ABA in the Treatment of PTSD
Post Traumatic Stress Disorder (PTSD) is a disorder of stress and anxiety that impacts the daily functioning and mental and emotional wellbeing of many individuals. Mental health practitioners and physicians have been working diligently over the past decade to increase knowledge and awareness of PTSD, as well as develop the most effective treatments. Previously thought of only as a treatment for Attention Deficit and Hyperactivity Disorders, Applied Behavior Analysis (ABA) is now widely recognized as a highly beneficial course of treatment for those struggling with PTSD.
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PTSD Behaviors Have Experiential Origins
Before diving into the behavioral signs and symptoms associated with PTSD, it is important to understand the causes of PTSD and its resulting emotions. Some of the most common stressful and traumatic events that lead to PTSD are military combat, civilian exposure to war and terrorism, abuse, tragic accidents, and experiencing manmade or natural disasters. The hallmark of PTSD is an intense and consistent fear of repeated exposure to the original traumatic stressor. This can take many forms, including panic attacks, night terrors, insomnia, and chronic anxiety. Some people stay hyper-vigilant, always braced for the return of the trauma. Others experience intense reactions to loud noises and any sensory information that evokes memories of the traumatic events. This can make it difficult or even impossible to move through work or school, maintain a social life, and sleep. PTSD is therefore often accompanied by loneliness and depression.
Behavioral Issues Related to PTSD Have Behavioral Solutions
For a long time, practitioners did not know how to help people who suffer these behavioral effects of PTSD. PTSD behaviors are a reaction to the thoughts and emotions remaining from the traumatic stressor. As explained by Georgia State University, the behavioral issues related to PTS, therefore, fit perfectly with the ABC model that serves as the foundation of ABA. It stands for Antecedent, Behavior, Consequence:
Antecedent: This refers to what triggers PTDS behaviors. Antecedent triggers can be immediate or slow. Examples of immediate triggers are unexpected trauma-related comments, loud noises, and other sights, sounds, smells, touches, and tastes that bring the individual back to the moment of trauma. Slow triggers are upcoming anniversaries of the trauma and approaching legal events surrounding the trauma.
Behavior: This refers to the person’s responses to the trigger. They might enter into a full blown panic attack, with sweating, a racing heart, chest pains, and trouble breathing. This is the body’s physical reaction. They might shut down or run away, an attempt to escape the trauma. They might become violent or aggressive, an attempt to fight off the trauma.
Consequence: This refers to the end result of the behavioral response to the trigger. Many of the typical behavioral responses lead the person to isolation in order to avoid other people’s negative reactions and prevent themselves from experiencing triggers.
Clearly, isolating oneself is not a viable solution to PTSD. It might remove the person from triggers and consequently from some instances of distress, but it also removes them from their support networks and all of the positive aspects of their lives. ABA researchers and therapists have therefore begun to create treatments based on exposure and desensitization to triggers. Behavioral Activation is a technique that involves exposing people with PTSD to their triggers, analyzing their maladaptive behavioral responses, and training them to have more positive behavioral responses. They then begin to have more positive, or at least neutral, associations to their triggering stimuli, replacing their previous traumatic associations.
Patients play an active role in forming their treatment goals. This is a powerful aspect of ABA’s effectiveness. PTSD is in large part characterized by a loss of control; anxiety is a fear of the unknown and a fear of losing control, panic is the experience of spinning out of control and impending doom, and patients feel under the control of their past traumas and the resulting trigger. Playing an active part in the treatment gives them back the element of control. Being able to face, rather than avoid, their triggers further empowers them.
Further Reading on Applied Behavior Analysis in the Treatment of PTSD
If this information has sparked interest, there is a wide array of more in-depth knowledge to gain through additional reading. The Applied Behavior Analysis Program Guide offers an entire section about applying ABA to anxiety disorders such as PTSD. An informative and interesting book to check out is Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies by Edna B. Foa, Terence M. Keane, Matthew J. Friedman, Judith A. Cohen.
Preparing for a Career Working With PTSD as an Applied Behavior Analyst
Those who are interested in taking their reading and understanding to a new level might consider a career working with PTSD as an Applied Behavioral Analyst. The first step is to earn a bachelor’s degree. There are bachelor’s degrees in applied behavioral analysis itself. For those who are not entirely sure of their commitment level to ABA, or those who want to specialize in PTSD, earning a bachelor’s degree in psychology would be the ideal first step. It will provide more training on anxiety disorders in general and PTSD in particular. It will also create a more diverse platform on which to build a career.
The second step is to earn a master’s degree. This could again be in a related field such as psychology, but a master’s degree in ABA specifically is a better idea for building a career in this area. It will provide a great deal of hands-on experience with ABA. For those particularly interested in applying ABA to PTSD, some elective courses in anxiety disorders and trauma are wonderful assets. One might also consider pursuing internships in this area.
Third, The Behavior Analyst Certification Board requires 1500 hours of supervised fieldwork in ABA. An additional benefit of completing an internship during the master’s degree program is that it will provide networking opportunities to find field placement. This experience culminates in the fourth step, which is passing the Board Certified Behavior Analyst examination. Certification must be maintained yearly through receiving continuing education or retaking the examination.
Applied behavior analysis in the treatment of post-traumatic stress disorder is groundbreaking. Instead of just managing symptoms for a lifetime, people who suffer from PTSD now have a chance to overcome them. It is a cause worth learning more about, and perhaps even pursuing a career in.
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