Behaviour therapy

PROF (DR) RAMANDEEP KAUR

1. PROF (DR) RAMANDEEP KAUR BEHAVIOUR THERAPY

2. introduction This therapy is applied to psychological treatments based on experimental psychology and intended to change symptoms and behaviour . It refers to a particular group of procedures based on operant conditioning.

3. DEFINITION It is the systematic application of scientific principles of learning and a form of psychotherapy, aims at changing maladaptive behaviour by substituting it with adaptive behaviour .

4. PURPOSES Permanent change in behavior occurs as a result of practice or experience. Correction of the abnormal psycho-dynamics which are contributing to the illness. Helpful even in those conditions which are refractory to other forms of therapy.

5. PRINCIPLES General reliance on principles of learning,i.e . by learning by doing,learning by trial and error,learning by condioning . Close observation of behaviour Concentration on the symptoms as they are target for therapy. A commitment to objective evaluation of efficacy.

6. INDICATIONS Panic Phobia Obsessive compulsion neurosis Genaralized compulsion neurosis Post traumatic stress Neuotic depression Bipolar disorder Major depression

7. CONTD…… Shizophrenia Tics,maladaptive behaviour Obesity Anorexia nervosa Headache Hypertension Chronic pain Asthma Insomnia

8. CONTD….. Paraphilia Alcohlic dependence Conduct disorders Hyperkinesia Habit disorders Mental retardation Autism Dementia crimniality

9. TECNIQUES OF BEHAVIOUR THERAPY

10. SYSTEMATIC DESENSITIZATION This is used in Reciprocal Inhibition. If a response incompatible with anxiety is made to occur at the time an anxiety provoking stimules , then anxiety is reduced by reciprocal inhibition. It involves 3 stages:

11. CONTD….. Training the patient to relax. Constructing with the patient a hierarchy of anxiety arousing situation(stimuli). The patient is asked to list all the conditions which provoke anxiety. Then he is asked to list them in a desending order of anxiety provation . Thus a hierarchy of anxiety producing stimuli is produced.

12. Patient is advised to give a signal whenever anxiety is produced with each signal he is asked to relax. After a few trials, patient is able to control his anxiety. Gradually the hierarchy is climbed till the maximum anxiety-provoking stimules can be faced in absence of anxiety. example: phobia, anxiety, neurotic patients.

13. CONTD…..

14. FLOODING It is a therapeutic process in which the client must imagine situations or participate in real-life situations that he or she finds extremely frightening for a prolonged period of time. Plenty of time must be allowed for these sessions because brief periods may be ineffective or harmful. A session is terminated when the client responds with considerably less anxiety than at the beginning of the session.

15. CONTD….. It involves exposing patients to a phobic object or situation in a non-graded manner with no attempt to reduce anxiety. It is usually given in non-graded manner or in reverse hierarchy(starting from most phobic to least phobic).

16. CONTD….. Example: Obsessive compulsive neurosis stammering

17. AVERSION THERAPY (IMPULSION THERAPY) It involves producing an unpleasant sensation in the patient, usually by influencing pain in association with a stimulus. Pairing of pleasant stimulus with an unpleasant response, so that even in absence of the unpleasant response (after therapy is over) the pleasant stimulus becomes unpleasant by association.

18. CONTD…. The unpleasant aversion is produced by: Electric stimulus low voltage. Drugs ( apomorphine disulfirm ) Fantasy Typically 20-40 sessions are given with each session lasting about 1 hour. After completion of sessions booster sessions may be given.

19. Modelling The origin of new behaviours by the process of imitation. In this form of treatment the patient observes someone else (may be thetherapist ) carrying out an action which the patient currently finds difficult to perform.

20. SHAPING The successive approximations to the required behaviour with contingent positive behaviour . example: rehabilitation of physically handicapped children with neurotic behaviour , autism.

21. RESPONSE PREVENTION AND RESTRAINT Exposing patient to a contaminating object. Example: Obsessive compulsive neurosis.

22. CONTD…. Exposing the patient to a contaminated soil towel from carrying out his usual cleaning ritual. Thought stopping is sometimes used in the control of obsessional thoughts

23. SELF CONTROL TECHNIQUE It divides into three types Self-monitoring: - Keeping the daily records of the problem behaviour and the circumstances in which it appears. Reinforcement: - Identifying stressor thought stopping. Self-evaluation :- Making records of progress and it helps to bring about change.

24. CONTINGENCY MANAGEMENT If behavior persists, it is being reinforced by certain of the consequences and if these consequences can be altered, the behaviour should change.

25. TOKEN ECONOMY an operant conditioning procedure that rewards desired behavior patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats

26. ASSERTIVENESS TRAINING It is designed to encourage direct but socially acceptable expression of thoughts and feelings by people who are shy.

27. CONTD…. example: Chronic depression Being ignored by a gossiping shop assistant, by a combination of coaching, modelling .

28. NEGATIVE PRACTICE It will be used in the treatment of involuentary movements. This sets up a state of inhibition which impairs or prevents the appearance of the movements.

29. CONTD….. Example Tics Stammering Thumb sucking Nail biting

30. RECIPROCAL INHIBITION Enquire the stimulus or situations which provoke anxiety in the patient and to rank these stimuli in order from the most to the least disturbing. i.e. a hierarchy of stimulus situation. Then the patient is asked to visualize the least disturbing stimulus when he is a state of relaxation produced by hypothesis or I.V. anesthetic like methohexitone .

31. CONTD….. Whenever marked disturbance occurs the therapist withdraws the stimuli and calms the patient. Each stimulus is visualized for 5-10 seconds and 2-4 items are presented in each session, each item usually being presented one. As soon as the patient is able to visualize the items without disturbance the therapist moves on to the next item in the next session.

32. CONTD…… Example: Severe OCD Depression

33. OPERANT CONDITIONING It affects the environment and generates stimuli which ‘feedback’ to the organism. Example: Child mental illness Hysteria Stammering

34. PROCEDURES FOR INCREASING THE BEHAVIOUR Positive reinforcement:- The desirable behaviour is reinforced by a reward, material or symbolic. Any response or behaviour which is rewarding and increase the likelihood of further response. Shaping(positive reinforcement):- The patient is systimatically instructed to do what he fears and is rewarded by the therapist with praises when he succeeds and with no response if he fails.

35. CONTD…… negative reinforcement:- On performance of the desirable bahaviour , punishment can be avoided. Modelling :- The person is exposed to the ‘model’ behaviour and is induced to copy it.

36. PROCEDURES USED FOR DECEARING BEHAVIOUR Time out:- The reinforcement is withdrawn for sometime, upon the undesired behaviour . example:- therapy with children The child is not allowed to go out of the ward to play, when he fails to complete the given work.

37. CONTD…. Punishment:- stimulus is presented, upon the undesirable behaviour i.e. whenever undesirable response occurs punishment is given. satiation:- The undesired response is positively reinforced, So that tiring occurs. It is a negative practice procedure.

38. RELAXATION TRAINING Progressive relaxation to bring about reduction of tonus in individual groups of skeletal muscles and to regulate breathing.

39. ROLE OF NURSE Accept the client as he is. Assessment of psychosocial behaviour of client. Active listening of the client. Nurse assists the therapist to observe which technique is suitable for client. Provides calm environment and proper seating arrangement.

40. CONTD……. Help the patient to improve insight and reduce negative symptoms. She should explain the whole session. Maintain good IPR with client. She should encourage to ventilate feelings and painful experiences. She can give suggestions to patient.

41. CONTD…… Nurse records the essential information. During interaction she should analyze the problem. Continue the session until there is satisfactory improvement in the clients situation.

42. THANKS