Framing an Appropriate Research Question 6b9b26d93da94caf993c038d9efcdedb.pdf
BEHAVIOURAL THERAPY.pptx
1.
2. INTRODUCTION
Behaviour is considered to be maladaptive
when it is age inappropriate, when it interferes
with adaptive functioning.
The principles of behavioural therapy as we
know it today are based on the early studies of
classical conditioning by Pavlov (1927), &
Operant conditioning by Skinner (1938).
3. CLASSICAL CONDITIONING
Introduced by Russian Physiologist Pavlov.
In his experiments with dogs, during which he hoped to
learn more about the digestive process.
In his trials he found that , as expected that the dog
salivated when they began to eat the food that was
offered to them.
This was the reflective response that Pavlov called as
Unconditioned response.
However he also noticed that with time, the dogs began
to salivate when the food came to the range of view,
before it was even presented to them for consumption.
Concluding that this response was not reflexive
but had been learned. Pavlov called it a conditioned
response.
4. He carried the experiments even further by introducing
unrelated stimulus, one that had no previous connection to
the animal food. The animal responded with the expected
reflexive salivation to the food.
After a number of trials with the combined stimuli (food &
bell), Pavlov found that the reflexive salivation began to
occur when the dog was presented with the sound of the bell
in the absence of food.
This was an important discovery in terms of how learning
can occur. Pavlov found that unconditioned responses
(salivation) occur in response to unconditioned stimuli
(eating food). He also found that, overtime, an unrelated
stimulus (sound of the bell) introduced with the
unconditioned stimulus could elicit the same response
alone i.e conditioned response
5.
6. OPERANT CONDITIONING
It is the use of consequences to modify the occurrence and
form of behaviour.
Operant conditioning is distinguished from classical
conditioning in that operant conditioning deals with the
modification of "voluntary behaviour" or operant
behaviour.
Operant behaviour "operates" on the environment and is
maintained by its consequences, while classical
conditioning deals with the conditioning of respondent
behaviours which are elicited by antecedent conditions.
Behaviours conditioned via a classical conditioning
procedure are not maintained by consequences.
7. Operant conditioning (sometimes referred to as
instrumental conditioning) is a method of learning
that occurs through rewards and punishments for
behaviour. Through operant conditioning, an
association is made between behaviour and a
consequence for that behaviour.
Operant conditioning was coined by behaviourist B.F.
Skinner, which is why you may occasionally hear it
referred to as Skinnerian conditioning. As a
behaviourist, Skinner believed that internal thoughts
and motivations could not be used to explain
behaviour. Instead, he suggested, we should look only
at the external, observable causes of human
behaviour.
8. Skinner used the term operant to refer to any
"active behaviour that operates upon the
environment to generate consequences" (1953). In
other words, Skinner's theory explained how we
acquire the range of learned behaviours’ we exhibit
each and every day.
13. BEHAVIOURAL THERAPY
It is a form of treatment for problems in
which a trained person deliberately
establishes professional relationship with
the client , with the objective of removing
or modifying existing symptoms &
promoting positive personality, growth &
development.
14. Major Assumptions of Behavior
Therapy
Based on the above-mentioned theories, 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 receives exposure to
specific stimuli and reinforcement for the desired
adaptive behavior.
Behavioral assessment is focused more on the current
behavior rather than on historical antecedents.
16. It was developed by Joseph Wolpe, based on the
behavioral principle of counter conditioning. In this
patients 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.
1. SYSTEMIC DESENSITIZATION
17. 1
• RELAXATION TRAINING
2
• HIERARCHY CONSTRUCTION
3
• DESENSITIZATION OF THE
STIMULUS
It consists of three main steps:
18. Relaxation training:
There are many methods which can be used to induce
relaxation, some of them are:
• Jacobson's progressive muscle relaxation
• Hypnosis
• Meditation or yoga
• Mental imagery
• Biofeedback
19. Hierarchy 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.
20. Desensitization of the stimulus:
This can either be done in reality or through
imagination. At first, the lowest item in hierarchy is
confronted. The patient is advised to 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.
Indications:
Phobias
Obsessions Compulsions
Certain sexual disorders
21. 2. FLOODING
The patient is directly exposed to the phobic
stimulus, but escape is made impossible. By
prolonged contact with the phobic stimulus,
the therapist's guidance and encouragement
and his modeling behavior reduce anxiety
Sometimes called Implosive therapy, is also
used to desensitize individuals to phobic
stimuli.
Flooding is used to treat agoraphobia and
specific phobias
22. 3. AVERSION THERAPY
Pairing of pleasant stimulus with an unpleasant response,
so that even in the absence of unpleasant response the
pleasant stimulus becomes unpleasant by association.
Punishment is presented immediately after a specific
behavioral response and the response is eventually
inhibited.
Unpleasant response is produced by electric stimulus,
drugs, social disapproval or even fantasy.
Indications:
Alcohol abuse
Paraphilias
Homosexuality
Transvestism.
24. Positive reinforcement: When a behavioral response is
followed by a generally rewarding event such as food,
praise or gifts, it tends to be strengthened and occurs
more frequently than before the reward. This
technique is used to increase desired behavior.
2. Token economy: This program involves giving token
rewards for appropriate or desired target behaviors
performed by the patient. The token can later be
exchanged for other rewards. For example on inpatient
hospital wards, patients receive a reward for
performing a desired behavior, such as tokens which
they may use to purchase luxury items or certain
privileges.
26. Modeling:
Modeling is a method of teaching by demonstration,
wherein the therapist shows how a specific behavior is
to be performed. In modeling the patient observes
other patients 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.
27. Shaping:
In shaping the components of a particular skill, the
behavior is reinforced step by step. The therapist
starts shaping by reinforcing the existing behavior.
Once it is established he reinforces the responses
which are closest to the desired behavior, and
ignores the other responses.
For example, to establish eye-to-eye contact, the
therapist sits opposite the patient and reinforces him
even if he moves his upper body towards him. Once
this is established, he reinforces the person's head
movement in his direction and this procedure
continues till eye-to-eye contact is established.
28. Chaining:
Chaining is used when a person fails to perform a
complex task. The complex task is broken into a
number of small steps and each step is taught to the
patient. In forward chaining one starts with the first
step, 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. Backward chaining is found to be more
effective in training the mentally disabled.
29. 6. OPERANT CONDITIONING PROCEDURES FOR
DECREASING MALADAPTIVE BEHAVIOUR
EXTINCTION
PUNISHMENT
TIME OUT
RESTITUTION
RESPONSE
COST
30. Extinction/Ignoring:
Extinction means removal of attention rewards
permanently, 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 etc, following the problem behavior.
This is commonly used when patient exhibits odd
behavior.
31. Punishment:
Aversive stimulus (punishment) is presented
contingent upon the undesirable response. The
punishment procedure should be administered
immediately and consistently following the
undesirable behavior with clear explanation.
Differential reinforcement of an adaptive or desirable
behavior should always be added when a punishment
is being used for decreasing an undesirable behavior.
Otherwise the problem behaviors tend to get
maintained because of the lack of adaptive behaviors
and skill defect
32. Timeout:
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 example, the child is not
allowed to go out of the ward to play if he fails to
complete the given work.
33. 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 example, if a
patient passes urine in the ward he would be required
to not only clean the dirty area but also mop the
entire/ larger area of the floor in the ward.
34. Response cost:
This procedure is used with individuals who are on
token programs for teaching adaptive behavior. When
undesirable behavior occurs, a fixed number of tokens
or points are deducted from what the individual has
already earned.
35. 7. CONTINGENCY CONTRACTING
•A contract is drawn up among all parties involved .The
behaviour change that is desired is stated explicitly in
writing.
•The contract specifies the behaviour change desired &
the reinforcers to be given for performing desired
behaviours.
•The negative consequences or punishers that will be
rendered for not fulfilling the terms of the contract are
also delineated.
•The contract is specific about how reinforcers & the
punishment will be presented.
36. 8. Assertiveness & Social skills
training:
Assertiveness training is a behaviour therapy
technique in which the patient is given training
to bring about change in the emotional & other
behavioural pattern by being assertive.
Social skills training helps to improve social
manners like encouraging eye contact,
speaking appropriately, observing simple
etiquette, & relating to people.
37. ROLE OF A NURSE
1. Providing direct patient care
2. Planning treatment programmes
3. Teaching others the use of
behavioural techniques
38. Application to nursing
• Nurses commonly use behavioural
techniques in a wide variety of mental
health settings.
• Additionally nurses who work with
clients having physical disability,
chronic pain, chemical dependency and
rehabilitation centres also apply these
techniques.
• she should provide direct care to the
patient and also teach others the use
of behavior technique and also
implement in her professional life.
