What do I mean by self-destructive behaviors? For the purposes of this post, I’m going to use the definition from Lisa Ferentz, which is broader than some: she includes any self-directed act that is “addictive, destructive acts that are punitive, are harmful, hurt the body or compromise physical safety.” She operates from the understanding that there is a strong correlation between abuse neglect and self-destructive behaviors, and that often these behaviors serve to both regulate emotion and also to communicate pain. We’ll learn more about her work next week but this post covers her CARESS model for assisting clients with self-destructive behaviors first substitute these with healthier behaviors that serve the same purpose as part of the recovery from trauma.
The first step is actually to do some grounding before moving into these steps. This makes sense—when we’re either hypoaroused or hyperaroused, the neocortex is not in the control seat, and we’re in really reactive place. That means that we end up using our standard responses to discomfort and pain, which haven’t been productive thus far. So it’s crucial to observe that we’re in fight-flight-freeze and then do some grounding in order to get a bit more centered and allow our higher order thinking to come back online.
Ferentz’s treatment centers around the belief that many self-destructive behaviors serve as a way for someone to indicate that they are in pain. This step encourages the individual to express those thoughts/feelings a different way. This can mean writing, drawing, singing about the what was happening when you got the urge, or what it is that you’re feeling compelled to do. Ferentz suggests doing this for 10-15 minutes.
Often, completing a self-destructive act such as cutting or bingeing/purging results in a release of endorphins, which helps regulate the individual and incentivizes him/her/ze to do the act again because it feels good. So it makes sense that a replacement would include an alternative way to release those endorphins. The two most effective ways to do this are physical exercise or laughter. So starting jumping around or watch a video/read a blog that’s guaranteed to make you laugh.
The last step is about promoting self-care and releasing anxiety. What helps someone do that really depends on the person. Some people like to light scented candles, others find a bath relaxing. Perhaps reading affirmations or a good book is helpful or perhaps even creating something, like a collage, or sewing or writing.