The Role of Models and Formulations in the Management of Behaviors that Challenge in Dementia

The British Psychological Society’s Briefing Paper for Behaviors that Challenge (BtC) in dementia states that psychological formulation helps in the development of effective and well targeted treatments [1]. While not explicitly using the term psychological formulation, the 2018 NICE UK Dementia Guidelines support the use of systematic problem-solving approaches in the management of BtC. The current paper gives an overview of the content of a number of formulation models developed in this area and contrasts two established models. This article looks at two different ways of understanding people’s agitation – one which emphasizes the reasons for their behaviour in terms of the person with dementia [2] and the other called DICE [3] which puts equal emphasis on the roles of both caregivers and the environment in explaining behaviors. We suggest that, while the Newcastle Model tacitly suggests a role for caregivers and the environment in BtC, the explicit emphasis in DICE encourages a more holistic understanding of agitation.