Survivors of trauma and early attachment disturbance are at elevated risk of a variety compulsive and self-endangering behaviors, ranging from suicidality and self-injury to substance abuse, indiscriminate sexual activities, and binge eating. Many of these difficulties are seen as symptoms of a personality disorder, behavioral addiction, or impulse control disorder. However, emerging research indicates that they are more accurately understood as coping/homeostatic responses to triggered childhood memories and inadequate emotional regulation capacities. Calling on his book (Treating risky and compulsive behavior in trauma survivors, Guilford, 2019), John Briere presents an integrated approach to self endangering behavior, the Reactive Avoidance model (RAm). This approach directly targets the memory/dysregulation dynamic, with interventions such as trigger management; metacognitive awareness and emotion surfing; a new trigger response exercise (ReGAINing); implicit memory processing; in vivo treatment of implicit memory activations; and harm reduction.
- Describe the Reactive Avoidance Model (RAM)
- List three different distress reduction behaviors
- Outline the central components of trigger management
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John Briere, PhD