Behavioural therapy

Behavioural therapy techniques

1. Psychotherapies According to Approaches Behavioural Therapy Psychoanalytic Cognitive therapy Humanistic Therapy According to Client Involvement Individual therapy Group Therapy

2. Others Interpersonal psychotherapy (family, marital) Occupational therapy Milieu therapy/ therapeutic community Recreational Therapy Supportive Therapy Counselling (Review)

3. Behavioural Therapy

4. Behaviour Adaptive Maladaptive- when it is age inappropriate, interferes with adaptive functioning or others misunderstand it in terms of cultural inappropriateness.

5. Behaviorism see psychological disorders as the result of maladaptive learning, as people are born tabula rasa (a blank slate).  Basic assumption is that the maladaptive behaviour can be corrected through the provision of adequate learning experiences.

6. Behavioural therapy A form of psychotherapy, the goal of which is to modify maladaptive behaviour patterns by reinforcing more adaptive behaviours .

7. Principles of Behavioural Therapies Theory of Classical conditioning: involves learning by association and is usually the cause of most phobias. Theory of Operant conditioning: involves learning by reinforcement (e.g. rewards) and punishment, and can explain abnormal behavior should as eating disorders.

8. Social Learning Theory Cognitive Behavioural Approach

9. Assumptions of Behavioural therapy 1. Based on principles & procedures of scientific method 2 . Deals with client’s current problems (as opposed to analysis of historical determinants) & factors influencing them & factors that can be used to modify performance 3 . Clients expected to assume an active role by engaging specific actions to deal with their problems

10. 4 . Emphasizes teaching clients skills of selfmanagement , with expectation they’re responsible for transferring what’s learned in office to everyday lives 5 . Focus on assessing overt & covert behaviors directly, identifying problem, & evaluating change 6 . Emphasizes a self-control approach in which clients learn self-management strategies

11. 7. Interventions individually tailored to specific problems “What treatment, by whom, is the most effective for this individual with that specific problem & under which set of circumstances ?” 8 . Based on collaborative partnership between therapist & client (clients informed about nature & course of Rx)

12. 9. Emphasis on practical application Interventions applied to ALL facets of daily life in which maladaptive behaviors are to be deceased & adaptive behaviors are to be increased 10 . Therapists strive to develop culture-specific procedures & obtain clients’ adherence & cooperation

13. Indications of Behavioural therapy obsessive-compulsive disorder (OCD) post-traumatic stress disorder (PTSD) depression social phobia bipolar disorder schizophrenia autism personality disorders substance abuse eating disorders

14. Behavioural Therapy Techniques Systemic Desensitization Flooding Therapeutic Graded Exposure Participant Modeling Assertiveness Training Social Skill Training Aversion Therapy Shaping Premack principle Extinction Token Economy Contingency Contracting Overt Sensitization Covert Sensitization Time out

15. Systemic Desensitization Developed by Joseph Wolpe Steps Relaxation Training: Relaxation produces physiological effects opposite to those of anxiety. Hierarchy Construction: 10-12 conditions in order of increasing anxiety Desensitization of Stimulus: gradual exposure of individual from least to most anxiety provoking situation in a deeply relaxed state.

16. Suitable for Anxiety disorder Phobic anxiety disorder Obsessive compulsive disorder Certain sexual disorder

17. Flooding/Implosion No relaxation No Grading Exposing the individual directly with the situation Based on the principle that escaping from anxiety reinforces the anxiety through conditioning Prematurely withdrawing from the situation may reinforce the phobia. Not suitable for client with heart disease and fragile psychological adaptation.

18. Therapeutic Graded Exposure Therapeutic grade exposure is similar to the systemic desensitization except that relaxation training is not involved and treatment is usually carried out in real life context.

19. Participant Modeling In participant modeling, patients learn a new behaviour by imitation, primarily by observation, without having to perform the behaviour until they feel ready. Useful in phobic children Children with problem are placed with children of own age and sex, who approach the feared situation together.

20. Assertiveness Training Assertiveness is a response that seeks to maintain an appropriate balance between passivity and aggression. Assertive responses promote fairness and equality in human interactions, based on a positive sense of respect for self and others. Assertiveness  training is a form of behavior therapy designed to help people stand up for themselves—to empower themselves, in more contemporary terms.

21. Social Skill Training Social skills training (SST) is a form of behavior therapy used by teachers, therapists, and trainers to help persons who have difficulties relating to other people A major goal of social skills training is teaching persons who may or may not have emotional problems about the verbal as well as nonverbal behaviors involved in social interactions.

22. Some examples of  social skills  are Eye contact with others during conversation Smiling when greeting people Shaking hands when meeting someone Using the right tone and volume of voice Expressing opinions to others Perceiving how others are feeling and showing empathy Appropriate emotional responses (e.g. crying when something sad happens; laughing when someone says something funny)

23. Aversion Theory When a noxious stimulus (punishment) is presented immediately after a specific behavioural response, theoretically, the response is eventually, the response is eventually inhibited and extinguished. Types of noxious stimulus Electric shock Substance that induce vomiting Corporal punishment Social disapproval

24. Aversion therapy is suitable for Alcohol abuse Paraphilias Impulsive and obsessive behaviour

25. Shaping a method of training by which  successive approximations  toward a target behavior are reinforced Shaping, or behavior-shaping, is a variant of operant  conditioning . Instead of waiting for a subject to exhibit a desired behavior, any behavior leading to the target behavior is rewarded . Speech therapy in Autistic Child- suitable

26. Premack Principle The Premack principle was derived from a study of  Cebus monkeys by Professor David Premack Premack's principle suggests that if a person wants to perform a given activity, the person will perform a less desirable activity to get at the more desirable activity; that is, activities may themselves be reinforcers . An individual will be more motivated to perform a particular activity if they know that they will be able to partake of a more desirable activity as a consequence.

27. R 1- Frequently occurring response R 2 - Less frequently occurring response Allowing R 1 to occur only afterR 1 R 1 – Telephone talking with friends R 2 - Completing homework Completion of homework may get incentive of telephone talking

28. Extinctio n Extinction  is observed in both  operantly conditioned and classically conditioned  behavior. "Extinction as a procedure occurs when reinforcement of a previously reinforced behaviour is discontinued; as a result, the frequency of that behaviour decreases in the future .“ Eg . Extinction in temper tantrum

29. Token Economy An operant technique applied to groups, such as classrooms or mental hospital wards, involving the distribution of "tokens" or other indicators of reinforcement on desired behaviors. The tokens can later be exchanged for privileges, food, or other reinforcers .

30. Contingency Contracting A contract is drawn up among all parties involved. Desired behavioural change is expressed in writing Contract is made for the reinforcement of compliance and punishment for non compliance

31. Restitution/Over Correction Restitution means restoring the disturbed situation to a state that is much better than what it was before the ocuurrance of problem behaviour . For example, if a patient passes urine in the ward he would be required to clean the dirty area but also mop the entire larger area of the floor of the ward.

32. Time Out Time out is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behaviour is being exhibited. The client is usually isolated so that reinforcement from attention of others is absent.

33. Reciprocal Inhibition Also called counter conditioning, it decreases or eliminates a behaviour by introducing a more adaptive behaviour , but one that is incompatible with unacceptable behaviour . Eg . Relaxation exercise for the phobic patient.

34. Overt Sensitization A type of aversion therapy Eg . Disulfiram for the person who wish to quit the alcohol

35. Covert Sensitization Individual’s imagination to produce unpleasant symptoms rather than on medication The individual learns through mental imagery to visualize nauseating scenes and even to induce mild feeling of nausea.

36. Exposure and Response Prevention Exposure and response prevention  (ERP) is a treatment method available from behavioral psychologists and cognitive-behavioral therapists for a variety of anxiety disorders, especially obsessive–compulsive disorder and   phobias.

37. Advantages of Behavioural Therapy Behavioral therapists use empirically tested techniques, assuring that clients are receiving both effective and brief treatment Evidence-based therapies (EBT) are a hallmark of both behavior therapy and cognitive behavior therapy Most studies show that behavior therapy methods are more effective than no treatment Emphasis on ethical accountability (does not dictate whose behavior or what behavior should be changed) Address ethical issues by stating that therapy is basically an education process; an essential feature of behavior therapy involves collaboration between therapist & client

38. Disadvantages of Behavioural Therapy Behavior therapy may change behaviors, but it does not change feelings Behavior therapy ignores the important relational factors in therapy Behavior therapy does not provide insight Behavior therapy treats symptoms rather than causes Behavior therapy involves control & manipulation by therapist