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Risky Business: Working with Compulsive and Self-endangering Behaviors in Trauma Survivors

2-Day In-Person Seminar/Webinar - REGISTRATION CLOSED

June 2, 2022 to June 3, 2022

Other seminar info: 

In-Person Seminar/Webinar

12 CE Hours

Seminar Description

Survivors of trauma and early attachment disturbance are at elevated risk of a variety of compulsive and self-endangering behaviors, ranging from suicidality and self-injury to substance abuse, indiscriminant sexual activities, and binge eating. Calling on his upcoming book, Treating-Risky-and-Compulsive-Behavior-in-Trauma-Survivors, John Briere presents an innovative, integrated approach to self-endangering behavior, the Reactive Avoidance model (RAm). Calling on new research on memory reconsolidation, implicit processing, and revisions to habituation theory, this treatment system directly targets the memory/dysregulation dynamic, with interventions such as emotional regulation training; mindfulness, metacognitive awareness, and emotion surfing procedures; ReGAINing; implicit memory processing; in vivo treatment of implicit memory activations; and harm reduction. A new treatment component, trigger management, increases client autonomy, resilience, and problem-solving. Approaches to three risky behaviors will be presented in detail: self-injury, risky sexual behavior, and bingeing and purging. Attendees will be provided with newly developed worksheets and assessment instruments that organize and inform the treatment process.


Participants will be able to:

  1. Describe the Reactive Avoidance model (RAm)
  2. List three different distress reduction behaviors
  3. Outline the central components of trigger management
  4. Discuss the limitations of classic prolonged exposure and habituation
  5. Describe two ways in which implicit processing occurs in RAm-based therapy


Thursday, June 2, 2022 

  1. Why self-endangering behavior

Traditional models

  • Borderline personality disorder, impulse control disorder(s), and behavioral addictions
  • Another (evidence-based) view: The Reactive Avoidance model (RAm)

a.)Effects of childhood trauma and attachment disturbance

b.)Fear structures, trauma schema, and conditioned emotional responses

c.)Emotional dysregulation

d.)Functions of Distress Reduction Behaviors (DRBs)

      2. An overview of specific DRBs

  • Self-injury, risky sexual behavior, bingeing and purging, reactive aggression, triggered suicidal behavior, problem gambling, compulsive stealing, problematic internet use, compulsive buying, firesetting, hair pulling and skin picking
  • Non-DRBs that nevertheless involve maladaptive coping

a.)Dissociation, substance abuse

      3. Assessing DRB in context

  • Immediate risks and comorbidities
  • New assessment tools

a.)Review of Distress Reduction Behaviors (R-DRB)

b.)Functions of Distress Reduction Behaviors (F-DRB)

c.)Memories-to-Triggers Worksheet (MTW)

      4. Safety, stabilization, and harm reduction

  • Environmental safety and stability
  • Safety from self-harm
  • Reducing the destabilizing effects of triggered states

a.)Proactive resilience

b.)Mitigating triggered distress

c.)Harm reduction strategies

      5. Acceptance and mindfulness

  • Settling, metacognitive awareness, and letting go
  • Urge and emotion surfing
  • Mindfulness applications for DRBs
  • A hybrid approach

Friday, June 3, 2022

1.      Trigger management

  • Psychoeducation on triggers
  • Identification: Direct and indirect
  • Trigger linkage
  • Intervening in triggered states

a.) Actions that immediately address triggered responses

b.)Positive self-talk and metacognitive statements


d.)Pre-and post-trigger activities that decrease reactivity

      2. ReGAINing for DRBs

  • Recognize
  • Ground
  • Allow
  • Investigate
  • Non-identify

      3. Processing trauma- and attachment-related memories

  • Emotional processing

a.)Fear structure and trauma schema

b.)What happened to habituation and how does this change things?


  • Implications of new reconsolidation research
  • Multiple memory targets: Sequential processing
  • Processing explicit versus implicit memories

a.)Explicit à implicit

b.)Direct implicit

c.)In vivo processing of implicit memory

Steps of processing

  • Prebriefing
  • Exposure
  • Activation
  • Disparity/new information
  • Counterconditioning/extinction
  • Debriefing/closure

       4. Intervening in three forms of compensatory avoidance

  1. Self-injury
  2. Risky sexual behavior
  3. Food bingeing and purging