Behavioural Therapy

BIOPSYCHOSOCIAL MANAGEMENT OF PSYCHIATRIC DISORDER

Psychotherapies and social interventions

1. BIOPSYCHOSOCIAL MANAGEMENT OF PSYCHIATRIC DISORDER Psychotherapies and social interventions Nur Fadzlina Zabri 082013100006

2. Psychotherapy Treatment by psychological means, of the problems of an emotional nature, in which a therapist deliberately establishes a professional relationship with patient to : Remove, modify or retard existing symptoms mediate disturbed patterns of behavior promote positive personality growth and development

3. The approaches used in Psychotherapy Psychodynamic : insight-oriented therapy . An approach to therapy that involved delving into a patients thoughts and past experiences to seek out unconscious desires or fantasies. Cognitive-behavioural : A type of psychotherapy that involves cognitive and behavioural techniques to change negative thoughts and maladaptive behaviours . Humanistic : A form of therapy that focuses on helping people maximize their potential.

4. A type of psychotherapy which is b ased on theories of learning that all behaviors are acquired or received through “ conditioning ” (state of shaping behavior) A ims at modifying maladaptive behavior and substituting with adaptive behavior Conditioning occurs through interaction with the environment. Behaviorists believe that our responses to environmental stimuli shapes our behaviors BEHAVIOUR THERAPY

5. 2 major types of conditioning Operant conditioning model (Skinner) Classical conditioning model (Pavlov) Technique used in behavioral training in which a naturally occuring stimulus is paired with a response Technique of learning that occurs through reinforcement for behavior

6. In order to understand how each of these behavior modification techniques can be used, it is also essential to understand how classical conditioning and operant conditioning differ from one another.

7. Classical Conditioning : First described by Ivan Petrovich Pavlov , a Russian physiologist. Involves placing a neutral signal ( stimulus ) before a reflex ( response ). Focuses on involuntary (unconditional or automatic) behaviors. Operant Conditioning: First described by Burrhus Frederic Skinner , an American psychologist. Involves applying reinforcement after a behavior. Focuses on strengthening or weakening voluntary (conditional) behaviors.

8. Short duration : 6-8weeks Easy to train and cost-effective Initial sessions are scheduled daily, later session are spaced out Behavioural analysis Behavioural therapy

9. Classical conditioning model (Pavlov) Derived from principles of Ivan Pavlov’s experiment Mowrer’s bell and pad method helped children learn to stop wetting the bed Learned response can be unlearned through Counterconditioning

10. B ehavioral therapy P sychodynamic therapy T rying to uncover unresolved conflicts from childhood (i.e. the cause of abnormal behavior F ocus on current problems and behavior A ttempts to remove behavior the patient finds troublesome Examples of classical condition : Systematic Desensitization Aversion Therapy Flooding

11. a) Systematic desensitisation Principle based on reciprocal inhibition ( Wolpe ) Associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli until anxiety towards stimuli is eliminated (Graduated Exposure Theory) Comprise of 3 steps Relaxation training Hierarchy construction Systematic desensitisation proper

12. Relaxation therapy Characterised by immobility of the body, control over the focus of attention, low muscle tone, cultivation of a specific frame of mind Methods used ; Jacobson’s progressive muscular relaxation Hypnosis Yoga, zen

13. Hierarchy construction List of fears related to phobia from least to most terrifying Eg ; school phobia Thinking about school Riding the bus Sitting in class Teachers

14. Systematic desensitisation proper Patients proceed systematically through the list from least to the most anxiety-provoking scene in a deeply relaxed state Treatment of choice in phobia or obsessive compulsive disorder

15. b) Aversion therapy Used for the treatment of conditions which are pleasant but felt undesirable by the patient Principle : pairing the pleasant stimulus ( alcohol ) with an unpleasant response ( low voltage electric, drugs,fantasy ), the pleasant stimulus becomes unpleasant by association The use has decline as it violate the human rights of patient

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17. c) Flooding Usually used in treatment of phobias and anxiety disorder The patient is directly exposed to the phobic stimulus and escape is made impossible. By prolonged contact with the phobic stimulus, therapist’s guidance and encouragement, the therapist’s modeling behaviour , anxiety decreases and the phobic diminishes. Flooding can lead to extinction of fear

18. Reinforcement is a term used in operant conditioning which refer s to anything that increases the possibility that a response will occur. Reinforcement increases or strengthens the behavior. Operant conditioning model (Pavlov)

19. Operant conditioning procedures increasing behaviour Common methods : Positive reinforcement Negative reinforcement Modelling Operant conditioning procedures decreasing behaviour Methods include : Time out - Punishment Satiation

20. There are Two Different Types of Reinforcement Positive reinforcement : Involves the addition of something to increase a response, such as giving a bit of candy to a child after she cleans up her room or token is given to patient with mental disorder for performing desired behaviour Negative reinforcement : Negative reinforcement is when a certain stimulus/item is removed after a particular behavior is exhibited. The likelihood ( possibility ) of the particular behavior occurring again in the future is increased because of removing or avoiding the negative stimuli.

21. Modelling Patient learn new behaviour by imitation , primarily by observation Useful in phobic children who are placed with other children of their age Irrational fears can be unlearned by observing fearless model confront the feared object A hierarchy of activities is established, with least anxiety-provoking

22. Punishment : Is designed to stop behavior, not to make it occur more often When undesired response occurs, punishment is given Time out : Reinforcement is withdrawn for some time

23. COGNITIVE THERAPY OR COGNITIVE BEHAVIOUR THERAPY Definition : Type of psychotherapy which aims at correcting the maladaptive methods thinking , thus providing relief from consequent symptoms. Developed separately by Beck and Meichenbaum . Indication : 1) depression 2) anxiety disorder 3) panic disorder 4) phobias 5) eating disorder 6) anticipatory anxiety 7) teaching problem-solving method. 8) delusion and hallucination ( rarely )

24. HOT CROSS BUN MODEL

25. Typically the CBT consist of about 15 visit over 3 months. Important techniques in CBT : COGNITIVE TECHNIQUES – recognising and correcting negative autonomic thoughts, identifying and testing maladaptive assumptions BEHAVIOURAL TECHNIQUES – activity scheduling, homework assignments, graded task assignment, behavioural rehearsal, role playing TEACHINGPROBLEM- SOLVING SKILLS. MINDFULNESS

26. EXPOSURE AND RESPONSE PREVENTION (ERP) ERP is a type of cognitive behavioural therapy which is used for a variety of anxiety disorder especially the obsessive compulsive disorder (OCD) and phobias. How the ERP works ? It works by breaking the link between your obsessional thoughts, images, urges or impulses and the compulsive things that you do to reduce the distress or anxiety that they cause. During ERP exercises you gradually expose yourself to situations that bring on or cue your obsessions, whilst not carrying out your compulsions.

27. Remember the five conditions: Condition 1: Graded List things in your exposure hierarchy that give you at least 50-60% anxiety from the easier things up to more difficult things. Remember not to grade an exercise by time. When you have been repeating an exercise and it no longer gives you at least 40% anxiety at the start of the exercise, you are then ready to move up to the next item on your exposure hierarchy. Condition 2: Prolonged Stay in the exposure exercise situation, without using distraction until your anxiety drops by 50% from the start of the exercise. So for example if you were 80% anxious, you would stay in the situation until your anxiety drops to 40%. You would then repeat the exercise until it no longer gets above 40% at the start of the exercise. Condition 3: Repeated Expose yourself to each step on the hierarchy at a time. You should repeat each step until the exercise no longer makes you feel anxious, say if it no longer goes above 40% anxiety at the start of the exercise. Then it is time to move up to the next exercise on your hierarchy ladder. On average you should aim to do exposure treatment 4-5 times per week (these may be different exercises depending on your ratings). Condition 4: Without Distraction Try to remove things from your hierarchy that reduce your anxiety artificially or distract you from how you are feeling during your exposure exercises. Whist these may seem like the give temporary relief from feeling anxious, they are keeping you stuck in that vicious circle. Condition 5: Without Compulsion Each time you expose yourself to an exercise on your hierarchy, you need to remain in the situation, resisting the urge to carry out a compulsion to reduce your distress (either one that you have done before, or a new one).

28. Quiz

29. References Kaplan & Sadock’s concise Textbook of Clinical Psychiatry A Guide to Treatments That Work by Peter E. Nathan 7 th Edition, A Short Textbook of Psychiatry by Niraj Ahuja Internets http://www.mhhe.com/cls/psy/ch06/ccapps.mhtml http://www.simplypsychology.org/behavioral-therapy.html