Mechanisms of change in the non-pharmacological treatment of behavioural expressions of need

Vollständiger Abstract

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Whatever form of therapy one employs, it is important to have a good understanding of the mechanisms of change and the techniques that bring about improved wellbeing. The ‘mechanisms of change’ refer to the active ingredients undertaken by the professional caregivers that lead to reductions in agitation and distress. Typically, there are two mechanisms: (i) the therapeutic procedures used to bring about helpful changes; and (ii) the clinicians’ processes, that is, actions and behaviours, that directly lead to positive changes (e.g. use of good eye contact, speaking slowly to aid understanding, etc.). The authors argue that the change mechanisms are different for behaviours associated with apathy compared to those linked to agitation. It is suggested that agitated behaviours require more comprehensive interventions, including the use of de-escalation and person-centred restraint guided with a Positive Behaviour Support framework (PBS).