Lancaster, PA–Anger, rage, and assaultive behavior are frequently seen in people who have suffered severe brain injury, and the problems may continue for months and years after the injury. Now, at ACADIA something new is happening that eliminates virtually all aggressive activity in the rehabilitation center community-based treatment population.

Too often, the emphasis is on what is known as “behavior management” that provides consequences for the behavior. While brain-injured clients learn by consequences, it is usually a slow process. A different procedure has been developed that focuses on situations that seem to elicit aggression and works toward reducing the stimuli in those situations that may provoke aggression. Such situations include minor provocations like a change in routine, being told that they “have to” do something, being spoken to in a condescending manner, being ignored or patronized, being yelled at, and many others.

Now at ACADIA a simple naturalistic classical conditioning technique is used. All staff including maintenance, secretarial, administrative, and clinical are taught to do a number of things to reduce the situations that seem to elicit aggression. For example, they are trained to talk to the client as they would to anyone else, to talk in moderate tones, to expect their clients to change their minds about goals and activities, to gradually and gently redirect an angry client, and to never block a client’s way. Also, they are taught to apologize if they make a mistake, never to ignore a client, to say hello to clients on a regular basis, to take the client seriously, and to handle behavioral outbursts without restraining the client or otherwise frustrating the behavior.

All of these teach the client to respond in ways that are more appropriate than aggression and rage. This is accomplished because the staff and setting are prepared for good social interaction, and because staff are constantly modeling acceptable social behavior.

For more information contact Bob Stein, czbobb@aol.com.–Bob Stein

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