Understanding trauma, dissociation, and voice hearing functionally

Photo by Alexandre Chambon on Unsplash

Todd A. Ward, PhD, BCBA-D

bSci21Media, LLC

Angela Cathey, M.A.

ENSO Group

Therapeutic treatment of trauma is widely considered both stressful and, at times, risky for clients as well as their treatment providers. In fact, many clinical psychology programs tend to refer out clients who need a significant trauma treatment component in their therapy. This is typically done because having a client talk about experienced trauma can reactivate many of these experiences for the client. This reactivation of traumatic experience has been known to lead to rapid decompensation of clients and increases in other symptoms or behaviors that function to avoid the distress associated with re-experiencing traumatic memories.

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Further complicating these issues is that many of the behaviors that clients engage in or experience as a part of contacting traumatic memories can be quite difficult for therapists to understand and handle effectively. These behaviors may include binging on substances, reduction of food intake, self-harming behaviors, suicidality, rapid shifts in interpersonal behavior and emotional regulation, dissociation (splits in consciousness that leave a person unaware or unable to move), and – at times – experience of auditory or visual hallucinations. Clients experiencing these symptoms after long periods of avoidance may further construe these short-term exacerbations as evidence that treatment is ineffective, or worse, counterproductive.

As behavior analysts, we seek to understand these occurrences functionally. Recent work in Relational Frame Theory (RFT) has included conceptualizations of dissociative and hallucinatory experiences as disturbances of the verbal symbolic ‘self.’ As a trauma treatment provider, this makes good sense. When you treat trauma, you notice quite quickly that the topography of a traumatic event matters relatively little to how much an individual experiences the event as ‘traumatic.’ Though many individuals experience classically conditioned fear responses to stimuli associated with trauma following an experience, these symptoms are generally far less impactful than experiences that alter the individual’s sense of themselves, others, or the world. When an event is so out of the ordinary that the individual can no longer assimilate the experience into their overall verbal symbolic frameworks about themselves, others, and the world – this can alter ‘self’ relating, perception of time/space, perception of others, and ability to regulate emotions. This is the essence of behavioral conceptualizations of trauma, dissociation, and voice hearing. Our verbal symbolic behavior about ourselves, others, and the world forms the basis through which we filter our experiences. When it is suddenly disrupted by an unusual learning experience that cannot be assimilated into one’s verbal network, the individual may experience an inability to fully orient themselves to time, place, and self-resulting in hallucinations and dissociation.

Would you like to learn more about this fascinating work?  Check out our CE on trauma, dissociation, and voice hearing.

Todd A. Ward, PhD, BCBA-D is the President and Founder of bSci21Media, LLC, which owns the top behavior analytic media outlet in the world, bSci21.org.  bSci21Media aims to disseminate behavior analysis to the world and to support ABA companies around the globe through the Behavioral Science in the 21st Century blog and its subsidiaries, bSciEntrepreneurial, bSciWebDesign, bSciWriting, and the ABA Outside the Box CEU series.  Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno under Dr. Ramona Houmanfar.  He has served as a Guest Associate Editor of the Journal of Organizational Behavior Management, and as an Editorial Board member of Behavior and Social Issues.  Dr. Ward has also provided ABA services to children and adults with various developmental disabilities in day centers, in-home, residential, and school settings, and previously served as Faculty Director of Behavior Analysis Online at the University of North Texas.  Dr. Ward is passionate about disseminating behavior analysis to the world and growing the field through entrepreneurship. Todd can be reached at todd.ward@bsci21.org

Angela Cathey, M.A. is a writer, consultant, entrepreneur, and Owner, Director, and Team/Leadership Development Consultant of Enso Group. Her background is in processes of change and intervention development. She has trained with experts in Acceptance and Commitment Therapy (ACT), Functional Analytic Psychotherapy (FAP), cognitive-behavioral exposure-based treatments, and Relational Frame Theory (RFT). Her interests are in process, innovation, and development of solutions for sustainable large-scale change. She has published in numerous academic journals on process, measurement, and intervention development. Enso-driven analytics systems are used to inform leadership and team building interventions, culture design, and research in the behavioral sciences. Angela can be reached at a.cathey@ensogroup.us. Stay up-to-date with Enso Group at ensogroup.us and LinkedIn.

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