Behavioural Therapy

ABC ModelExpand

Behavioural therapy is one of the effective ways to handle behavioural and psychological symptoms. Common reasons behind the symptoms are unsatisfied needs, external stress and self-defence. Caregivers usually can find solutions with careful observations and a flexible mind-set.

Antecedent

Behaviour

Consequence

Prior to having the symptoms

What was the person doing?
How was the person's mood?
How was the person's physical condition?
What were others doing?
What happened in the environment?

Exhibited symptoms

What were the symptoms?
When did they manifest themselves?
Where did they manifest themselves?
To whom was the person showing the symptoms?
For how long did they manifest themselves?
Has it happened in the past?

Results of having the symptoms

How did the person feel?
How did the person react?
What was the next action of the person?
How did others feel?
How did others react?
What was the next action of others?

Various causes

Feeling uncomfortable
Unable to understand what was said
Forced to do something
Unable to complete a task
Being interrupted
Saw a stranger
Saw a specific person
Saw others doing a certain thing
Heard a specific sound
Touched a specific thing
Smelled a specific smell
Tasted a specific taste
Went to an unfamiliar place
Went to a specific place
When it was a specific time of the day

Active

Aggression
Screaming
Cursing
Shadowing
Wandering
Socially inappropriate behaviour
Sexual disinhibition
Hoarding
Restlessness
Agitation
Anxiety
Hallucinations
Delusion

Passive

Depressed mood
Apathy or retardation
Sleep changes
Appetite changes

Rewards

Gets what he or she wanted or wished for
Receives attention
Receives rewards
Allowed to do some things
Being praised
Others smile to the person
Allowed to continue showing symptoms

Punishments

Being ignored
Being scolded
Prevented from doing specific things

Interruptions

Being redirected to attend to other things
Being requested to do other things

Behavioural managementExpand

Behaviour of the person	Active behaviours (e.g. Repeating the same questions, searching for things)	Passive behaviours (e.g. Refusing to bathe, refusing to speak)
Possible solutions	Reward the person if you want him or her to continue the behaviour. Redirect the person to do other things if you want him or her to stop the behaviour.	Reward the person, ignore the behaviour, or ignore the person if you want him or her to continue the behaviour. Consult a physician or identify and satisfy the underlying needs of the person if you want him or her to stop the behaviour.

Case example 1: SuspiciousnessExpand

Antecedent

Decline in short-term memory.
Anxiety.

Behaviour

The person says he or she has already or has not taken medications.
The person counts the money in the wallet repeatedly.
The person says others have stolen his or her money or belongings.

Consequence

The person curses the caregiver for imprisoning him or her.
The person continues to be nervous.
Caregivers feel bad.
Caregivers grumble that the person is having mental problems.

Possible solutions

Using pill boxes.
Avoiding giving the person a large amount of cash.
Letting the person look at his or her bankbook at a specific time every day and having him or her sign a record.
Letting the person look inside his or her safe at a specific time every day and having him or her sign a record.

Case example 2: Urging to go homeExpand

Antecedent

Decline in cognitive functions.
Changes in home environment from when the person was young.

Behaviour

The person says a place is not his or her home.
The person requests to go home repeatedly.
The person is unhappy.

Consequence

The person curses the caregiver for imprisoning him or her.
The person continues to be anxious.
The person is confined to a chair.
Caregivers feel bad.
Caregivers argue with the person.
Caregivers grumble that the person is having mental problems.

Possible solutions

Tell the person he or she is in a resort or in the house of a close family member or friend at the scene, and tell the person more often that it is his or her home when the person is calm.
Tell the person his or her family member will arrive to pick him or her up soon, and distract the person by giving him or her an attractive task.

Case example 3: Repetitive questionsExpand

Antecedent

Decline in short-term memory.
Confusion with time.
Anxiety.

Behaviour

The person asks for meals repeatedly.
The person asks for medications repeatedly.
The person repeatedly asks when family members will return home.

Consequence

The person is unhappy.
The person continues to be anxious.
Caregivers feel bad.
Caregivers argue with the person.
Caregivers grumble that the person is having mental problems.

Possible solutions

Display the time for meals, medications, and/or the time family members return home in a prominent place.
Teach the person to read the time on the clock.
Distract the person by giving him or her an attractive task after he or she checks the time.
Tell the person what time it is whenever he or she has meals, takes medications, or a family member returns home.

Case example 4: Confusion with timeExpand

Antecedent

Confusion with time.
Decline in judgmental ability.
Anxiety.

Behaviour

The person wakes up at midnight and starts to clean the house.
The person wakes up at midnight and starts eating.
The person wakes up at midnight and starts wandering.

Consequence

The person sleeps during the day.
The person gets hurt.
Caregivers cannot sleep well.
Caregivers get emotional.
Caregivers grumble that the person is having mental problems.

Possible solutions

Arrange safe tasks for the person at the scene, such as folding clothes or simple food preparation. Arrange more activities for the person and prevent the person from taking naps during the day so he or she will get tired at night.
Avoid letting the person go to bed too early at night.

Case example 5: HoardingExpand

Antecedent

Decline in short-term memory.
Decline in judgmental ability.
Anxiety.

Behaviour

The person collects things such as newspapers or tissues.
The person refuses to throw away broken things.
The person throws a tantrum after others try to clean his or her room.

Consequence

The person is unhappy.
The person continues to be nervous.
The person collects more things.
Caregivers feel bad.
Caregivers argue with the person.
Caregivers grumble that the person is having mental problems.

Possible solutions

Handle the person's collection with a better reason, such as putting the “useful things” in the safe of a bank or giving them to a friend who just moved. Remember to throw away things in a distant place and not at the garbage station nearby.
Forbid the person from collecting things while at the same time praising him or her.
Arrange safe tasks for the person to raise his or her self-esteem and self-worth.

Behavioural Therapy

Key points