Using Operant Conditioning to Understand Self-Harm

Self-Harm

Self-harm occurs when someone hurts or injures themselves on purpose, without intending to cause death. Common forms of self-harm include cutting, burning, scratching, hitting, and ingesting toxic substances. Self-harm is also known as self-injury, or non-suicidal self-injury (NSSI).

Self-harm is a serious and growing phenomenon, yet little is known about the function of this behavior. For many, these behaviors can seem baffling. Why do people hurt themselves on person? One model that describes why people commit self-harm describes the behavior using the principles of operant conditioning

What is Operant Conditioning?

The famous behavior science B.F. Skinner first defined the idea of operant conditioning. He described the interaction of people and animals with their environment as consisting of three factors:

  • The antecedent. This is the triggering or prompting event or circumstances that leads to the response.

  • The behavior. The response to the antecedent is the behavior we are interested in.

  • The consequences. This occurs after the behavior, and it makes the behavior more or less likely to occur again.

There are two recognized processes through which consequences can impact future behavior: reinforcement and punishment. Reinforcement is at work when the consequences of behavior maintain or increase the prevalence of that behavior. Punishment is at work when the consequences of behavior result in the reduction of future incidents of that behavior. Reinforcement and punishment can be either negative or positive. A consequence is negative when it results in the removal of something from the environment. A consequence is positive when it results in the addition of something to the environment.

Positive reinforcement: the addition of something that results in a behavior being maintained or increased (such as when a child cleans his room and his mother gives him a cookie).

  • Negative reinforcement: the removal of something negative that results in a behavior being maintained or increased (drinking makes a socially anxious individual feel more relaxed).

  • Positive punishment: the addition of something that results in a behavior decreasing (a child disobeys their parent and gets a spanking).

  • Negative punishment: the removal of something positive that results in a behavior decreasing (a person’s is caught speeding and has their license suspended). 

If the consequences of self-harm were only negative, the operant conditioning model would expect the behaviors to become stop. However, research indicates that self-harm behaviors tend to persist. According to a model of self-harm based upon operant conditioning, persons who harm themselves must be receiving some benefit from the behavior. It is in some way rewarding or reinforcing, which explains why they keep doing it.

Antecedents: The Reasons People Self-Harm

Why do people hurt themselves?

So, why do people self-harm?

The reasons vary, but researchers and clinicians have suggested many possible reasons why someone might hurt themselves. Commonly cited reasons include:

  • Feeling dissociated or numb.

  • Feeling overwhelmed with negative emotions (such as anger, sadness, or anxiety).

  • Feeling neglected, abandoned, or lonely.

  • Feeling ashamed after engaging in behavior or having thoughts believed to be “bad.”

These are certainly very broad and general categories. The reasons people self-harm are complex, and may change over time. However, understanding these basic reasons can help to illustrate the fact that there are some potential “benefits” for persons who commit self-harm. If there were not, it would be a much rarer problem.

Clearly, self-harm is a complex behavior with many possible prompting conditions.

Self-Harm as a Behavior

Many people who commit self-harmer report daily urges to hurt themselves; however, few act on these urges with that frequency (Nixon, Cloutier & Aggarwal, 2002). About 80% of individuals who repetitively self-harm do so a maximum of once a week (Nixon, Cloutier & Aggarwal, 2002).

Additional research between the relationship of self-harm urges and self-harm incidents could be important for developing better treatment. Why don’t self-harmers act on every urge or at least act more frequently? By what mechanism are they able to resist the urge to self-harm? Also, is there something unique to the antecedent condition that precedes actual self-harm incidents?

While these issues remain largely uninvestigated, there is preliminary evidence that self-harm behavior takes different forms depending on the behaviors antecedent condition. 

For example, individuals who engaged in self-harm for social reasons (because they were faced with an undesirable task or felt lonely) contemplated injuring themselves for more time before engaging in the behavior. These individuals also endorsed experiencing more pain during self-harm episodes.

In contrast, individuals who self-harmed in an attempt to stop feeling bad or in order to feel something (stop dissociation), reported they thought only a few minutes before self-harming and experienced no pain during their episodes (Nock and Prinstein, 2005). Interestingly, Nixon et. al. (2002) found that a history of child-abuse was most associated with individuals who indicated that self-harm was motivated by an attempt to stop dissociation.

Consequences: Rewards and Reinforcement From Self-Harming

If the antecedents above lead persons to commit self-harm, what do they get out of it? Why do so many people keep doing it, often with increasing intensity? Here are some of the theorized rewards for each of the antecedents discussed above.

  • Feeling dissociated or numb —> self-harm results in feeling something.

  • Feeling overwhelmed with negative emotions (such as anger, sadness, or anxiety) —> self-harm results in those emotions being masked (through distraction, or an endorphin release)

  • Feeling neglected, abandoned, or lonely —> self-harm results in attention and/or sympathy.

  • Feeling ashamed after engaging in behavior or having thoughts believed to be “bad” —> self-harm acts as self-punishment.

Due to the neglect of the role that specific antecedents play in the development of self-harming behavior, it is difficult to assess what categories of consequences are related to which categories of antecedents. The only consequence that seems to have been empirically tested by researchers is the emotional consequences of self-harm. Even so, most frequently these emotion consequences are lumped together as “bad” emotions.

Anecdotally, the reinforcement that occurs by the removal of negative emotions appears to be very powerful. One young woman described the process as “feel(ing) like a pressure cooker that’s going to explode. Cutting and bleeding sufficiently is like letting out the steam. If I do this to my satisfaction, I feel immediate relief, as if injected with Valium or something. It helps stop the inner turmoil for a while” (As cited in Magnall and Yurcovich, 2008).

The experience of self-harm as a powerful negative reinforcer has an addictive quality (Nixon, Cloutier & Aggarwal, 2002).  Of the 42 self-harmers surveyed by Nixon, Cloutier & Aggarwal, 90% stated that the frequency and severity of their self-harm has increased despite the realization that their behavior is harmful. Additionally, 85% of the participants in this study noticed that their tension levels reoccurred when the stopped engaging in self-harming behavior. From an operational conditioning standpoint, if tension levels were reduced by self-harming on previous occasions, then the learned consequences of that action will make it more likely that an individual will reengage in the behavior. 

Additionally, Nock and Prinstein (2005) hypothesize that while the first episode of self-harm may be well thought-out, as the behavior is reinforced through its consequences it is undertaken in a more impulsive manner. The impulsivity, or lack of forethought, that develops as self-harm behavior becomes more habitual could make it more resistant to treatment.

Interestingly, there is little evidence to indicate how self-harm works to relieve emotional distress. Current research hypothesizes that self-harm functions to reduce negative affect by either serving as a distraction or by triggering a biological mechanism such as an endorphin release (Klonsky, 2007). Clinically, all that is known is that for many individuals, self-harm is an effective emotional regulation strategy. 

How do we treat self-harm?

Treatment of self-harm could theoretically occur at any of the three levels:

Treating self-harm
  • Antecedent intervention would treat self-harm through changes to the environment in which the behavior occurs, and reducing or removing the reasons for committing self-harm.

  • Behavioral intervention would involve restricting, or making it difficult to engage in the behavior at all.

  • Consequential intervention would require changing the reinforcing effects of the behavior, it make it less rewarding or more “punishing” to commit self-harm.

For self-harm, it is difficult to intervene at the behavioral or consequential level. Intervening at the behavioral level would require preventing self-harm through heightened security or bodily restraint. While this may occur in some hospital or correctional settings, this is obviously not a feasible treatment, or realistic long-term approach. Additionally, the consequences of self-harm are not well understood and seem to vary from person to person, making intervention at this level difficult. Therefore, the most likely intervention point in the treatment of self-harm is at the antecedent condition. 

While it is important to acknowledge that self-harm is a complex behavior, research does support the idea that the most common antecedent in self-harm is the experience of some form of negative emotion. Therefore, interceding at the antecedent level of self-harm involves changing the way the client either perceives or reacts to their emotional experiences.

According to Dialectical Behavioral Therapy, poor emotion regulation skills contribute to self-harm (and other misguided attempts to escape negative emotion). DBT attempts to teach people emotion regulation skills, which includes replacing maladaptive methods of emotion regulation (such as self-injury) with healthy ways of regulating emotion. In fact, many research studies have shown DBT to be highly effective at reducing suicidality and self-harm.

At FRTC, our Dialectical Behavioral Therapy clinicians are intensively trained in DBT and the treatment of self-harm. If you or someone you love is struggling with self-harm, contact us to learn how DBT can help.

Jenell Effinger