The ABC (antecedents-behaviour-consequences) model of functional analysis sounds complicated but in actual fact it merely depicts the triggers, the behaviours and the consequences of those behaviours. As with the motivational interviewing techniques, the ABC model can be used to boost self reflection. It is useful to think about and note down the unspoken emotions which may have triggered the unwanted behavior.
One of the main tools to help stop or reduce any maladaptive or problematic behaviour is first to monitor how often it is happening. A notebook or diary can be used for this process. If amenable, this can be a useful task for carers and sufferers to share at home and can encourage open and honest discussion around feelings. The diary can then be reviewed on a weekly basis, particularly if the sufferer finds it helpful and not intrusive. Carers often find this model useful in addressing some of the problematic behaviours that accompany an eating disorder. Rather than ignoring the signs of a binge in their absence, for example, they can combine the ABC model in a motivational interviewing style:-”I noticed signs that suggested you’ve had a binge. It could be helpful for us to have a chat and reflect on what happened. What do you think? ”
Carers can also use the ABC model to self-reflect on their own responses to symptoms and the ensuing consequences. Scenarios 1 shows the ABC model being used with the sufferer whilst Scenario 2 allows for the carer to reflect on her own response to the illness.
Amy has binged whilst her mother was at work. Upon her return they eventually sit down together when all is calm again and investigate the scenario objectively. Amy had planned to go shopping with her friend that afternoon but at the last minute, her friend cancelled. Amy felt let down, lonely and unworthy ….”a crap person”. Using money that she found in her mother’s bedroom, she went to the local shop, bought food, binged and vomited. Her mother was confronted with the mess upon her return from work.
|BEHAVIOUR||→||STEALING MONEY, BINGEING AND VOMITING|
|CONSEQUENCES||→||INITIAL RELIEF FROM NEGATIVE EMOTIONS FOLLOWED BY SHAME, EMBARRASSMENT, DISTRESS, DISGUST (AMY)|
|MESS IN KITCHEN AND BATHROOM|
|INITIAL CRITICISM & HOSTILITY FROM MUM|
|ANTECEDENTS?||→||FRIEND CANCELLING PLANS|
|TRIGGERS IMMEDIATE FEELINGS OF SELF-LOATHING, LOW SELF WORTH AND GENERAL DISTRESS|
Scenario 2: Claire has come home from university for her Christmas holidays. She has been in maintenance for the last six months and mum, for the past three months, has been cautiously optimistic that total recovery is now a possibility. However, during the first few days of the Christmas holiday, although Claire looks healthy weightwise, mum has noticed some restricting symptoms as well as creeping denial. Mum feels the return of the familiar emotional rollercoaster: frustration, fear, anger, disappointment…. The family meet on Christmas Eve with an older sibling and his wife. Claire announces that she won’t have any dinner that evening that she would rather save herself for the following day’s dinner. Mum loses her temper. This results in great distress for the whole family. Mum screams and shouts, Claire is in tears vocalizing feelings of self-loathing saying she is a horrible daughter and it would be better if she left now. The scene continues for two hours until the emotional wave has leveled out. The family, now exhausted, go to bed with nothing resolved.
|ANTECEDENTS?||→||FEAR IN MUM. ANXIETY IN CLAIRE.|
|TRIGGERS HEIGHTENED FEELING OF ANXIETY IN BOTH. DISAPPOINTMENT, FEAR AND ANGER IN MUM WHICH MAY, OR MAY NOT, BE PICKED UP BY CLAIRE.|
|BEHAVIOUR||→||SHOUTING, TEARS:- HIGH EXPRESSED EMOTION IN ALL FAMILY MEMBERS|
|CONSEQUENCES||→||INITIAL RELIEF FROM EARLIER PENT-UP EMOTIONS IN WEEK FOR MUM FOLLOWED BY UNCOMFORTABLE DISTRESS AND FEELINGS OF OVERWHELMING GUILT. CONSIDERABLE DISTRESS FOR CLAIRE AND OTHER FAMILY MEMBERS. UTTER EXHAUSTION. YET ANOTHER CHRISTMAS RUINED BY ANOREXIA.|
Think of ways that the antecedents can be addressed in both the above scenarios.