This document discusses behavioral therapy techniques. It begins by introducing some of the founders of behavioral theory including Pavlov, Watson, and Skinner. The basic assumptions of behavioral therapy are that behavior is learned from the environment and can be unlearned. Techniques discussed include systematic desensitization, flooding, aversion therapy, positive reinforcement using a token economy, modeling, shaping, chaining, time out, and assertiveness training. The role of nurses is to apply behavioral principles like positive reinforcement and relaxation techniques.

1. PREPARED BY
Mrs. Divya Pancholi
M.Sc. (Psychiatric Nursing)
Assistant Professor
SSRCN, Vapi

2. INTRODUCTION
 It is derived from ‘learning theories’ focused
on client’s actions, not on thoughts and
feelings.
Behavioral approach is used frequently to
control the undesirable behavior.
Prominent therapists of behavioral
theory/model/therapy include Joseph Wolpe,
BF Skinner, Ivan Pavlov and John Watson

3. BASIC ASSUMPTIONS:
Behavior is a response to stimuli from the environment.
Either adaptive or maladaptive behavior is learnt.
Change in behavior leads to a change in the cognitive and
affective spheres.
Therapist will emphasize on quantitative aspect of observable
behavior.
Deviations from the norm are habitual responses that can be
modified through application of learning theory.

4. CONTI…
Positive response is reinforced. The response is strengthened by
repetition of the learning sequence. Reinforcement is essential to
get the response. Positive reinforcement is a reward for selected
behavior.
Human beings are passive organisms that can be shaped or
conditioned to do anything. If correct responses are rewarded or
reinforced.
Maladaptive behavior can be unlearnt and replaced with adaptive
behavior, if the person receives appropriate stimuli to eliminate the
maladaptive learning.

5. TECHNIQUES OF
BEHAVIORAL THERAPY

6. 1. SYSTEMIC DESENSITIZATION
•Based on ‘Reciprocal Inhibition Behavioral
Principle’ of counter conditioning.
•In this the clients will attain a state of complete
relaxation and are then exposed to the stimulus that
elicits the anxiety response.
INDICATION
•Phobia
•OCD
•Sexual disorder

7. CONTI…
1. Relaxation training
2. Hierarchy construction
3. Desensitization to stimulus

8. 1. Relaxation training will be given, e.g.
mediation, hypnosis, mental imagery, bio-
feedback, Jacobson progressive relaxation.
2. Ask the client to construct a hierarchy of
anxiety provoking situation in descending order of
anxiety provocation.
3. Desensitization of the stimuli: patient is asked
to give a signal whenever anxiety is produced
with each signal; he is asked to relax, after a few
trials, client is able to control his anxiety
gradually.

9. 2. FLOODING
•Prolonged contact with the anxiety will
make the client to face the frustration and
anxiety situation without much difficulty.
INDICATION
•Specific Phobia

10. 3. AVERSION THERAPY
Pairing of pleasant stimuli with an unpleasant response so
that even in the absence of unpleasant response, the
pleasant stimuli becomes unpleasant because of
association.

11. INDICATION
•Alcohol abuse
•Paraphilias
•Homosexuality
•Transvestism.

12. 4. OPERANT CONDITIONING
PROCEDURES FOR INCREASING
ADAPTIVE BEHAVIOR
•Positive reinforcement
•Token economy

13. POSITIVE REINFORCEMENT:
•To reinforce or improve the performance of the
desirable behavior repeatedly a token.
•Reward material or symbolic appreciation will be
given whenever the client performs an
acceptable behavior,

14. TOKEN ECONOMY:
•It is a positive reinforcement
programme to encourage
socially acceptable or
desirable behavior among
client;
•A small token will be given as
an exchange for privileges.
•Indications- chronic
hospitalized patients, children
up to adolescent age.

15. 5. OPERANT CONDITIONING
PROCEDURES TO TEACH NEW
BEHAVIOR
•Modeling
•Shaping
•Chaining

16. MODELING:
• Acquiring new desirable behavior through
imitation or by demonstration;
• The client will be given an opportunity to
observe ‘model behavior’ either from
therapist or psychiatric team members or
through other patients.
• The team members will exhibit a specific
desirable behavior which will be observed by
the client and the he will be given an
opportunity to perform target behavior in
desirable manner, if he does so, reward or an
appreciation will be given to encourage the
client to perform those act repeatedly
whenever is required.

17. SHAPING:
• A procedure that teaches a complex behavior by reinforcing small steps
towards completion of the behavior
• the therapist tries to shape the desired behavioral skill step by step.
• He positively reinforces the existing behavior and the responses which are
closest for the desired behavior and ignores the other responses.
• Therapist will praise the client for his desired behavioral performance and if he
fails no response will be given.
• Indication: Neurosis, Phobias, Physically handicapped, Autism, Obsession.
E.g.

18. CHAINING:
• Training will be given to learn complex tasks in break up
manner, step by step:
Forward chaining:
• The therapist will identify the difficulty of the client in
performing complex tasks. He will give training to the client to
learn first step, after client achieves it, the second step and the
third until client achieves the task.
Backward chaining:
• In backward direction, step by step the client will be assisted to
learn desirable tasks from last step to next step likewise, E.g For
mentally disabled this training is adapted.

19. 6. OPERANT CONDITIONING
PROCEDURES FOR DECREASING
MALADAPTIVE BEHAVIOR
•Time out
•Response cost
•Punishment
•Ignoring/extinction
•Restitution/over-correction

20. TIME OUT:
•If the client performs undesirable acts
or exhibits undesirable behavior.
•He will not be encouraged to perform
the similar act and will be given
negative reinforcement by some sort
of punishment,
•e.g. if the child exhibits odd behavior,
he is not allowed to play until he
changes the behavior and adapts
healthy, desirable behavior,
punishment can be avoided if the
caretaker is satisfied with the
behavior.

21. RESPONSE COST:
•To teach adaptive
behavior among the
client token programs
were activated.
•If those clients exhibit
undesirable behavior, a
fixed number of tokens
or pints deducted from
what the individual has
got already.

22. PUNISHMENT:
• Whenever undesirable
behavior exhibits, it has to be
avoided by administering
some sort of punishment
with proper explanation;
• it will be used to decrease
the undesirable behavior
/maladaptive behavior.

23. IGNORING/EXTINCTION:
•Whenever the
problematic behavior
exists rewards or
attention can be
removed,
•e.g. not to have eye to eye
contact or physical contact
or moving away, not
showing interest to talk or
mingle with them.

24. RESTITUTION/OVER
CORRECTION:
•If the client exhibits undesired or problematic
behavior, it will be corrected by wide range of
punishment,
•e.g. if the child passes stools within the dress after
toilet training, to avoid the repetition of the
undesirable behavior, mother will ask the child to
wash his clothes by himself.

25. Examples of Restitution/Over correction:

26. 7. ASSERTIVENESS TRAINING
In 1949, Salter and in 1958, Wolpe have described assertiveness
training.
Aims:
 Alleviates interpersonally based anxiety.
 Improves interpersonal relationship, self-esteem, self-control
 Improves the ability to stand up for one’s own rights
 Clients are assisted to identify the usual mode of behavior
 Brings change in emotion and other behavior pattern.


27. Technique:
• The therapist will give assertive behavior training by role playing,
coaching, modeling and role reversal technique and the by practicing it in
real life situations.
• This training will help the client not to infringe on the rights of others and
helps to ascertain the ability to stand for their rights, ignores passive
behavior, inculcates the client for usual mode of behavior.
• Through assertiveness training, the client will learn social skills and
improves interpersonal relationships, social behavior and social
contacts. For example, eye-to-eye contact while speaking, appropriate
behavior, etiquette behavior, interaction pattern, etc
• Indications: Chronic depression, Socially anxious person, Shy tendency

28. ROLE OF THE NURSE IN
BEHAVIORAL THERAPY
• Nurses have to keep in mind, the principles of learning while
administering behavioral therapy for the clients.
• Uses behavioral approaches like positive reinforcement, relaxation
techniques.
• Involves the client and significant people in provision of care
• Positive responses will be reinforced.