What are you doing? by Ross Warwick

Ross 1If there was a camera trained on you right now like in Big Brother or The Truman Show, transmitting to televisions and tablets up and down the country, how would the audience see you behaving? Take a moment to notice what it is you’re doing. Are you sitting or standing? Are you mutli-tasking, trying to read this whilst having a conversation with a colleague? Are you tapping an NHS biro on the desk or drumming your fingers? These things that you are doing, whatever they may be, are behaviours.   

So if I was watching a monitor, observing that live broadcast of you reading this blog, I might make informed assumptions about why you were acting as you are. I might guess that your decision to sit or stand is perhaps motivated by a need to be comfortable; multi-tasking might illustrate a wish to get as many things done as possible; and drumming your fingers and tapping your biro might be impatience that I have yet to get to the point (SPOILER: you may be expecting too much…).

It’s not just psychologists who make assumptions about the behaviours of others; everyone does it. To help us make our judgements it’s likely we would call upon other contextual information. This might include the things we already know about that person, our previous contact with them, things we know are going on in the environment around them, their personality and so on. Furthermore, the conclusions we reach are filtered through our own particular view of the world and our mood at the time.

Ross 2Behaviour can be a rich source of information. Analysing behaviour can be of significant clinical value because all behaviour happens for a reason. It serves a purpose. If a behaviour didn’t fulfil a particular need then you wouldn’t do it. If by pressing a certain button on a broken vending machine you got a free Mars Bar then you would repeat the behaviour again and again. Once the machine had been repaired your frantic button tapping would stop (although only after a few bonus taps for good measure, just to be sure).

Considering behaviour and the needs it may be fulfilling is one of the central tenets of therapeutic approaches such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). In this context we are interested in the things that people do that are detrimental to their long-term well-being. In mental health that might be a depressed young man who doesn’t contact his friends or an anxious lady who has stopped going out. In these two cases the behaviours of interest serve an important purpose: they protect against harm. The young man is protected from his belief that no one wants to spend time with him because he’s boring; the older lady is protected from anxiety about falling over and injuring herself. Their actions have a clear logic when the reasoning behind them is explored.

In physical health the behaviour of interest may not be related to a mental health problem. Consider a patient who is at ease with a diagnosis of kidney disease.   However, they have not taken on recommendations regarding dietary and fluid intake, putting them at risk. So the behaviour here could be characterised as a failure to follow advice that would improve their physical health. See also a patient with COPD who continues to smoke; someone with Type I Diabetes who doesn’t monitor their bloods; the drinking habits of someone with liver disease.

It can be hard to comprehend such behaviours when the stakes are so high but there will be needs underlying them nevertheless. I would wager that most of us have tried to change our behaviour in order to improve our health and relapsed into old habits after a few weeks. I bet too that when quizzed there were a whole range of sound reasons why. Personally, I couldn’t find the time to keep running, plus my ankle was hurting. And it’s not safe to run in the dark round where I live. And the routes aren’t varied enough so it was boring. Look, just back off will you?!

In some cases the need to change is a priority for those involved in providing care, not the patient themselves. This might mean that our behaviour towards them will change as a result, driven by our own needs to make sure they keep well. If you were in such a situation and there was a camera trained on you, what might we see?

Attending the Emergency Department is a behaviour that fulfils an important need; to seek urgent medical attention. Patients who frequently attend also do so to fulfil a purpose but the reasons are sometimes complex and difficult to discern. I’m involved with a project in A&E designed to help understand why people frequently attend. This understanding leads to the development of management plans that colleagues can use to ensure patients receive the treatment that they require. We use the formulation below to help:

 Ross 3

Figure 1. Formulation model (based on James et al, 2006)

So how are you behaving just now? If you were seated are you standing? If you were multi-tasking are you now just reading? If you were restlessly tapping are you now still and calm? If so I choose to interpret your behaviour as evidence that my blog has succeeded in engaging you. Please feel free to challenge my assumptions in the comment box below.

Dr Ross Warwick is a Clinical Psychologist and Neuropsychologist for the Physical Health and Psychology Service at NHS Dumfries & Galloway




9 thoughts on “What are you doing? by Ross Warwick

  1. really enjoyed your blog Ross! Thanks! … and I am definately pleased theres not a camera trained on me all day (or is there??)

  2. Thanks for the kind words folks. I felt there was plenty more to say in terms of distressed behaviour in dementia, behavioural change in brain injury, behaviours between members of staff, and the difficulty in making changes. Maybe I can do Part 2 next year…

  3. A good introduction to clinical psychology. It would be really beneficial for healthcare workers to do diplomas in this if it was something they are interested in.

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