Parley Services

ABA technical concepts covered in this podcast: automaticity; functional adaptation; operant conditioning; parsimony; pragmatism; S-R-S contingencies; radical behaviourism; interbehavioural contingencies

Presenters - Bobbi Hoadley, Cathy Knights.

We have a lot of myths and misconceptions about behaviour.

The science of behaviour has provided a lot of information and insight over the last 100 years.

I like to read the science and go out into the real world and see how it applies.

Applied Behavioural Analysis. Good behavioural science should make good common sense.

Behaviour is about how we act, interact and react with others, and analysis uncovers the underlying reasons why we do the things we do.

We can choose to change our own behaviour to make our lives work better for us.

You are never too old to learn new behaviour.

New ways to think about and understand our own behaviour.

Your first mistake is you wait until New Years to make changes!

All behaviour is:

Cathy: we've got a lot to learn ahead of us!

 

Bobbi and Cathy review a conferrence session on the dangers of misinformation, and how our cognitive behaviour can trap us into believing things that aren't true.

Dr. Peter Gerhard, shares his insight and expertise with Bobbi and Cathy about teaching and learning that truly supports the lives of individuals living on the Autism Spectrum (ASD).

Dr. Ron Van Houten, Bobbi Hoadley, Cathy Knights

ABA technical concepts covered in this podcast: Behaviour change procedures; pattern analyses; measurement; Functional Analysis; punishment procedures; negative reinforcement by reducing time and effort; positive punishment using delay and exertion; motivating operations and establishing operations; contextual fit; visual contextual cues; efficiency; group contingencies; maintenance  

Bobbi and Cathy: When we have a problem that isn’t being solved, we create an intervention, or an invention, that will address the problem. The person we are talking to is such an interesting man, his name is Doctor Ron Van Houten and he is an ABA doctor and a professor at Western Michigan University. He has done work all over North American and Europe in traffic safety and how to decrease the conflicts that create near misses and people getting hurt. He has changed the behaviour of both drivers and pedestrians using Behaviour Analysis. Ron sets up solutions that engineer the behavior of everybody in those situations to mitigate the risk.



Ron: There were studies done that show that cars coming up to a crosswalk don’t have a good line of sight. Places in NY city a number of people crushed to death by trucks. So they put an arrow up high but it didn’t work. One simple solution was staggering the stop lines.

Cathy: There are times when I would jay-walk, I think to myself ‘could I not have walked down to the corner to the crosswalk?”

Ron: In essence, we know that people don’t like to wait. We find out where people would like to cross. Pedestrian generators. You can try educating with behavioural solutions.

Bobbi: I would think all good functional analysis of behaviour is doing that – find  out where the behaviour is going and then decide whether you can actually change it or whether it’s better to go with the behaviour and just change the circumstances. Always juggling the reinforcement. In my situation, I measure a person against themselves. For you, you are dealing with people and conflicts and they all want efficiency.

Ron: I wanted to get people to not use the elevator when they didn’t need it. I tried putting information about health benefits of using the stairs. Didn’t change. So I increased the wait time on the elevator and everyone who could use the stairs went to the stairs. By increasing their effort and time, I changed their behaviour.

I did some things for the National Traffic Safety Administration, and we wanted to get people to wear seatbelts. I gave a survey, and sure enough put them into the car and baseline showed they wore their belts. Then we moved it to treatment, which was moving the car increase speed, if you buckled your belt, that force gradually went away. You have to repeat the reminders. A lot of people don’t buckle their seats before moving the car. You do a repeat reminder after they’re going. Pedal force-gets 100% seatbelt use, whereas before it was a delay. I used GM’s brake shift, to then get seatbelt reminder, and if they don’t buckle they can’t shift immediately, they have to wait 8 seconds. We had big increases in seatbelt use. They still have some choice.

One of the cities in Florida, were having children struck going to and from school. I did the analysis and said 1) you don’t have a lot of sidewalks near the school. I looked and people were in such a hurry dropping kids off. Motivating operation-community wants to do something about it. 2) Reduce speeding when kids are going to and from school. Educate parents about kids getting struck, needing to be under speed limit or enforce it aggressively. For years, no more children were struck going to and from school. You need to prepare people before the change that they have to accept it.

Bobbi: And this is a project you went back to and took data?

Ron: We got the community buy-in to change the way things are done. Four years later, people were telling me it was awesome. They hit a tipping point into the high 70’s-people and drivers imitate behaviour. Everyone starts to yield. It become self-sustaining and changing dynamics of culture.

Bobbi: Set up the group dynamics to either punish or reinforce.

Ron: Some of the worst places I’ve seen, people say “oh we don’t have a problem”. When people try and make efforts, that’s where change is. Where there’s no motivation to change, it becomes harder. It’s almost paradoxical, when there’s a lot of interest, usually things are happening already.

Bobbi: That’s why we follow our data.

Ron: Score and look at what’s going on in Toronto-measure running lights.

Bobbi: The programs to increase biking and decrease risks of biking in Vancouver use tools that are really varied.

Ron: Consider for a moment, children used to walk or bicycle to school. Look today at obesity cause-lack of walking and bicycling. It’s a good thing to promote walking and bicycling because it saves on our healthcare costs.

Bobbi: I do notice the more they put in structures to help bikers be more safe, it’s also the changing driver behaviour to be politer, I think you do reach a tipping point. I can’t hit them, I better join them.
Ron: There is a greater acceptance of cycling than there used to be, and a little better with pedestrians. I would say Canada does better in yielding than the United States. I tried something years a go, it was the idea at the start of the walk, we had eyes that animated to look left and right. It would increase looking-so we could prompt people to look for vehicles. In Britain they have signs “look right” because we in North America look left, to look for moving cars. Winston Churchill was almost killed in NY City stepping off the crosswalk and was hit. Reminding people to look and knowing where to look. Crossing clockwise is different than crossing counter-clockwise. You have to use more behaviour to look at something coming from behind you than ahead of you. With texting you can’t see anything.

Bobbi: I personally love the scrambling intersections in Europe. I don’t see these happening, can we expect that in the future?

Ron: Scrambling intersections, creates more delay, but tends to be where there’s a lot of people. Match up treatments to people best you can.

Bobbi: They have to provide equipment anyway, why not engineer it to be more helpful and safe for everyone. Ron: You can use something called a gateway treatment, so driver’s have to cross between them, we can get very good yielding with that and it’s an inexpensive tool. How much is it just the sign with no message? But going between these signs seems important too.

Bobbi: So it’s a visual contextual fit.

Ron: Exactly. We started to look at survival rates of the solutions. We found some that reduce the maintenance cost. Developing new ideas, some low cost. Think of the reminders in the car to wear seatbelt – costs nothing when software is already there.

Bobbi: I would contend that most of the time it’s a lot less expensive to maintain a solution, than maintain a problem. Why I love behaviour analysis, we’re all about the solution.

Ron: The other thing we can do is feedback and reinforcement. When we have a community making progress, we need to convey that to them to keep going in the right direction.  

It was so nice to have Ron interacting with us and telling us more. The part I really like is that everything he does is the same as what I do. Even though he’s applying it to a variety of groups of people and he has a specific goal, he still does an analysis of the behaviour, and uses all the same tools I do, keeps it pragmatically going until he hits a tipping point and then keeps maintaining and generalizing it. It’ll be different for me crossing the street now.  It just goes to prove that necessity is the mother of invention.

14- Old Habits Die Hard
Bobbi Hoadley, Cathy Knights

ABA technical concepts covered in this podcast: Experimental Analysis of Behaviour; empirically supported behaviour change procedures; habit reversal; self-management techniques; schedules of reinforcement; behaviour shaping; differential reinforcement; social significance

Bobbi and Cathy are in Chicago at the International Applied Behaviour Analysis Conference 2016.

Today we attended one of the Skinner lectures. B.F. Skinner translated behavioural science into concrete understanding of laws, through experimenting with animals. Later on, he wrote on human behaviour and how the laws may apply. His work helped to transition behavioural science from a theory into an applied practice.

Our first lecture was given by Michael Kim, who’s not an Applied Behaviour Analyst. We are learning from someone who’s using the science to demonstrate incredibly effective applications. He leads a company that figures out how to do habit reversal through organizational behaviour – how to motivate people. His website is habitdesign.org.

He talked about the steps required for habit change and why it’s so good to develop routines and habits. He discussed neuroplasticity, which is relevant to our work with people after experiencing a brain injury. When you learn a routine and make it a habit, you don’t have to use so much brain power on it. It’s critically important to learn routines after a brain injury so that you don’t have to stress out just getting through the day. Former habits are easier to re-learn, but you need more new habits when motivation and initiation are so much harder after an injury to your brain. It takes more work to make things happen, so the more things are done routinely and habitually, the less difficult life is. Example, you may not remember when you took your last shower. It’s much better to have a routine shower everyday so you don’t have to remember and initiate to do it. It’s way easier to set up a habit and take the shower every day and it just occurs. The way we do it is set up a task analysis, and break down the small steps. You have to work on establishing a habit at each step of those routines. Companies spend lots of money over organizational habits and the best ones are the ones that encourage maintaining and practicing the routines even after the change.

Clicker training is used in shaping behaviour- to ensure you’re getting the immediate feedback about what is right. It’s way more effective than trying to teach a support person to give a differential verbal reinforcement cue, but we don’t use it much with adults. We have various ways of doing shaping. Michael Kim showed a video example of an instructor teaching high jumping. She taught each piece then put them together. We have a variety of techniques and use them to teach a new behaviour. Like any other behaviour change, you have to have stimulus control, and you get stimulus control through rapport.

We’re not going to teach a behaviour that has no meaning or significance to the person who is doing it. An example of teaching that isn’t was the VonTrapp family, Sound of Music, used training to come with a whistle. It wasn’t age appropriate and was disregarding as Maria pointed out.

ABA technical concepts covered in this podcast: Discriminative Stimuli or Sd; Evocative MO’s; Ontogeny; neuroplasticity; pivotal behaviours; Maintenance; Intrinsic vs. extrinsic reinforcers; Unconditioned R+ and R-; Conditioned R+; Stimulus Control; Pairing; NCR; Topographies of behaviour; Stimulus class; Desensitization; Habit reversal; Flooding procedure; de-stimulation; Cusp behaviours; contextual cues; choosing target behaviour; social validity; dysregulation; behaviour shaping; Positive Behaviour Support; behaviour intensities

Presenters - Bobbi Hoadley and Cathy Knights

Cathy's dog Clara is the star of this discussion about desensitization. Teaching an old dog or an adolescent one doesn't have to be challenging if you know how!

We like to talk about behaviour, yours, mine, and the dogs. The theme: you can’t teach an old dog new tricks and looking at why that’s a myth.

We have MO’s that are driven by our internal states. Hormones are one example. Cathy’s dog recently spayed, could be reacting to that internal state. Also the age, adolescence she is creating neuro connections all the time. As you become older, neuro connections become harder and harder to change. It’s just a little more work to change when you’re older. She will probably mature.

Bribing with treats doesn’t maintain behaviour unless it turns into an intrinsic reinforcer. Wanting to please the owner will be intrinsic. Can be the same with people. Use an external reinforcer to pair ourselves with it. But we need stimulus control for behaviour change. The best way is to have good rapport, then you have influence. Influence can become stimulus control.

Cathy’s dog appears to be aggressive toward other animals, including dogs. Without knowing the learning history, as she is a rescue dog, it is difficult to understand the behaviour fully. There was a time when people thought that removing the fear of water out of someone was best done by throwing them in the pool. There are still misconceptions around de-sensitization.

The first step is rapport. Very often we teach some foundational behaviours first, before a desensitization technique. Cathy’s dog Clara, it can be hard to de-stimulate her. People can actually be more reactive to the suggestion of the object of fear.

People who are afraid of dogs, can become very reactive to hearing the word dog or hearing the dog bark in the distance. Whereas they can look at a picture of a dog and say it’s cute. The anticipation can create more anxiety than the object itself. Not to say that an aggressive dog wouldn’t bring on a huge attack of fear. The suggestion of the dog on a more regular basis can create more reactivity.

You don’t want to mix up typical behaviour with the challenging behaviour that is so antisocial. You know what the stimulus is for Clara - it’s another dog. You’ve been building rapport with her and gaining some control. Provide non-contingent reinforcement meaning she doesn’t have to do anything in return. Caring, generosity, attention, eye contact, smiles, compliments, interest in who they are. The other one is pair yourself with primary reinforcers – food, warmth, all the good things in life. Anyone who cannot build rapport, cannot teach, and then you have no control over stimuli.

The next is to understand that labels or suggestions can activate the behaviour. If she is easily overstimulated, you need to get control over that first. Otherwise she can’t hear what you are trying to teach. Cathy is now pairing de-stimulation with a command. She is teaching Clara some regulation, but really they are tricks to perform. Without the intrinsic reinforce of how to self-soothe or calm. Tricks are different from habits. Feeling calm is a whole lot better than not feeling calm. Clara needs to learn a foundational behaviour of how to de-stimulate and regulate. It’s different for everyone, is it poor waiting behaviour, low frustration tolerance, poor self-monitoring, poor self-regulating – any one of these behaviours can cause a person to become reactive in an environment where they feel threatened. We teach a lot of self-soothing and resilience. Resilience is the ability to have a set-back and be able to bring yourself back from it. It’s tied to the self-soothing.

Cathy’s been reinforcing successive approximations of behaviour with Clara and the dishwasher. That’s what she will be doing with desensitization. Any organism is an investment in relationship. Rescue animals are a special commitment.

ABA technical concepts covered in this podcast: Operant conditioning; Learning histories; Inter-behavioural conditioning; intergenerational conditioned behaviours; behavioural cusp; habilitation

Presenters - Bobbi Hoadley, Cathy Knights.

As always, Bobbi and Cathy chat about a new take on an old adage – this one is full of hope and optimism, as they smash rules written in stone.

The apple doesn't fall far from the tree. The influences of learning on behaviour. What are all those influences that create this perfectly individual human being that's not like any other human being? Identical twins are not the same people. So many studies use twin studies because it's such a good control of the variables, and still individual development makes distinct individuals. The tree may be a whole lot more complex than we understand. We often see the tree as the family system or parent – that may be the trunk of the tree, but there's also the branch, the roots, the leaves, etc. and the environment that supports the tree being alive. It's a great adage, but to just say a person becomes who they are because of their genetics, or what their parents did, or their IQ - it's too simplistic to say that because we know an individual has been created by all those things.

So we talk about inter-behavioural learning – all the things on the tree and more. It's a mistake for us to do an analysis simplistically. Adults are more complex than children. We have inter-behavioural generational conditioning, e.g. if you had a great grandfather who died from a snake bite, you'll probably have a greater incidence of phobias of snakes in your family even if they are unaware of Grandpa's death. You have the demeanour your mother had, or your movements are very reminiscent of someone in your family – all intergenerational conditioned behaviours.

Study of epigenetics, genes aren't hardwired, they are more like switches- they change over our life-spans. We'll have a predisposed gene that we can switch off. Plants or animals where genes can change in a matter of hours. It's still important for us to know what is in your history. The whole nature-nurture argument closed off to us the idea that change was possible if it was in your genes, e.g. if you mother had schizophrenia, it could happen to me. But it's more hopeful to see us as organisms who are responding to our environments with what we know.

Critical incidences in a person's life – sometimes something will happen during a key developing milestone and that incident can be huge.

Disordered personality in adults, the medical model was more focussed on expertise than human treatment, patient became an object. At least 10% of the analyses I do, will have had a prolonged illness in childhood where they were hospitalized for a long period of time with very little nurturing. It can be traumatic. We don't do that to children anymore.

Let's not limit the accidents of fate. Fate teaches resilience, don't try to protect children, and on the other hand facilitate to support them to the next stage of development.

We become a part of our environment and that's where our soul is. It tends to be that understanding that we are part of a whole, something greater than ourselves.

IQ testing can be wildly unreliable if we don't accommodate where the apple fell from, or the internal state of the person being tested. IQ is not a good understanding of human cognition. All those people with cognitive disabilities who are hypervigilant of caregivers, it's highly intelligent to read the internal state of another person. I've had people tell me, this person can't learn. Any person who adapts to their environment, is learning. Maybe I can't learn new phone numbers, does that mean my IQ might suffer from that or that I'm not intelligent?

A diagnosis gives you some more clues, how to best interact with someone, but don't pathologize them. When we say that these things are predetermined, then we absolutely dead-end an individual. I worry about the lack of understanding around these issues. Some of it is marketed around psychotropic drugs. Even psychiatry currently says there's no science to support a chemical imbalance in the brain.

We need treatments that take into consideration a broader understanding that each person needs to develop into who they are. We need to climb their tree, take a nap under it, and eat their apple. We need to understand there's no other apple like them. That apple has the ability to do a good job at becoming itself.

 

ABA technical concepts covered in this podcast: Description, prediction, control; Objective observation; observable phenomena; P+; Positive Behaviour Support; Behavioural cusp or pivotal behaviour; Intrinsic reinforcement

Presenters - Bobbi Hoadley, Cathy Knights.

Cathy finds it creepy that she gives her private thoughts away without knowing it.

Only partly true. Some TV shows about behaviour analysts – people who can analyze people's facial characteristics, and more work being done on it all the time. More recent research is the polyvagal theory, by Stephen Porges. I want to talk about how much you can judge a book by its cover and how much we pick up on that at any time. You walk into a room, you size people up pretty quick. A good bit of first impressions come from what you're observing in the person's body, and facial features, and the presentation of the situation they are in. Judging how they are coming across in a very physical way. The polyvagal theory discusses the autonomic nervous system.

One of the questions I ask is how does it feel when you're anxious or stressed? Sick to stomach, short of breath, heart is pounding. The nerve endings are in the spinal cord behind the thoracic cavity, so you have this whole nervous system that is responding to the environment. One of the uses is biofeedback. If your system is firing all the time, then your whole physiology is working overtime. You want your parasympathetic and sympathetic systems to work in concert. You can learn how to have less stress. Autonomic nervous system is one way of recognizing what's going on. Stephen Porges points out you can always tell a lack of congruency, e.g. facial features don't match. Body language is such that you're drawn away, or...

A lot of work done on more intuitive vibes coming from people- where does the soul in a human being exist? Experiments done by Alva Noe http://www.alvanoe.com/ trying to isolate where in fact is that place - he's come to understand it's in the environment. We share amongst each other and there's this interconnectedness. Our First Nations seem to have known that, part of a huge organism.

I teach staff about the way they're presenting themselves physically. There's a quote "The success of an intervention is the direct result of the internal state of the intervener". I'm trying to create interveners who are successful. So we're trying to assess where's the quality of the interaction coming from in this person because that's critical to how successful they're going to be. If I screen staff, can they give eye contact, is their face congruent? Pets, horses, and babies pick up on our autonomic nervous system. Always under our plans of what doesn't work, mirroring anxiety or concern. Many people with disabilities become quite sensitive to the internal state of the person. I'm anxious because you're anxious – fear and anger look very similar in your face. There's a hypervigilance that comes from having caregivers because it's such a vulnerable place to be. There's also a sense of pets feeling your internal state.

I'll have a client who's extremely agitated, and I need to bring my internal state down to calm, and I can control that. The best way to deescalate someone, is lower your voice, speak softly, look the person in eye with no unpleasantness.

Studies show if you spend time smiling for a minute, it changes your internal state. I'll teach and say smile and hold that smile until it becomes real.

I know in our police departments, there is currently teaching on how to approach people with mental health problems in a nonthreatening way. Sometimes they are too reinforcing – we have to tell facilities to have police more strong and firm in order to have a good natural consequence.

The internal state of the intervener is everything for the success of the intervention – we can all be a little more aware of how we present. Older people have frozen into certain looks. I had a client who I put the smiley face on his hand. He had a demeanour that was very cross and threatening looking. He reminded me of the radio show the Champ www.youtube.com One of the early interventions was to practice smiling every time he looked at it. Then go to a mirror-learn to smile. He says to me, it's like a miracle – I smile at people, and they smile brain at me. He has a brain injury, if he can do it, so can you.

Who we are is in the physical presentation. We don't want to make assumptions about people so don't judge a book by its cover. On the other hand, make sure you have some awareness of the message you're sending at critical times in your life. Let's make sure that our internal state models what others need in that moment –for our pets and our children. I'm okay, you're okay.

 

ABA technical concepts covered in this podcast: Positive Behaviour Support; R+ and R-; Maintaining Consequences; positive social attention; Motivating operations; Positive pairing; Non-contingent reinforcement; respondent behaviour; P-;

Presenters - Bobbi Hoadley, Cathy Knights.

Cathy promises to practice more effective positive behaviour around the challenging behaviour in others, because sometimes polite and respectful or annoyed and irritated just doesn't do the trick.

There's more than one way to skin a cat. If there's a task at hand, you can be creative about how to get it done. The reason I like this podcast, is because it's going to be about how we can positively support others in counter-productive behaviours.

How do we not reinforce behaviour? The rule of thumb is if the behaviour is continuing or increasing, you are reinforcing it. You're maintaining it. You have a relationship with someone that is continually counter-productive, an interaction that doesn't work, if it continues or it gets worse, than whatever it is you're doing, you're actually reinforcing it. I never want to start the relationship with clients believing that I am another person who reinforces the status-quo. I take an observational approach – I never read the reports before I meet the person. I try not to have any prior assumptions. By not reinforcing, I just don't participate. On the other hand, I try to build rapport, which is necessary to bring interventions, or bring defenses down. Typically I meet the person first.

An example, "I's not about the nail" video, on Youtube. An interaction between two people where there's a whole lot of things going on, not about the nail. A person who doesn't have good insight as to why they have a specific concern, and another person who sees what's going on and is pushing back to make the other person see. What does she/he want in the video, bottom line? He wants to be the fixer. She wants him to listen to her. For most of us, we really do want people to listen to us and be sympathetic to the things that cause us strife. It's very frustrating to him, he's not being served by the behaviour, if she escalates, and she's getting some sort of underlying need met, not about the nail.

First lesson - don't try to fix people. Positively support people to come to the understanding of change. A lot of fixers reinforce the wrong thing, behaviour continues to go on. When the fixer did understand that this is what she wanted from him and he used it, she was very happy. In fact, she needs the loving attention for something other than the nail. The underlying need is there and needs to be met. Chronic problem in relationship between men and women.

So how do you build rapport with someone, without reinforcing the problem? Ignore the nail. I'm not going to participate with the nail. Non-commital, brief empathy. Ted talk on empathy https://www.ted.com/talks/brene_brown_on_vulnerability?language=en , which is not about investing in the other person's feelings, it's about listening to the other's feelings- a genuine interest in finding out what's going on with you.

Two behaviours that build rapport- people who do it are often the life of party, genuinely successful at their job, they connect well to other human beings. There's a study now, if you can teach these two behaviours to care staff, you can eliminate a number of behaviours in care settings. First one is positive pairing – pair yourself with something that's reinforcing to the person. Talk about the things we like, the things we have in common. A lot of advertising is on positive pairing. You like that movie, I love that movie. Pairing something nice with you, to another person. In facility, staff have access to reinforcers, they can provide with eye contact and a smile, serving a meal for example. Food is an unconditioned reinforcer. I drove a client to McDonald's for the first sessions to get him to open up to me. I'd get lost from his house, and ask him which way, which was difficult to get from him. After week 5, he says to me as we're driving, "you drive like shit" and I was so thrilled he'd say that to me. Positive pairing.

The second behaviour is, non-contingent reinforcement – giving someone reinforcement for nothing. Those two skills cause you to build rapport with everyone. I tell staff, use it and practice with people you already have rapport with and connection. Watch yourself. You can do it in less than 15 seconds. Increase those behaviours in yourself, to a point where it's working even with the more difficult people.

In a million years I would not hold behaviours against someone. When you have someone you don't like, make sure you don't interact with them or participate with that behaviour. Look away. It's a great way to not participate in a behaviour you don't like. Build rapport- you at least will have a better relationship with that person than someone else who doesn't. If there's someone who's badly behaved, you can't go wrong. I suggest you know it's a problem if the behaviour is driving you nuts- how do you interact with that person? Come up with a way to address it. Generally they're going to be fixers or a punisher. But if the behaviours don't change...

We talked about a relationship rift with you. We ended up coming to how not to be a door mat, or don't reinforce the asking, or don't reinforce that side of the person. And not feeling guilty or uncomfortable by not participating in it.

If you're not relationship building all the time, the relationship will start to wither and die. At the end of a difficult session with a client, I move immediately into rapport building. There's a quote that I love: "you would not worry so much about what others think of you, if you knew how little they actually do". You can make a mistake, but it's fixable, with rapport.

 

ABA technical concepts covered in this podcast: Behaviour adaptation; avoidance and escape behaviour; positive reinforcement; verbal behaviour reinforcement; choosing target behaviour; functional behaviour; operant conditioning; coping behaviour.

Presenters - Bobbi Hoadley, Cathy Knights.

Bobbi and Cathy confront denial without confrontation. Along the way they see it is much more than a river in Egypt.

See no evil, hear no evil, and speak no evil. We're going to talk a little bit about denial. A big behaviour. Like all behaviour it occurs on a spectrum. It's a necessary behaviour, a coping strategy. There's a lot of human suffering adapting our behaviour. Denial is a way of managing a situation without having to commit to it, such as I'll think about that tomorrow. It's considered to be a necessary part of grieving, and many life events. It can be a good coping strategy, helping you get through an issue, you can come out of the situation and learn from it.

An example - you're in a situation at work where you've been asked to team up with someone who is quite counterproductive. You've been assigned to do a job with them and a finite period of time, you might be in a bit of denial about the behaviours of that person. It's giving them the benefit of the doubt in order to get the job done, a strategy to keep an eye on a goal or task at hand. Events that create a lot of human suffering - it's is almost necessary.

Persons with acquired brain injury sometime think there's nothing wrong with me and I'm okay. They're very much not aware of how much has changed in their brain. Often we'll label it as a loss of insight. Insight behaviours they came to the injury with or not. Insight into consequences, feelings of others - so there's lots of insight behaviours and whatever those behaviours were prior to injury they'll probably be able to gain back. After an injury, denial is often there in the first year, and its' a real impediment to rehabilitation. I'm not going to work on this as there's nothing wrong with me. Often when I'm called in, I'll say this person isn't quite ready yet for behaviour change. Some people with acquired brain injury really need to get out in the real world again understanding how their interactions with the environment have changed. You won't get a good opportunity for rehab when someone is unaware. So I'll say, call me in a year, as soon as they begin to understand that there's a problem.

Some people get pushed into a corner early on. After the acquired brain injury, things get quickly set as neurons re-wire together. A lot of people will look at denial and try to confront it, repeatedly and the person ends up fighting against it. It can be family members, friends, and professionals. If we just let the person have it for as long as it takes, it would be better. Denial is an adaptation specifically for the purpose of coping. If denial lasts longer than would be considered healthy for the person, than it becomes an insight problem.

Why is it so hard for women to leave an abusive relationships? Often because of the denial behaviour that helps them to be able to cope. Or one of the hardest jobs for human beings, is parenting. When I realized I could lose the infant in my arms, denial was the better option. Don't hold it against someone, it's a symptom, and as such you have to understand what it is the person needs help coping with.

Some people use the tactic to their benefit. When you haven't really learned to cope with feelings, such as men, sometimes with their wives, they can use denial behaviours, as they are more reinforcing than trying to explain feelings. Or there's the ones where "I never did that". Generally we would want this to be a temporary tactic and come out of it ready to problem solve.

Strategies for someone stuck in denial - if it has no solution in the moment, don't punish it and don't reinforce it. You don't want to give too much credibility but you don't want to take away someone's hope. Don't spend time on it - don't elaborate; simply acknowledge and move on.

Another tactic is just questioning - asking more about their situation. Is there any solution to the problem or, whatever it may be. Or substance abuse - if you have evidence, you can share it and say have you considered this? Provide support for what the coping is. If a person is stuck because of grief - it's better is to deal with the grief, and how can they cope better with the grieving.

Counter denial with a reality statement that's empathetic, such as it is really hard to live without that parent. Typically, you defend the safe spot you're in, as opposed to allowing another person to change it. You need the opportunity in the environment to be weak and vulnerable, to become safe and strong.