information refer to Quintiliani, A. R. (February, 2016). Trauma Informed Care…Monkton, VT: Self-Published.  See also Kasehagen, L. (2012, 2016). National Survey of Children’s Health – Vermont Sample. Vt. Department of Health/CDC.

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

ChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Featured, Trauma Informed Care Tagged With: ANTHONY QUINTILIANI, MINDFUL HAPPINESS, TIC, TRAUMA INFORMED CARE

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