techniques of behavioural therapy

1. Behavioural Therapy Techniques
BY
B.SHALINI
M.SC(N)I YR
DEP.psychiatric nursing

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

3. 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

4. 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.

5. • Suitable for
– Anxiety disorder
– Phobic anxiety disorder
– Obsessive compulsive disorder
– Certain sexual disorder

7. 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.

9. 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.

11. 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.

12. 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.

14. 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.

16. 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)

17. 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

19. • Aversion therapy is suitable for
– Alcohol abuse
– Paraphilias
– Impulsive and obsessive behaviour

20. 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

22. 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.

24. • R1- Frequently occurring response
• R2- Less frequently occurring response
• Allowing R1to occur only afterR1
• R1 – Telephone talking with friends
• R2- Completing homework
• Completion of homework may get incentive of
telephone talking

25. Extinction
• "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

27. 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.

29. 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.

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

35. 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.

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

37. 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.

38. 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.

39. • 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

40. • 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