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Behavior therapy
- 1. SEMINAR ON BEHAVIOR THERAPY Presented by :Rahul Gusain Msc N Ist year
- 3. Introduction Psychotherapy is defined as a treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient to remove, modified or retarded existing symptoms, disturbed pattern of behavior and promote positive personality growth and development.
- 4. Definition According to Lego S. defines psychotherapy – “A method of treatment based on the development of therapeutic relationship between client and therapist for the purpose of exploring and modifying the patient’s behavior in a satisfying direction.”
- 5. Aims Psychotherapy aims to improve an individual’s well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions and to improve relationships and social skills.
- 6. Objectives • To establish therapeutic relationship between the patient and therapist. • To modify, remove or reduce the factors causing a disturbed behavior. • To help the patient to grow and develop coping mechanism to face the problem in future and improve in social functioning. • To improve family relationship with spouse and other family members. • To improve emotions, behavior and try to be safe and well-being. • To help to improve behavior, self-esteem and mood.
- 7. Goals • Changing maladaptive behavior • Modifying environment causing maladaptive behavior • Improve IPR skills • Helping the patient to overcome a feeling of handicap. • Helping him to make an accurate assessment of himself and develop self- identity.
- 8. Types and techniques of psychotherapy • Individual psychotherapy • Psychoanalysis • Hypnosis • Narcoanalysis • Abreaction • Reality therapy uncovering
- 9. Behavioral psychotherapy • Behavior modification • Systemic desensitization • aversion therapy • assertive training • cognitive behavior therapy
- 10. Interpersonal psychotherapy • Marital therapy • Family therapy • Transactional therapy
- 12. Supportive psychotherapy •Ventilation - Implosive therapy or flooding •Environment modification •Persuasion - positive reinforcement •Re-education – response shaping •Reassurance - modeling - Token economy
- 13. Contraindication • Psychotic patient with severe behavior disturbance like excitement • Organic psychosis, hysteria, and personality disorder (malingering) • Patient who are unmotivated and unwilling to accept it.
- 14. Behavior therapy
- 15. Introduction Emphasized the overriding importance of the environmental events, rejecting covert aspects of the individual. He claimed that all behavior could be understood as a result of learning. (Nature vs. Nurture)
- 16. HISTORY • B.F. Skinner (1904 – 1958) • Skinner developed the theory of operant reinforcement theory which is the notion that how often a behaviour is executed depends on the events that follow the behaviour (Seligman,2006). For example, if the behaviour is reinforced, the behaviour is more likely to be repeated. • He emphasized observable behaviour and rejected the notion of “inner causes” for behavior.
- 17. • Albert Bandura (1925) • Bandura applied the principles of classical and operant conditioning to social learning. Basically, people learn behaviours through observation of other’s behaviour, also known as modelling (Seligman, 2006).
- 18. Current Focus •The traditional behavioural approach is no longer used as it once was. It has moved towards a more collaborative treatment with cognitive therapy and as such this has meant a more applicable approach (Seligman, 2006).
- 19. Definition •Behavior therapy (behavior modification) is an approach to psychotherapy based on learning theory which aims to treat psychopathology through techniques designed to reinforce desired and eliminate undesired behaviors.
- 20. Indication • obsessive compulsive disorder (OCD) • panic disorders • eating disorders • post-traumatic stress disorder (PTSD) • bipolar disorder • depression • ADHD • anxiety • anger issues • phobias, including social phobias
- 21. Common elements of behavioral approaches • An emphasis on the present rather than on the past • Attention to changing specific dysfunctional behaviors • Reliance on research as an integral partner for developing and testing interventions • Principles of learning can account for the development and treatment of maladaptive behaviors. • A preference for carefully measuring treatment outcomes
- 23. Goals of behavioral therapy • To create new conditioning of learning • Client and therapist work collaboratively to specific treatment goals • Goals must be specific and measurable • It is fundamental to behavior therapy that the client should have the major say in setting treatment goals, it is important that the client is fully informed, and consents to and participates in setting goals.
- 24. Goals • Provide a direction to counseling • Provide a basis for selecting and using • strategies & interventions. • Provide a framework for evaluating the outcome
- 25. Process
- 26. Process of behavioral therapy • Counselor explains the purpose of goals. • Client specifies the positive changes desired as a result of counseling. • Together they explore whether the goals are realistic. • They discuss advantages and disadvantages of the goals. • On the basis of the information obtained about client-stated goals, the counselor and the client make one of the following decisions: to continue counseling, to reconsider the client’s goals, or the seek a referral
- 27. Scientific basis • Scientific basis • Behavior therapy is based upon the principles of • Classical conditioning developed by Pavlov • Operant conditioning developed by B. F skinner
- 28. CLASSICAL CONDITIONING Classical conditioning is a type of learning when an unconditioned stimulus (UCS) such as food produces an unconditioned response (UCR) such as salivation. If a neutral stimulus such as a bell is then paired with the UCS to get the UCR and this is repeated, the neutral stimulus will create the response of salivation. The neutral stimulus is now the conditioned stimulus (CS) and the response is a conditioned response (CR).
- 30. Techniques of classical conditioning and examples
- 31. Systematic desensitization It is a technique to overcome their fear of a phobic stimulus. It is “systematic’ in that there is a hierarchy of anxiety- producing events through which the individual progresses during therapy.it is based on reciprocal inhibition principle.
- 32. The process of systematic desensitization is applied to an example. • Discuss riding an elevator with therapist. • Look at the picture of an elevator. • Work into the lobby of a building and see the elevators. • Push the button for the elevator. • Walk into an elevator with a trusted person, disembark before the doors close.
- 33. • Walk into the elevator with a trusted person, allow doors to close, then open the doors and walk out. • Ride one floor with a trusted person and then walk back down the stairs. • Ride one floor with a trusted person and ride the elevator back down. • Ride the elevator alone.
- 34. Indication • Phobia • Obsessive compulsive disorder • Sexual disorders
- 35. Time out It is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is being exhibited. The client is usually isolated so that the reinforcement from the attention of others is absent.
- 36. Reciprocal inhibition • It is also called counter conditioning reciprocal inhibition decreases or eliminate a behavior by introducing a more adaptive but one that is incompatible with the unacceptable behavior, e.g. relaxation exercise are given to reduce anxiety.
- 37. Overt sensitization • Overt sensitization is a type of aversion therapy that produces unpleasant consequences for undesirable behavior. e.g. disulfiram is drug that is given for individuals who wish to stop drinking alcohol.
- 38. Covert sensitization • It relies on the individual’s imagination to produce unpleasant symptoms rather than on mediation. • The technique is under the clients control and can be used whenever and wherever it is required. • The individual learns through mental imagery, to visualize nauseating scenes and even to introduce a mild feeling of nausea.
- 39. Covert sensitization • This mental image is visualized when the individual is about to succumb to an attractive but undesirable behavior. • The primary advantage of covert sensitization is that the individual does not have to perform the undesired behaviors but imagines them.
- 41. Introduction Operant conditioning can be described as a process that attempts to modify behavior through the use of positive and negative reinforcement. Through operant conditioning, an individual makes an association between a particular behavior and a consequence (Skinner, 1938).
- 42. Techniques of operant conditioning with examples Reinforcement occurs when a response is strengthened by an outcome. These are two type of reinforcement, negative and positive reinforcement.
- 43. Positive Reinforcement • Positive reinforcement strengthens a behavior by providing a consequence an individual finds rewarding. For example, if your teacher gives you Rs 5 each time you complete your homework (i.e., a reward) you will be more likely to repeat this behavior in the future, thus strengthening the behavior of completing your homework.
- 44. PROCESS BEHAVIOUR CONSEQUENCE EFFECT ON BEHAVIOUR Positive Child behaves well Rewarded with a Tendency to behave Reinforcement at shops chocolate well at the shops Negative Stress Relaxation exercise Tendency to not get Reinforcement as stressed Positive Punishment Child misbehaves Given chores Tendency to not Misbehave Negative PunishmentFails to secure bike Bike is stolen Tendency to secure personal property in the future
- 45. Negative Reinforcement The removal of an unpleasant reinforce can also strengthen behavior. This is known as negative reinforcement because it is the removal of an adverse stimulus which is ‘rewarding’ to the animal or person. Negative reinforcement strengthens behavior because it stops or removes an unpleasant experience.
- 46. For example, • If you do not complete your homework, you give your teacher Rs 5. You will complete your homework to avoid paying Rs 5, thus strengthening the behavior of completing your homework.
- 47. Punishment •Punishment occurs when a response to behavior decreases the likelihood of the behavior reoccurring. There are also two types of punishment, negative and positive punishment.
- 48. Positive punishment occurs when an aversive response to behavior is used and therefore the behavior is less likely to occur. For example, a child is given chores when he or she has been naughty. The child therefore, has been given a punishment to reduce the likelihood of the bad behavior continuing.
- 49. Negative punishment occurs when something is taken away and therefore decreases the likelihood of the behavior reoccurring. For example, a person fails to secure a bike and this leads to the theft of the bike. This therefore decreases the likelihood of the person leaving property unsecured in the future.
- 50. Flooding Flooding involves the client being exposed to the actual or imagined fearful situation for a prolonged period of time. The example of the client with the spider fear would be that the client would be exposed to the spider or the thought of a spider for a prolonged period of time and uses relaxation techniques to cope.
- 51. Aversion Therapy - The most controversial of the behavioral treatments and is used by therapists as a last resort to an aversive behavioral . This treatment involves pairing the aversive behavioral (such as drinking alcohol) with a stimulus with an undesirable response (such as a medication that induces vomiting when taken with alcohol).
- 52. Token economy Token economy is a system in which targeted behaviors are reinforced with tokens (secondary reinforcers) and later exchanged for rewards (primary reinforcers). Tokens can be in the form of fake money, buttons, poker chips, stickers, etc. While the rewards can range anywhere from snacks to privileges or activities. For example, teachers use token economy at primary school by giving young children stickers to reward good behavior.
- 53. Shaping • In shaping the behavior of another, reinforcements are given for increasingly closer approximately to the desired response. For example, in eliciting speech from an autistic child, the teacher may first reward the child for (a) watching the teacher’s lip, then for (b) making any sound in imitation of the teacher, then for (c) forming sounds similar to the word uttered by the teacher. Shaping has been shown to be an effective way of modifying behavior for task that a child has not mastered on command.
- 54. Modeling • It involves learning of new behavior by imitating the behavior in other models are individuals who have qualities or skills that a person admires and wishes to imitate children imitate the behavior patterns of their parents, teachers and friends. • In therapeutic community it can occur in a therapy session in which the clients watch a model demonstrate appropriate behavior in a role play of the clients problem. • The client is instructed to imitate the models behavior in similar role play and is positively reinforced for appropriate limitation.
- 55. SOCIAL LEARNING • Social learning (or modeling) occurs when an individual (or animal) responds a certain way due to having observed the behavior previously. • Social learning is an extension of classical and operant condition in that an individual is conditioned indirectly by observing another’s conditioning.
- 56. Social learning examples For example, a child receives praise for setting the table. The younger child’s own tendency to set the table for parents is reinforced as result of the praise the older child receives.
- 57. Social learning (i)Modeling : learning by observing others • It serves two purpose: (a) person can learn new behavior (b) behavior that is inhibited become less (ii) vicarious learning : • Observing other peoples behaviors being rewarded or punished leads to reinforcement of those behaviors in an observer.
- 59. Principles of behavioral therapy • Although genetics play a role. Individual differences are derived primarily from different experiences. • Behavior is learned and acquired largely through modeling, conditioning, and reinforcement. • Behavior has a purpose. • Behavior is the major determinant of habits, thoughts, emotions, and other aspects of personality. • Behavior therapy seeks to understand and change behavior.
- 60. Principles • Therapy should be based on the scientific method and be systematic, empirical, and experimental. Goals should be stated in behavioral, specific, and measurable terms, with progress assessed regularly. • The focus of treatment should generally be on the present. Even if behaviors are longstanding, they are maintained by factors in the current environment. • However, behavior must be viewed in context, and some exploration of the past is appropriate to provide that context and help people feel understood.
- 61. Principles • Education, promoting new learning and transfer of learning, is an important aspect of behavior therapy. • Strategies of behavior therapy need to be individualized to the particular person and problem. • Clients have primary responsibility for defining their goals and completing homework tasks. The treatment plan is formulated collaboratively, with both client and clinician participating actively in that process.
- 62. AREAS OF APPLICATION Behavioral therapy can be used to treat many psychological disorders including anxiety disorders, sexual disorders, depression, interpersonal and marital problems, chronic mental conditions, childhood disorders, eating and weight disorders as well as prevention and treatment of cardiovascular disease .
- 63. STRENGTHS WEAKNESSES When using in therapy, it accomplishes Overdependence on animal research what the theory predicts will happen Treatment outcomes have been Denies the existence of free will and the scientifically and empirically validated importance of cognitive processes Emphasizes ethical accountability Treats symptoms rather than underlying Wide variety of techniques that may be Does not provide insight (Corey, 2005). utilized in therapy Personality structure only focuses on Stimulus-response associations. There is no emphasis on underlying concepts
- 64. Role of nurse • Nurses can implement behavior therapy techniques to help clients modify maladaptive behavior patterns. • Nursing process is a systematic method of directing care for clients who acquire this type of assistance. • As the role of the psychiatric nurse continue to expand, the knowledge and skills associated with a variety of therapies will need to be broadened. • The psychiatric nurse is vital in making nursing process in context to behavior therapy.
- 65. • The nursing process is the vehicle for delivery of nursing care with the client requiring assistance with behavior modification. • The clinical nurse specialist plays an essential role in the treatment of patients with functional bowel disorders, a group of patients who are traditionally difficult to manage medically or surgically. • A nurse of the psychiatry department is the primary person responsible for providing the requirements of the therapeutic environment in clinics.
- 66. Research study
- 67. Journal of Behavior Therapy and Experimental Psychiatry Upright posture improves affect and fatigue in people with depressive symptoms • Background and objectives Slumped posture is a diagnostic feature of depression. While research shows upright posture improves self-esteem and mood in healthy samples, little research has investigated this in depressed samples. This study aimed to investigate whether changing posture could reduce negative affect and fatigue in people with mild to moderate depression undergoing a stressful task.
- 68. Methods • Sixty-one community participants who screened positive for mild to moderate depression were recruited into a study purportedly on the effects of physiotherapy tape on cognitive function. They were randomized to sit with usual posture or upright posture and physiotherapy tape was applied. Participants completed the Trier Social Stress Test speech task. Changes in affect and fatigue were assessed. The words spoken by the participants during their speeches were analysed.
- 69. Results At baseline, all participants had significantly more slumped posture than normative data. The postural manipulation significantly improved posture and increased high arousal positive affect and fatigue compared to usual posture. The upright group spoke significantly more words than the usual posture group, used fewer first person singular personal pronouns, but more sadness words. Upright shoulder angle was associated with lower negative affect and lower anxiety across both groups.
- 70. Limitations The experiment was only brief and a non-clinical sample was used. Conclusions This preliminary study suggests that adopting an upright posture may increase positive affect, reduce fatigue, and decrease self-focus in people with mild-to-moderate depression. Future research should investigate postural manipulations over a longer time period and in samples with clinically diagnosed depression.
- 71. Summary • In this chapter we have discussed about the psychotherapy, behaviorism, history, adaptive and maladaptive behavior, classical conditioning, operant conditioning, techniques and examples, principles, treatment types and role of nurse in behavior therapy.
- 72. CONCLUSION Overall, behavioral therapies are not generally used on their own in treating psychological disorders however the techniques used in behavioral therapies are applicable to treatment in a wide variety of settings. Behavioral therapies have contributed to greater understanding of the learning processes and have also significantly influenced measurement strategies for identifying psychological problems such as anxiety disorders.
- 73. Bibliography • Sadock, B.J., & Sadock, V.A .synopsis of psychiatry: behavioral science / clinical psychiatry (10th edition), wolters Kluwer pg-423-424 • Mary C. Townsend, Psychiatric mental health nursing concepts of care in evidence-based practice , Jaypee publication, pg-321-324 • I clement ,Textbook of Psychology ,jaypee publication pg 12-13 • Skinner, B.F The behavior of organisms. New York: macmillan. • Manish gupta, a textbook of treatment modalities in psychiatric nursing, first edition jaypee publication page no.83-93 • S.k mangal , advanced educational psychology, second edition eastern economy edition, page no.192-201 • Raymond J. corsini, current psychotherapies , fourth edition, peacock publication, page no-241-285