ABA in the Treatment of Alzheimer’s

One of the most feared diagnoses today is that of Alzheimer’s . The disease kills more people than breast cancer and prostate cancer together. More than 15 million people are caregivers for patients with Alzheimer’s disease, and often develop depression or other symptoms because of dealing with dementia issues. Drug intervention is an option for the care of people with Alzheimer’s, but there are other treatments as well. One that is being used with dementia of many types, including Alzheimer’s, is Applied Behavioral Therapy.

Related resource: Top 15 Best Applied Behavior Analysis Online Programs

What Difficult Behaviors Arise with Alzheimer’s

There are many, and they develop sequentially as the disease progresses. The important thing to recognize is that there is no cure for the disease. Treatment focuses on maintaining mental status as long as is possible. Non-medical symptoms of Alzheimer’s are divided into cognitive issues and behavioral problems. On the cognitive side, caregivers wrestle with disappearing memories and language and thinking impairments. Behavioral issues include anxiety, depression, sleep disturbances, agitation, hallucinations, delusions, verbal and physical acting out, pacing and others. One therapist called Alzheimer’s “aging in reverse.” That description explains why behavioral therapy may be effective in treating the disease.

What is Behavioral Therapy?

A scientific definition is “the application of basic behavioral practices (positive reinforcement, teaching in small steps, prompting and repeated practice) to facilitate the development of languages, independent living skills and other aptitudes.” In other words, it is a way of teaching people with impaired abilities. It began as a way of thinking about the causative factors of behavior, and it soon evolved into the science of both the cause and consequence of these behaviors. There are three ways behavioral therapist approach patient teaching. In discrete trial training skills are broken into small steps. The trainer, or caregiver, introduces new skills in small increments. At each step, success is rewarded, and failure is met with repeated learning opportunities. In other words, the patient must try again until he succeeds. In Incidental training, the same thing happens, but the occasion for the training arises out of a natural social situation. Pivotal response training is the third method, and this is the teaching of pivotal, or fundamental skills. An example might be sitting quietly which is a skill people need at places like doctor’s waiting rooms.

How Is Behavioral Therapy Used with Alzheimer’s?

Before answering that question, there is another that is more relevant. Why is behavior therapy used with Alzheimer’s patient? According to statistics, 14 percent of people who have this disease are being treated with antipsychotics, yet studies have shown the medications to be just half as effective as non-pharmaceutical interventions in treating the symptoms of Alzheimer’s. Again, doctors are not talking about curing the disease; they can only hope to alleviate the symptoms. Besides the relative ineffectiveness, there is a danger of death from the medications. In the early stages of the disease the chances of fatalities with the drug is small, but they rise the longer the drug is administered. Behavioral therapy addresses the symptoms in a safe way. Two of the foundational symptoms of Alzheimer’s, or any dementia, are anxiety and depression. Both can be addressed by therapy. At least in the early stages of the disease, patients can be taught the skills of stress management and behavior modification. Therapies can enter around the patient’s interests such as music or art therapy. Later in the progression of Alzheimer’s caregivers can move the patient through the skills. Electronic tools like alarms and prompts can remind a person with Alzheimer’s to take medication or to stay inside a given perimeter. According to Dementia.org, consistent daily routine is important too. Calming environments and stress management techniques all can help a person at the early stage of Alzheimer’s. After the disease progresses, the caregiver’s role becomes increasingly important.

Behavioral Therapy and Caregivers

Although caregivers can doubtless benefit from stress management skills, the focus of behavior analysis is on teaching caregivers to use the teaching techniques as the “practitioners.” The goal of the caregiver is to modify behaviors that are problematic. That lessens the anxiety of the patient and makes caregiving easier. A twenty-year British study showed that the most effective way to treat Alzheimer’s and other dementia is to train the caregivers to “communicate with and engage the patients without exacerbating the situation.” One model of this idea of training the caregivers is the ABC method. “A” stands for antecedent. What occurred immediately before the behavior that might have precipitated it? “B” stands for the behavior itself. “C” is the consequence. What happened immediately after the behavior?

Making Behavioral Analysis simple for Caregivers

The key to caregiver application of the therapy is to avoid making the situation worse. The first question practitioners train caregivers to ask themselves is if the behavior is really a problem. Family members and caregivers are often embarrassed by patients who act out in social situations. They react by correcting the patient as though he was a child, or by intervening unnecessarily. That can escalate a behavior. Caregivers learn to separate behavior from the patient and recognize that behaviors may be caused by delusions such as someone stealing from them or threatening them, or by hallucinations or another manifestation of the anxiety that accompanies the loss of control of Alzheimer’s. If the behavior isn’t causing harm to the patient or to someone else, it may be only an embarrassment and not a real problem that must be addressed. Caregivers are taught to think about the smells, the sounds or the visual stimuli that preceded the behavior because one of those things may have triggered the reaction. Following a behavior, caregivers are taught how to validate the patient by showing understanding and acceptance. Analysis of the things that might have triggered the behavior could enable the caregiver to adjust the environment to avoid the trigger entirely. Things to consider in this environmental assessment might include a change in caregiver or routine, bright lights, stimulating patterns, noises or strong odors. Studies show that dementia patients do better in peaceful surroundings.

The devastating thing about Alzheimer’s is that it is not yet curable. Until it is, the focus must be on helping patients to have the highest life quality possible. Certainly at later stages of the disease medication may be indicated, but research has shown that applied behavioral therapy may be the best treatment option for those patients in whom the disease has not progresses as much.

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