Table 1

Stepwise Behavior Analysis of Aggression

Identify antecedents of aggression or of stimuli correlated with the behavior's onset. An example is when a patient becomes frustrated and angry when staff members refuse his unreasonable requests.
Specify the aggressive behavior in operational terms so that all will agree when it occurs (e.g., shouting threats and expletives with fists clenched, angry facial expression, and shoving or hitting).
Note the immediate consequences of the aggression that may be inadvertently maintaining it. Staff members can congregate in a show of force and speak to the patient in a soft tone of voice, reassuring him that he will be all right if he de-escalates by sitting down and relaxing.
Inventory the patient's social, personal, and cognitive strengths and deficits and conduct a survey of personally relevant reinforcers for him. Reinforce the patient's positive qualities, using reinforcers that are appropriate to his values and preferences while ignoring provocative behavior.
Identify alternative ways of reducing anger and aggression in the current and future episode. Implement positive programming, differential reinforcement for behavior other than threats and anger, and social skills training to improve the patient's ability to express his frustration in words and to ask staff members to explain how and when he can have his request honored.