John Briere developed the self-trauma model to explain the etiology, maintenance, course, and treatment of trauma associated with severe childhood abuse. This developmental model integrates cognitive, behavioral, and psychodynamic perspectives with existing theories of trauma and self psychology. According to the self-trauma model, an overarching negative consequence of childhood abuse is that it inhibits the development of adequate coping skills that, in turn, increases the likelihood that a person’s resources will be overtaxed when he or she encounters memories of the abuse and/or new environmental challenges. Moreover, due to primitive affect regulation, maladaptive coping strategies such as dissociation and substance abuse are likely to evolve in the face of past and current trauma experiences. This dissociation and avoidance may contribute to a vicious cycle as it prevents an individual from learning to manage and process the negative memories and feelings associated with the original trauma, an inability which further fuels the need for dissociation and avoidance during subsequent distressing events.
To the extent a person’s coping resources have been exceeded by a traumatic event, an individual may compensate and attempt to process the experience during posttraumatic intrusive responses, such as flashbacks and nightmares. Thus, in addition to being an indication of psychopathology, the intrusive and avoidance symptoms associated with a traumatic experience are self-protective in that they reflect the mind’s attempt to process and regulate affect. The intrusive symptoms initiate the process of desensitizing oneself from the anxiety by allowing fragments of information associated with the initial trauma to be processed; these symptoms are typically followed by avoidance behaviors, which Briere suggested may be the mind’s attempt to limit the level of exposure to the traumatic memory. However, if the individual’s avoidance behaviors are excessive, the person will not have adequate exposure to the traumatic memory, and thus consolidation cannot occur. In those instances, a person may experience further intrusive symptoms that are likely to be followed by even greater avoidance. This deleterious cycle may continue indefinitely if it is not interrupted by adequate intervention.
According to the self-trauma model, therapy should progress sequentially, such that earlier sessions are devoted to increasing coping skills and later sessions are dedicated to cognitive and emotional processing of the traumatic events. For example, treatment may involve the use of dialectic behavior therapy distress tolerance and emotion regulation skills training, which may contribute to increasing an individual’s self-capacities and provide the client with a foundation upon which trauma exposure therapy can begin. As with other cognitive behavioral interventions, careful assessment of the client throughout treatment is important to ensure that the client is equipped to handle challenges elicited in therapy. Removing the avoidance behaviors of the client too quickly can overextend the client’s coping resources and lead to more intrusive and avoidant symptoms and/or attrition from treatment. The therapist needs to challenge but not overload the client’s coping skills, providing a therapeutic environment that is safe and supportive.
Once abuse related events have been identified in therapy and the individual has the relevant coping resources, gradual reexposure (e.g., systematic desen-sitization) to the material can begin. The goal of this exposure is to reduce anxiety as well as the intrusive trauma symptoms. The graduated exposure advocated by the self-trauma model is not an inflexible, progressive set of exposure exercises but, rather, a set of exposure experiences that are dictated by the client’s coping skills at the time of the session. Thus, there is a consistent feedback loop in therapy, such that the therapeutic focus may change from exposure, to skills building and cognitive restructuring, to consolidation, followed by more exposure. According to the self-trauma model, it is crucial that the client experience the traumatic memory in the absence of danger cues in a safe environment to help promote emotional and cognitive processing and consolidation of the memory. In contrast to some trauma treatments involving more prolonged exposure, the self-trauma model advocates the use of systematic desensitization in doses that are centered on the client’s current coping capacities.