Will I hurt myself today… Or do something (F.A.B.) instead?

Time for a Trauma Tuesday post. But this one is not what you think.

By this time, most people have heard the notion that those who have been hurt may be more at risk to hurt others.

In my work with clients who have been through childhood abuse, mistreatment and neglect, I often see the tragic pattern they try to stop, often failing because of a lack of resources, or knowledge about what to do differently.

And on our caseloads with clients with autism or developmental disabilities, we frequently treat another kind of pain, the kind that a person produces for themselves and often related to the challenging environments in which our clients live, or a lack of skill in expressing one’s needs. In our field, hurting oneself is known as “self-injury” or SIB (self-injurious behavior).

However, this post is not about treating SIB in our clients, although there are many resources for doing this, and your friendly local behavior analyst can do a functional behavior assessment to determine where to start, before making an individualized plan.

This post is about something else that is common, yet hidden.

Recently in a women’s empowerment group for supposedly “neurotypical” people, a behavior analyst was stunned when 75 percent of hands went up as the question was asked, “how many of us have actually hurt ourselves, or do this on a regular basis?”

Today, my question for us is, what about the pain all around us? What about self injury in the general population?

We hurt ourselves for many of the same reasons as our clients. Perhaps we can’t express our needs, and we sit in a closet creating wounds and wishing we could. Or perhaps we are teens screaming inside to be noticed, and we cut our legs (while, paradoxically, hiding this from parents who love us). Maybe, from the vantage point of an abusive relationship, we sit nearby listening to vitriol and later wake with deep scratches on our body parts. And other times we abuse ourselves with alcohol or drugs to the point of numbness, escaping from a painful memory- or a painful reality.

Something we forget is that it’s hard to stop living in pain if we remain in the same old aversive or painful environment. 

What can we do about it?

In our clients, we would attempt to establish and reinforce a “functional alternative behavior” or a new behavior repertoire that pays off… just as learning to communicate what is wrong with my voice might take the place of my needing to scratch myself to gain attention and support from someone who loves me.

First we’d determine the functions and more importantly, the context (why is this happening? When does it occurs? Who else is around when it happens? What were the things that happened right before (these are called the “antecedents” because they came first)? What are the consequences, or ways that the environment changes for the person, right after it happens? We’d remember carefully that thoughts are private behaviors and they matter today. For a verbal client we might use any one of several behavioral approaches, often helping the person gain more skills to cope with a stressful situation, or get out of a stressful situation.

So what can we do for ourselves when it happens?

We can still take a functional approach.

Many of us forget that even neurotypical folks can benefit from a good FBA, or functional behavior assessment, from a trained and experienced behavior analyst.

And finally, when we figure out the functions, we can arrange the environment around us to do something else—F.A.B. or functional alternative behavior—instead.

This art was produced by a behavior analyst who wanted to do something different instead of the same old self injurious behavior.

After she did a quick assessment she determined the most likely places and settings it occurred.

And this step is very important: she also figured out the settings in which it almost NEVER occurred.

An upcoming post shares how to do a brief “scatterplot”, a way to learn about and record someone’s behavior patterns across different situations and times of day or week; you can read more here.

Art! She realized she had never hurt herself while doing art.

So she arranged her environment to enrich it. She stashed art supplies right beside her seat, where she usually s found herself causing harm. And then she got ready. The next time her hand rose to hurt herself, she grabbed a pen, forced it to the paper next to the couch, and quickly doodled. She did this over several weeks, adding to her doodle until it became a full picture.  This one was entirely produced during times she would, in the past, have been using self injury.

This worked because it wasn’t just squeezing a stress ball or some other random and not functional “replacement” behavior… It was functional to produce something she loved, and it was a great alternative. It encouraged a new repertoire! And now she paints far more frequently than ever before. It turns out she really needed some meaningful activities in her life to which she could “switch” when she was hurting.

Don’t we all?

If you’re a behavior analyst, use the contact form below and write us today to find out more about arranging concurrent schedules for someone in pain, or stay tuned to this blog. As another behavior analytic friend who runs an amazing site says, please don’t be afraid to contact this blog, because it’s just me, your friendly local behavior analyst. J If you’re in pain yourself and you’d like to do this, contact a behavior analyst local to your area (click on Find/Locate a Certificant).

If you’re a behavior analyst and thinking “this is sort of similar to RIRD (Response Interruption and Redirection), you’re on to something (and can look up some Journal of Behavior Analysis results on that topic here). But this post is more about what kind of behaviors we redirect to. Too many times I’ve observed someone redirecting to a non-functional behavior that won’t “take off” and become reinforcing in itself. This post is more about a real, functional alternative to doing what we used to do “habitually” or “mindlessly” (and too often, those habitual behaviors can be self-injurious or at the least, time-wasters… facebook, anyone?:)