Behavior therapy psychiatric nursing

Behavior therapy is a type of psychotherapy which is based on theories of learning and aims at changing maladaptive behavior and substituting it with adaptive behavior.

1. Behavior Therapy

2. Introduction It is a form of treatment for problems in which a trained person deliberately establishes a professional relationship with patient, with the objective of removing or modifying existing symptoms and promoting positive personality, growth and development.

3. Definition Behavior therapy is a type of psychotherapy which is based on theories of learning and aims at changing maladaptive behavior and substituting it with adaptive behavior.

4. Goal of behavior therapy The main goal or aim of the behavior therapy is to remove the maladaptive behavior and substitute it with the adaptive or positive and desirable behavior.

5. Assumption of behavior therapy All the behavior is learned. Human beings are passive organism that can be conditioned or shaped to do anything if correct responses are rewarded or reinforced. Maladaptive behavior can be unlearned and can be replaced by adaptive behavior if the person receives exposure to specific stimuli and reinforcement for the desired adaptive behavior.

6. Cont.. Behavioral assessment is focused more on the current behavior rather than on historical antecedents. Treatment strategies are individually tailored.

7. Advantages of behavior therapy Behavior therapists use empirically tested techniques, assuring that the clients are receiving both effective and brief technique. Reduce incidence of self harm. Improve social skill. Better functioning in unfamiliar situation.

8. Cont.. It is a short duration therapy. The total duration of therapy is 6-8 weeks. Therapies are easy to train and is cost effective.

9. Limitations of behavior therapy Behavior therapy may change the behavior but does not change the feelings. Behavior therapy ignores the important relational factors in therapy. It does not provide insight. Treats symptoms rather than causes. Involves control and manipulation by therapist.

10. Indications of behavior therapy Phobias Social anxiety Nocturnal enuresis Sexual dysfunctions Tension headache Maladaptive habits Smoking Anorexia nervosa Psychosomatic reactions alcoholism

11. Cont … Eating disorders Post traumatic distress Bipolar disorder Attention deficit/ hyperactivity disorder Obsessive compulsive disorder Self harm Panic disorder Anger issues

12. Techniques of behavior therapy Systemic desensitization Flooding or explosion therapy Aversion therapy Operant conditioning procedures for increasing adaptive behavior Operant conditioning procedures to teach new behavior Operant conditioning procedure to decrease maladaptive behavior

13. Cont.. Assertiveness or social skill training Classical conditional conditioning

14. Systemic desensitization It was developed by Joseph Wolpe . In this patient attain a state of complete relaxation and are then exposed to the stimulus that elicits the anxiety response. It consists of 3 main steps 1) relaxation training 2) hierarchy construction 3)desensitization of the stimulus

15. Relaxation Training Progressive muscle relaxation Hypnosis Yoga and meditation Guided imagery Biofeedback training

16. Hierarchy construction In such technique the patient is asked to list out all the conditions or stimulus that provoke the fear and anxiety and make its hierarchy from higher provoking to least provoking factors and the sensitization is done accordingly.

17. Desensitization of the stimulus This can either be done in reality or in imagination. First of all the lower item in hierarchy is confronted. In this technique the patient is able to control his anxiety gradually. Example of this technique done for the fear of lizard.

18. Cont … Looking at a picture of lizard. Looking at a real lizard in a jar. Holding the jar. Touching a small or dead lizard. Touching a real and large lizard.

19. Flooding or Implosion Therapy It is an alternative way of treating the phobic disorder by exposing the anxiety provoking stimulus in full intensity, not gradually. It is repeated until the client no longer feels anxious. Eg . Fear of lizard treated by putting rubberized lizard suddenly on the table. For a minute the patient may get scared but gradually may start handling a rubberized lizard while talking.

20. Aversion Therapy/Classical Conditioning procedure Aversion therapy is used for treatment of conditions which are pleasant but undesirable, e.g. alcohol dependence homosexuality, nail biting, and other sexual deviations. In this the patient is conditioned to avoid an undesirable behavior or symptoms by associating them with painful or unpleasant experiences. Eg . Putting bitter taste on nails for nail biting, giving drugs like disulfiram which cause nausea and vomiting on taking alcohol. Etc.

21. Operant Conditioning Procedure for Increasing Adaptive Behavior Positive reinforcement When the behavioral response is followed by a generally rewarding event such as food , praise or gift. It tends to strengthen the adaptive behavior before rewarding.

22. Cont.. Token economy This program includes giving token rewards for appropriate or desired target behaviors performed by the patient. The token can later be exchanged for other rewards which they purchase luxury items or certain privileges.

23. Operant conditioning procedure for decreasing the maladaptive behavior Ignoring Punishment Timeout Restitution or over correction Response cost

24. Operant conditioning behavior to teach new behavior Modeling This is the method of teaching by demonstration . Where, the therapist show how a specific behavior is performed. The patient learns the model behavior from others. Shaping In shaping the components of a particular behavior is reinforced step by step. Eg . To establish eye to eye contact, the therapist sits opposite of the client and reinforces him even if he moves his upper body parts towards him. Once this is established, he reinforces the person’s head movement in his direction and this procedure is continued till eye to eye contact is established.

25. Cont … Chaining Chaining is used when the person fails to perform a complex task, the complex task is broken into the small steps and each step is taught to the patient. This is most effective training for mentally disabled person.

26. Assertiveness or social skill therapy Assertiveness training is a behavior therapy technique in which the patient is given training to bring about change in emotional and other behavior pattern by being assertive. Patient is encouraged not to be afraid of showing an appropriate response, negative or positive to an idea or suggestion. Social skill training helps to improve social manners like encouraging eye contact, speaking appropriately and relating to people.

27. Role of Nurse in Behavior Therapy The nurse plays role in behavior therapy according to different techniques chosen by psychotherapist and client parties. The main role of nurse is to ease the therapy There are some vital roles that nurse plays before during and after procedure of behavior therapy. Nurses role before therapy The nurses role is primarily facilitator, provide a safe, comfortable environment for the therapy.

28. Cont … Select the correct patient. Maintain good rapport with patient. Collect necessary information regarding clients. Assess degree of maladaptive behavior. Obtain verbal informed consent for therapy. Explain about the time duration or process of therapy to the patient parties.

29. During procedure Make patient to sit in comfortable position. Encourage the patient to explore the feelings and emotion. Check the judgment and insight of the patient. Encourage the p atient to perform activities in correct manner. Provide reward for desired target behavior. Encourage the patient to be relaxed in any situation over the period of the therapy. In this phase, the nurse acts as an assistant, an observer, a motivator, a teacher, a listener, collaborator, and a well wisher for the desire behavior of the patient.

30. After procedure Make patient comfortable. Record and report the outcome of therapy. Advice the patient about next date and time of therapy if needed.