Behaviourtherapy 160424142214

BEHAVIOR THERAPY,GROUP
THERAPY &OCCUPATIONAL
THERAPY

Today we will discuss about……
• Introduction of behaviour therapy
• Major assumptions
• Characterstics of behaviour therapy
• Indications of behaviour therapy
• Principles of BT(Classical conditioning &Operant
conditioning)
• Four context of Operant conditioning
Behaviour techniques:-
• Systemic desensetization
• Principles of systemic desensitization
• Aversion therapy

Contd…..
• Operant conditioning for increasing adaptive
behaviour
• Operant conditioning for teaching new behaviour
• Operant conditioning for decreasing new behaviour
• Advantages of behaviour therapy
• Disadvantages of behaviour therapy

Contd….
• Group therapy,introduction
• History of groups
• Goals of group therapy
• Types of group therapy
• Stages of group development
• Guidelines for group therapy
• Therapeutic factors
• Concerns of group work
• Purposes of therapist intervention
• Functions of group therapy
• Techniques of group therapy
• Role of a therapist
• Areas for group therapy
• Benefits/limitation of co-therapists
• Conclusion

Contd…..
• Occupational therapy-
• Introduction
• Goals of OT
• settings of OT
• OT Activities
• Classifiation of OT
• Advantages
• Suggested OT activities
• Points to be remembered
• Nurses role
• Conclusion

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

MAJOR ASSUMPTIONS OF
BEHAVIOUR THERAPY
The following are the assumptions of behavior
therapy.
All behavior is learned (adaptive and
maladaptive)
Human beings are passive organisms that can be
conditioned or shaped to do anything if correct
responses are rewarded or reinforced.
Maladaptive behavior can be unlearned and
replaced by adaptive behavior if the person recieves
exposure to specific stimuli and reinforcement for
the desired adaptive behavior.

Behavior assessment is focused more on the
current behavior rather than on historical
antecedents.
Treatment strategies are individually tailored.

Characterstics of behaviour therapy
• Empirical(data-driven)
• Contextual(focus on the enviornment and context)
• Functional(interested in the effect of behaviour
ultimately)
• Probabilistic(viewing behaviour as statistically
predictible)
• Monistic(rejecting body-mind dualism &seeing
individual as a whole)
• Relational (analyzing bidirectional interactions)

Indications of behaviour therapy
• Bipolar disorder
• Borderline personality disorder
• Eating disorders
• Obsessive compulsive disorders
• Panic disorder
• Phobias
• PTSD
• Psychosis
• Schizophrenia
• Insomnia
• Alcohol misuse
• Irritable bowel syndrome
• Chronic fatigue syndrome
• fibromyalgia

Principles of behavioural therapy
• Classical conditioning by Ivan Pavlov(1927).
• Operant conditioning by BF skinner(1938).

Classical conditioning
• Offered food-dog salivation(unconditioned response)
• View of food-dog salivation(conditioned response)
• Offered food with Sound of bell-dog salivation,then
with time sound of bell-dog salivation in the absence
of food(unrelated stimulus).
• Findings-unconditioned response occur in response
to unconditioned stimuli.
• Unrelated stimulus +unconditioned stimulus-
conditioned response.

Operant conditioning
• It is the use of consequenses to modify the
occurrance and form of behaviour.
• It deals with the modification of ‘voluntary
behaviour’.
• it works on the enviornment and is maintained by its
consequenses.

Principles of operant conditioning
• Reinforcement(positive &negative)
• Punishment(positive &negative)
• extinction

Contd….
• Reinforcement-is a consequence that causes
behavior to occur with great frequency.
• Punishment-it’s a consequence that causes the
behavior to occur less frequently.
• Extinction-it’s a decline in consequence following
behavior.

Four context of operant conditioning
• Positive reinforcement-it occurs when behaviour is
followed by a favorable stimulus that Increases the
frequency of the behavior.
• In the skinner box experiment,a stimulus such as
food or sugar solution can be delivered when the rat
engages in target behaviour,such as pressing the
lever.

contd…
• Negative reinforcement- it occurs when a behaviour
is followed by the removal of an aversive stimulus
thereby increasing that behaviour frequency
• .e.g-in skinner box experiment,negative stimulus can
be a loud noise continously sounding inside the rat
cage until it engages in the target behaviour,such as
pressing a lever,upon which the loud noise is
removed.

Contd…
• Positive punishment-it occurs when behaviour is
followed by an aversive stimulus ,such as introducing
a shock or loud sound,resulting in a decrease in that
behaviour
• Negative punishment-it occurs when a behaviour is
followed by the removal of a favourable
stimulus,such as taking away a child’s toy following
an undesirable behaviour resulting in decrease in
that behaviour.

• BEHAVIOR TECHNIQUES
Systemic desensitization
It was developed by joseph wolpe,based on
the behavioral principle of counter
conditioning. In this, patient attain a state of
complete relaxation and are then exposed to
the stimulus that elicits the anxiety
response.The negative reaction of anxiety is
inhibited by the relaxed state, a process called
reciprocal inhibition.

It is based on behaviour modification.
It consists of three main steps:
 Relaxation training
 Hierachy construction
 Desensitization of the stimulus

a)Relaxation training
There are many methods which can be used
to induce relaxation. Some of them are:
 jacobson’s progressive muscle
relaxation(client first tightens and then relax
various muscle groups in the body. During the
alternative clenching &relaxing the client
should focus on the contrast between the
initial tension &the subsequent feeling of
relaxation &softening of muscles.

Contd….
 Hypnosis
 Meditation or yoga
 Mental imagery
 biofeedback

Changes during relaxation training
• Physiological signs-slow heart rate,increased
peripheral blood flow and neuromuscular
stabiility,pupil constriction,increased peripheral
temperature,decreased oxygen consumption.
• Cognitive signs-altered state of
consciousness,heightened concentration on single
mental image
• Behaviour changes—lack of attention on
enviornmental stimuli,no verbal interaction,no
voluntary change in position.

b)Hierachy construction
Here the patient is asked to list all the
conditions which provoke anxiety. Then he is
asked to list them in a descending order of
anxiety provocation.
c)Desensitization of the stimulus
This can either be done in reality or though
imagination.At first, the lowest item in hierachy is
confronted.The patient is advised to signal
whenever anxiety is produced. After a few trails,
patient is able to control his anxiety gradually.

Contd…
• By pairing the old conditioned stimulus with a new
relaxation response that is compatible with the
emotions and the physical arousal associated with
it,the person fear removes gradually.

Principle of systemic desensitization
• It was designed to decrease the avoidance behaviour
linked to a specific stimulus.
• Its main aim is to prevent help the patient change
his/her response to threatening stimulus.
• It is also called as graduated exposure therapy.

INDICATION
• Phobias
• Obessions
• Compulsions
• Certain sexual disorders
• Anxiety disorder

AVERSION THERAPY:
Pairing of the pleasant with an unpleasant
response, so that even in absence of the
unpleasant response the pleasant stimulus
becomes unpleasant . Unpleasant response is
produced by electric stimulus,drugs,social
disapproval or even fantasy.

INDICATIONS
 Alcohol abuse
 Paraphilias
 Homosexuality
 Transvestism

OPERANT CONDITIONING PROCEDURE
FOR INCREASING ADAPTIVE BEHAVIOUR
a)Positive reinforcement
When a behavioral response is followed by a
generally rewarding event such as food, praise or
gifts, it tends to be strengthed and occur more
frequently than before reward. This techniques is
used to increase desired behavior.
b)Token economy
This program involves giving token rewards for
appropriate or desired target behaviours
performed by the patient.

Contd….
Non contingent reinforcement
• Refers to the delivery of reinforcing stimuli on a fixed
–time schedule regardless of the organism’s
behaviour.it is not dependent on any kind of
behaviour.
• The idea is that the target behaviour decreases
because it is no longer necessary to receive the
reinforcement.
• E,g-The teacher told the student that he’s smart and
can do the test, even after the student has failed in
the test.

OPERANT CONDITIONING PROCEDURE
TO TEACH NEW BEHAVIOUR
a)Modeling
modeling is a method of teaching by
demonstration where the therapist shows
how a specific behavior is to be performed.In
modeling the therapist observes other patient
indulging in target behaviors and getting
rewards for those behaviors.This will make the
patient repeat the same behavior and earn
rewards in the same manner.

b)Shaping
In shaping the components of a particular skill,
the behaviour is reinforced step by step. The
therapist starts shaping by reinforcing, the
existing behavior.

C)Chaining
Chaining is used when a person fails to perform a
complex task. The complex task is broken in to a
number of small step and each step is taught to
the patient. In forward chaining one start with
the first steps, goes on to the second step, then
to the third and so on. In backward chaining, one
starts with the last step and goes on to the next
step in a backward fashion.

D) premack principle
• Named after its originator
• Frequently occuring responses (R1)can serve as a
positive response for response(R2) that occurs less
frequently.
• E.g-13 yr old jennie has been neglecting her
homework for the past few weeks and spending
more time on phone talking to her friends.applying
premack principle she being allowed to talk to her
friends on the phone if she completes her
homework.

e)Contingency contract
• A contract between all the parties involved.
• The desired behaviour is stated explicitly in writing.
• The contract specifies the desired behaviour change
&the reinforcers given with them.
• The contract also mentions the punishers for not
fulfilling the terms.

f) Reciprocal inhibition
• Inhibition of one response that is incompatible with
the other behaviour.e.g-introduction of relaxation
exercises for the individual who is phobic.

g) ASSERTIVENESS AND SOCIAL
SKILL TRAINING
Assertive traning is a behavior therapy technique in
which the patient is given training to bring about
change in emotional and other behavioral pattern by
being assertive. Patient is encouraged not to be afraid
of showing an appropriate response, negative or
positive, to an idea or suggestion. Assertive behavior
training is given by the therapist, first by role play and
then by practice in a real life situation. Social skills
training helps to improve social manners like
encouraging eye contact, speaking appropriately,
observing simple etiquette and relating to people.

h).Avoidance learning
It is a type of learning in which certain behaviour
results in the cessation of an aversive stimulus. For
example shielding ones eye when in sunlight will help
avoid the aversive stimulation of having light in ones
eye.

0PERANT CONDITIONING PROCEDURES FOR DECREASING
MALADAPTIVE BEHAVIOR
a)Extinction/Ignoring
Extinction mean removal of attention
rewards parmanently, following a problem
behavior. This includes actions like not looking
at the patient, not talking to the patient, or
having no physical contact with the
patient.This is used when patients exhibit odd
behaviour.

b)Time out
Timeout method includes removing the patient
from the reward or the reward from the
patient for a particular period of time
following a problem behavior.This is often
used in the treatment of childhood disorders.
for eg the child is not allowed to go out of the
ward to play if he fails to complete the given
work.

c)Restitution (over correction)
Restitution means restoring the disturbed
situation to a state that is much better than
what it was before the occurrence of the
problem behavior. for eg if a patient passes
urine in the ward he would be required to not
only clean the dirty area but also map the
entire area of the floor in the ward.

d)flooding
The patient is directly exposed to the phobic
stimulus, but escape is made impossible.By
prolonged contact with the phobic stimulus,
the therapist guidance and encouragement
and his modeling behavior reduce anxiety.
Indication: specific phobias

e) Response cost
• It is the term used for removing reinforcement for an
undesirable or disruptive behaviour.in terms of
applied behavior analysis,it is a form of negative
punishment.by removing something you decrease
the likelihood that the target behavior will appear
again.e.g- a fine is charged on late submitting of
assignment.

f) Overt sensitization
• It is a type of aversion therapy which produces
unpleasent experiences for undesirable behaviour
• I,e disulfiram for alcohol consuption when on
antabuse therapy produces severe nausea
&vomiting.

g) Covert sensitization
• It is a form in which an undesirable behaviour is
paired with an unpleasent image in order to
eliminate that behavior.
• This technique can be used for patients under
control.
• E.g-thinking of nauseated images before taking
alcohol can prevent its use.

Contd…
• Extinction-it occurs when behaviour that had
previously been reinforced is no longer effective.in
the skinner box experiment ,when rat pushes the
lever gets food grains in reward…but after some time
when he stopped getting reward on pushing lever
several times he ceased this activity

• Group psychotherapy is a treatment of
psychological problem in which two or
more patients/client interact with each
other on both an emotional & cognitive
levels in the presences of one or more
psychotherapists who serve as catalysts
(the person who can be related to or who
can understand the other’s point of view),
facilitators or interpreters.

History of Groups
• Originally found successful in treating
patients with TB in the early 1900’s
• Jacob L. Moreno introduced group
therapy in counseling in 1920.
• Later used during WW II for treating
those with emotional reactions

• In 1946 “T-groups” emerged, to enhances
interpersonal relationship. It was the beginning
of modern group work.
• Encounter group- intended for “Normal
Functioning” who wanted to grow.
• Marathon group- breakdown barriers that
individuals use.
• The 1960 human potential movement
“Founded on the belief that the most people
only use a small percentage of their capability
but that within a group experiences, they can
recognize their full potential”.

Advantages of behaviour therapy
• Identify negative thoughts &emotions
• Preventing addiction relapse
• Managing anger
• Coping grief & loss
• Managing chronic pain
• Overcoming trauma &dealing with PTSD
• Overcoming sleep disorders
• Resolving relationship difficulties

Disadvantages of behaviour therapy
• Not useful in people with learning difficulties
• Feeling of shame &guilt
• Suicide
• Social withdrawal

• Help Individuals
Identify Maladaptive
Behavior
• Help with Emotional
Difficulties through
Feedback
• Offer a Supportive
Environment

1. Psychoeducational/ Guidance group
2. Counseling/Interpersonal Problem-
Solving Groups
3. Psychotherapy Groups
4. Task/work Groups

Psychoeducational/ Guidance
group
• The purpose is to teach group participant how
to deal with a potential threat (catching the
flu), developmental life events (growing older)
or immediate life crisis (death of love one)
• Used in educational setting but frequently
used in hospital, mental health center, or
social service agencies.

Counseling/Interpersonal Problem-
Solving Groups
These groups help participants
resolve problems of living through
interpersonal support and problem
solving.

Psychotherapy Groups
• These groups focus on personality
reconstruction or remediation of
deep-seated psychological
problems.

Task/work Groups
• A group that comes together to perform a
task that has a concrete goal (e.g.
community organizations, committees,
planning groups, task force).

Guidelines for group therapy
• Maintain Confidentiality
• Commitment to Attendance.
• Socializing with Group Members
• Putting Feelings into Words Not
Actions.
• Role of Leader and Members

Yalom’s Therapeutic Factors
• Yalom (1995) defined therapeutic
factors as "the actual mechanisms of
effecting change in the patient“.
• Yalom identified 11 factors that
influence the processes of change and
recovery among group therapy clients.

11 Therapeutic Factors
1) Universality- feeling of having problems similar to
others, not alone
2) Altruism - helping and supporting others
3) Instillation of hope - encouragement that
recovery is possible
4) Guidance - nurturing support & assistance
5) Imparting information - teaching about problem
and recovery
6) Developing social skills - learning new ways to
talk about feelings, observations and concerns

Cont…
7) Interpersonal learning - finding out about
themselves & others from the group
8) Cohesion - feeling of belonging to the group,
valuing the group
9) Catharsis – release of emotional tension
10) Existential factors – life & death are realities
11) Imitative behavior – modeling another’s
manners & recovery skills

Group Composition
Homogenous groups
Group composed of patients of the
same age, race, sex, socioeconomic
level and similar of illness.

Group Composition
Heterogeneous groups
Group vary on different clients age, race,
sex, socioeconomic level and different
category of illness.

Concerns in Group Work
Group Size
Group counseling and
psychotherapy generally work best
with 6-8 members.
If group run as long as
6 months 10 people
can be included.

Cont…
Length and Duration of Sessions
Group sessions range
from 1-2 hours.

Purposes of therapist intervention
• To help build an atmosphere of trust and safety.
• To enforce rules and norms.
• To provide feedback.
• To get a member’s input, reaction or feedback.
• To draw connections between members or point out themes.
• To correct irrational or faulty thinking.
• To empower participants.
• To offer support when needed.
• To reinforce helpful contributions.
• To encourage constructive risk taking

Functions of group therapy
• Sharing experiences
• Support to & from group member
• Socialization
• Imitation
• International learning

Sharing experiences
• This help the client to realize that they
are not isolated & that other also have
similar experience & problem
• Hearing from other client that they
shared experiences is often more
convincing & helpful then reassurance
from the therapist.

Support to & from group members
• The sharing action of being mutually
supportive is an aspect of the group
cohesiveness that can provide a sense of
belonging for client feeling who feel
isolated in their everyday lives.

• It is acquisition of social skill (E.g.
maintaining eye contact) with in a
group through comments that member
about one another deficiencies in
social skills.
• This process can be helped by trying
out new ways of interacting within the
safety of the group.

Imitation
• It is learning from observing &
adopting the behaviors of other group
members.
• If the group is run well, client imitate
the adaptive behaviors of other group
members.

International learning
• It refers to learning about difficulties in relationships
by examining the interaction of individuals with the
other members of group.

Techniques of group therapy
Cognitive therapy
Focus on irrational thoughts and
beliefs of members and restructuring
perceptions and beliefs by substitution
of new effective thoughts and beliefs.

Cont…
Behavioral therapy
Behavior is learned so ineffective
behavior can be unlearned and
replaced by effective behavior.

Cont…
Role play
One member of the group can portray
someone in another group member's life
to give the other member a chance at
practicing how to communicate
effectively.

Cont…
Story Writing and Sharing
Members write a story about themselves
and their lives and then read it aloud for
the group to hear and discuss.

Cont…
• Task oriented groups
To develop social skills ,interacting in a
group home.
• Therapeutic activity groups
Wide array of art, music, dance,
psychodrama and many other
techniques having a defined therapeutic
goal.

Roles of Therapist
• An advisor
• An advocate
• A facilitator
• A social policeman
• A technician
• An enabler

Areas That May Particularly
Benefit From A Group Therapy
• Addiction
• Anxiety
• Depression
• Obsessive Compulsive Disorder

Benefits of having
co-therapists
• More expertise.
• Allows for division of labor (e.g. one leader
can concentrate on content and the other
leader can look at process variables).
• Group members receive more individual
attention.
• Two leaders can model communication and
conflict resolution.
• Two leaders provide diversity in theoretical
orientation, interpersonal style, and cultural
resources.

Limitations/dangers of
co-therapists
• If two leaders do not get along, it can be detrimental
and even harmful to group
• Co-leaders might develop competition between
themselves and this too is not good for the group
• If co-leaders have different skill levels, one might try to
lead the other. This can lead to coalitions with other
group members or even in the marginalization of the
more inexperienced leader
• Group members might feel ganged up on if both
leaders become adamant in getting across a
therapeutic message

Advantages
• You realize you’re not alone.
• Facilitates giving and receiving support.
• Helps you find your “voice.”
• Helps you relate to others (and yourself) in
healthier ways.
• Social Skills
• Learn From Others Mistakes
• Diversity of Opinions
• It costs less

Disadvantages
• Limited Privacy
• Personality Clashing
• Loss of trust
• It strikes fear into some patients.
• It doesn’t guarantee confidentiality.
• Social Anxiety
• Mourning A Loss

Conclusion
• Group therapy plays a major role in
rehabilitation of mentally ill client.
• It gives an opportunity for immediate
feedback.
• It facilitates chance for therapist to
observe the clients emotional and
behavioral response towards variety of
people.
• Enhances clients communication,
decision making and assertive skill.

Occupational Therapy (OT) can be
described as the art and science of
challenging an individual’s effort in
specially selected activities that have
been designed to restore and enhance
his performance.
introduction

OTis the application of goal –
oriented and, purposeful activity in
the assessment and treatment of
individuals with psychological,
physical or developmental
disabilities.
definition

1. Promotion of recovery
2. Mobilization of total assets of the patient
3. Prevention of hospitalization
4. Creation of good habits of work and leisure
5. Enhance the patient to regain self –
confidence
goals

OT is provided to children, adolescents, adults
and elderly patients.
Psychiatric Hospitals
Nursing Homes
Rehabilitation Centers
Special Schools
Community Mental Health Centers
Halfway Homes and De – addiction Centers
settings

Independent living skills: Self – care or Self
Maintenance.
Crafts, Socialization, Leisure activity and Education.
Employment and Academic preparation, Home making,
child care or parenting.
Design fabrication and application of orthotic devices.
Therapeutic exercise
Patient or family education / Counseling.

• Music, Art and
Clay Work.
• Poetryand
Drama.
• Craft Work
OT ACTIVITIES
Assertiveness Training
Daily Activities Living

I. Diversional – E.g.. Organized games.
II. Remedial – E.g.. Physiotherapy for particular muscle
groups. (Basket making, Weaving, Carpentry,
Gardening, Embroidery) Physiotherapy also includes
(Heat massage, Electrotherapy)
classification

1. OT helps to build a more healthy and integrated
ego.
2. OT helps to express and deal with needs and
feelings.
3. Assists in the gratification of basic needs.
4. Strengthens Ego defenses.
5. Reverses Psychopathology
6. Facilitates personality development.
7. Develops Self Esteem and Good Self – Concept.
Advantages

Anxiety Disorde r
Simple concrete tasks with
not more than 3 or 4 steps.
(Sweeping, Washing,
Weeding garden)

Depressive
Disorder
Simple concrete tasks which
are achievable. (Crafts)

Non-competitive
activities that allows
the use of energy and
expression of feelings.
(Raking Grass)
Manic
Disorder

Non-competitive solitary
meaningful tasks that require
some degree of concentration
(Puzzles)(paranoid person)
Simple concrete tasks in
which patients involves
actively. (Molding clay)
( catatonic person)
SUGGESTED OCCUPATIONAL
ACTIVITIES

Anti-Social
Personality
Dementia
Activities that enhance
self – esteem and
expressive and creative.
(Leather Work, Painting)
Group activities to
increase feeling of
belonging and self-worth.
(Cover making, packing
goods)

Substance
Abuse
Group activities in which
patient uses his talents.
(Involve patient in
planning social activities)
SUGGESTED OCCUPATIONAL
ACTIVITIES

Childhood and
Adolescent
disorders
Children – Playing, Story
telling, Painting, Poetry
Music etc.
Adolescents – Leather
work drawing, painting
etc.
MR – Cover making,
candle making and
packing goods.

Involve patients to select activity
Activity should utilizes patients strength and
abilities.
The activity should be of short duration to
foster feeling of accomplishments.
The selected activity should provide new
experience for the patient.

I. Observer
II. Teacher
III. Parent
IV. Supporter
V. Guide and Friend
VI. Warden
NURSE’S ROLE IN OCCUPATIONAL
THERAPY

It is well clear that
occupational therapy
plays an important role
for treating and
rehabilitating mentally –
ill clients.

Behaviourtherapy 160424142214

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