Framing Trauma: How do we apply behavior analysis to a mentalistic term?

A Perspective on Relational Frame Theory and Trauma

Talks on Trauma

Trigger Warning: talks about traumatic experiences 

I am going to use some words that as behavior-analytic professionals we are taught are indefinable, untouchable, and forbidden as a part of our professional language. The frank part is you wouldn’t be wrong to think those things. Yet, you are thinking them. That internal dialogue is an important experience most of us have and is recognized under our radical behaviorism perspective. So, what existential point am I getting at here?

The point is that there are mentalistic experiences we have yet to define but can recognize the observable behaviors that we assign as a part of those experiences. One of these is trauma. We do not have a thorough explanation of psychological trauma, because it is psychological in nature. However, it is generally accepted that it is developed through exposure to events that has a negative impact on the functioning of individuals (Rajaraman et al., 2022). We are familiar with documented events such as domestic violence, war, and adverse childhood experiences (ACEs). These events often directly change behavior in more ways than one. It is behavior that we see a change in. That is the important point. 

Defining Trauma

The idea that trauma is developed through exposure to adverse experiences has been loosely defined. So, let's take it a step further. Adverse experiences inherently include aversive stimuli such as pain. We generally do not need to be conditioned to find pain aversive or for it to function as a punisher. However, the stimuli that are associated with those aversives are conditioned. In the infamous Watson and Rayner (1920) study in which neutral stimuli (animals) were paired with aversive stimuli (loud noise) to elicit a conditioned fear response (e.g., crying), the development of conditioned aversives were demonstrated. A similar experience can be seen when stimuli indicate that a situation is about to get worse. Everyone has had that boss that when they walk into the room, you immediately do everything you can to prevent being reprimanded. You’ll put away the snacks on your desk, hide your cellphone, and frantically pull up document after document on your computer. Then your heart rate raises, your palms start to sweat, and you await the impending reprimand. Your boss has stimulus control over your behavior because they have been reliably associated with punishment in the past. The same applies to the development of trauma responses (Rajaraman et al., 2022).

Development of trauma responses is inherently a behavioral process through which previously neutral stimuli are conditioned to become aversive and/or stimuli become indicators for the availability of punishment, which evokes behavior related to terminating or preventing the punishers. This creates a complex stimulus-response relation that can significantly impact the everyday lives of individuals, including ourselves and our clients. These stimulus relations are important to consider in clinical practice. Recently, fields including behavior analysis have started to recognize the importance of trauma-informed care because of the impact traumatic experiences have on behavior. Rajaraman et al. (2022) addresses this idea of including trauma- informed care as a part of our treatment packages. Yet, there is still more to be considered. A bidirectional relationship exists between behavior analysis and the behavioral components of trauma.

“Framing” Trauma

At the top of this article, there is a “trigger warning” to inform you about the potential responses the topics in this article might elicit. These warnings are becoming common practice, such as in education, to increase listener awareness of the potential responses the topic might cause. Why exactly did I bring this to your attention (again)?

There is something in our field known as Relational Frame Theory (RFT). This describes the patterns of “derived relational responding that emerge, and include frames of coordination (including equivalence); comparison (including more-than and less-than); distinction; opposition; and hierarchy,” (Barnes-Holmes et al., 2004). In plain English, we derive relations between words and events, which can evoke behaviors and elicit responses. There are many wonderful, complex facets of RFT that I would highly recommend you take time to melt your brain studying. However, the particular core aspect I would like to focus on is the idea of transformation of function. 

Transformation of function occurs when there is a relation derived between two stimuli. Barnes-Holmes et al. (2004) highlights the less-than and more-than relation. The authors deliver an example of if I tell you that token A is worth more than token B, then associate reinforcement with Token B, A will be even more reinforcing after that without training. The same thing occurs when we coordinate, or associate things to be the same. These effects are amplified with contexts that elicit certain responses.

This is a lot to digest, so let’s give an example. (I promise it will all come together—hang in there). I am going to give you an instruction: think of an apple. What pictures came to mind? Is it that perfect picture of a prized red apple? Did you think of the taste of an apple? Or eating fruit? I gave no specific instructions, yet you are likely to come up with these associations simply from context of instruction to think of an apple. If I asked you to think of the texture of an apple, then that would elicit an entirely different function than the first instruction. These two different cues controlled the response that was elicited. 

You were not explicitly trained to think of the variety of images or somatosensory (feelings of touch) perceptions, but you derived relations between these things. I would hope that this exercise elicited a pleasurable feeling (my sincere apologies to those that dislike apples). Unfortunately, these frames are not always so positive. The basic exercise I described of contextual cues controlling relational frames that then effect the transformation of those psychological functions (Barnes-Holmes et al., 2004) are also relevant for trauma responses. 

Relations between words and events are derived from these frames. Words that used to be neutral no longer are, because of the derived relations and direct experiences that transform their functions (Barnes-Holmes et al., 2004). Experiencing assault is an example of this. If the assault occurs on the street at night, and you go to a different street at night, there is an equivalence relation that is likely to elicit fear responses because they are viewed to be the same. Verbal behavior often comes under the same control—thus, the trigger warnings. Certain words have developed a relational frame with traumatic events such that they take on the aversive properties of the event itself (Barnes-Holmes et al., 2004). This process is what leads to generalization of these stimulus-class relational frames (Cooper et al., 2020). It creates a generalized repertoire that is expanded exponentially as we create more and more stimulus relations.

Putting it Together

So far, we have talked about the behavioral process of developing trauma responses and the relational frames that lead to contexts or verbal behavior to elicit responses and evoke behavior. At this juncture I know it may feel like an information overload without end or point. To bring it together, the possibility that trauma can be analyzed and addressed as a behavioral process needs to be emphasized—because it is developed as such. This means that as a field we can access that bidirectional relation that makes this relevant for us.

First, consider reading Rajaraman et al. (2022) and adding trauma-informed care into your practice. The term is mentalistic, the process is not. Awareness of the effect that traumatic experiences have on clients’ behavior can help to improve the effectiveness of our interventions. An example given by Rajaraman et al. (2022) is the idea of physical guidance. Clients that have experienced physical abuse in the past may engage in severe problem behavior when being physically guided. This has nothing to do with your intervention because we know physical guidance as a prompt is effective, but it has everything to do with making our environments and protocols conducive to creating positive behavior change without re-traumatization. In other words, there is an empirical basis for the use of trauma-informed care in clinical work. 

Second, behavior analysis is universally applicable. We have the luck of being taught a knowledge and skill set that allows us to assess and address behavior in a unique way. There is a place for professionals in trauma fields since development of trauma responses is a behavioral process at its core. Although we are not currently able to objectively observe thoughts, we can observe overt verbal and non-verbal behavior: both are integral aspects of trauma responses. If we can do that, then that means we can teach others, including those in our field, how to address and assist in crisis intervention or long-term support following traumatic experiences.

For future practitioners with an interest in this area, additional research and practice is needed. Relational frame theory and other behavior-analytic techniques can be applied in therapeutic practice, in the training of practitioners that work within trauma fields (such as law enforcement or advocacy) and embedded within present clinical practice. There is a space for us, we just need to be brave enough to fill it. 

A Final Note

For those reading this who are professionals in behavior analysis or anyone else, remember that your responses to traumatic experiences and triggers that develop afterwards are not your fault. There are many ways of explaining trauma responses and the development of them, none of them negate your individual experience of how it develops for you, and if it does, throw it out the window! Everyone is different. Your experience is valid. Your thoughts are valid. Your feelings are valid. No matter the explanation for them, your individual experience matters and none of it is your fault. Have compassion for yourself and know that help is out there if you need it.     

National Resources for People Seeking Help After Traumatic Experiences

*This is not a comprehensive list but may be a good start to reach out if you need it. 

• Rape, Abuse, and Incest National Network (RAINN): https://www.rainn.org/
• Veterans’ Crisis Line: https://www.veteranscrisisline.net/
• National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org/

Resources

Barnes-Holmes, Y., Barnes-Holmes, D., McHugh, L., & Hayes, S. (2004). Relational frame theory: Some implications for understanding and treating human psychopathology. International Journal of Psychology and Psychological Therapy, 4(2), 355-375. 
Blackledge, J.T. (2003). An introduction to relational frame theory: Basics and applications. The Behavior Analyst Today, 3(4), 421-433. http://dx.doi.org/10.1037/h0099997
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behavior Analysis (3rd Ed). Pearson Ed., Inc.
Rajaraman, A., Austin, J.L., Gover, H.C., Cammilleri, A.P., Donnelly, D.R., & Hanley, G.P. (2022). Toward trauma-informed applications of behavior analysis. Journal of Applied Behavior Analysis, 55(1), 40-61. https://doi.org/10.1002/jaba.881
Watson, J.B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3(1), 1-14. https://doi.org/10.1037/h0069608