Fig 4.4 The ABC of Behavioural Analysis Antecedents Situations, Circumstances and Activities associated with behaviour
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Behaviour The behaviour itself - forms and frequencies
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Consequences The physical, emotional and social results of the behaviour
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Fig 4.5 Key Messages
Scratching is an objective behaviour Itching is a subjective experience
Fig 4.6 Six Methods of Scratching 1. Nails, including picking
2. Rubbing skin on skin
3. Rubbing through cloth
4. Rubbing against object
5. Use of an instrument
6. Involving someone else
format of Antecedents, Behaviour, and Consequences (Fig 4.4). The enquiry serves to draw attention to and clarify the behaviours that need modification. Antecedents. Questioning can take the patient through a 'typical day', from waking to sleeping again, and asking for each activity, situation and circumstance: 'Do you scratch then?', or 'When do you scratch?', and 'When do you never scratch?'. Here there is a further opportunity to differentiate between scratching and itching, as it is scratching behaviour more than itching experience that is the focus for the analysis (Fig 4.5). Particular patterns for the individual will emerge, illustrating issues that become relevant in planning treatment. Thus a behavioural characteristic for many adults who go out to work, is the scratching done on first returning home in the evening. For this there will need to be particular strategies devised as part of their behavioural prescription (p. 69). Behaviour is detailed by asking about the methods of scratching employed (Fig 4.6). The seemingly infinite number of techniques possible, and the inventiveness of some individuals will quickly become clear (Plate 4.1). Questioning can open up otherwise intimate personal experience, and will demonstrate to the patient the therapist's interest and knowledge of self-damaging behaviours, preparing the ground favourably for the introduction of behaviour modification. The discussion of scratching method is placed in our protocol after registration, as the latter procedure increases awareness of self-damaging behaviour. Initial discussion of such behaviour can itself achieve this however, and can be effective therefore if introduced before registration. The
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