1) Applied behavior analysis (ABA) is a scientific approach for modifying behaviors that uses principles of learning theory. ABA breaks tasks into small steps and uses techniques like positive reinforcement to teach skills. 2) ABA is used to help people with intellectual or developmental disabilities by systematically introducing skills in small steps and rewarding correct responses while ignoring incorrect ones. 3) Cognitive behavioral therapy (CBT) techniques can also help patients adjust to chronic illness by addressing thoughts, monitoring triggers, and changing distressing beliefs. Supportive psychotherapy provides comfort and helps patients cope.

1. APPLICATION OF
BEHAVIOURAL PRINCIPLES
IN HEALTH AND DISEASE
DPT LNH
DR HARIM

2. Objectives
 Mentally /emotionally handicapped
 Physically handicapped
 Chronically ill
 Homebound
 Medically compromised.

3. What Is Applied Behavior Analysis?
 Applied Behavior Analysis is the science of human behavior. The best
definition available is still the one written about in 1968 by Baer, Wolf, &
Risley:
 “Applied Behavior Analysis is the process of systematically applying
interventions based upon the principles of learning theory to improve
socially significant behaviors to a meaningful degree, and to demonstrate
that the interventions employed are responsible for the improvement in
behavior“

4. ABA basics
Understanding (and modifying) behavior in the context of environment is the
basis for ABA therapies.
 "Behavior" refers to all kinds of actions and skills (not just misbehavior).
 "Environment" includes all sorts of physical and social events that might
change or be changed by one's behavior.

5. ABA therapy techniques
 ABA therapy includes many different techniques. All of these techniques
focus on
 Antecedents (what happens before a behavior occurs) and on
Consequences (what happens after the behavior).
 One technique is “positive reinforcement.” When a behavior is followed by
something that is valued (a reward), that behavior is more likely to be
repeated.

6. Basis of ABA
The ABA approach utilizes two, well-researched learning theories.
These are:
 1) classical conditioning and
 2) operant conditioning.
The ABA does not require great intellectual ability in order for learning to be
successful. Thus, ABA is ideally suited for people with intellectual disabilities.

7. Basis of ABA
 In its most basic form, ABA is very simple and common sense. It rewards a person for
making a correct choice. Incorrect choices are ignored, or not rewarded. Therefore,
students learn by making simple associations between cause and effect.
 With repetition, a student learns to associate a correct action with a reward. As such,
this correct choice will be repeated.
 An incorrect action does not earn a reward. When not rewarded, behaviors begin to
slowly fade away. This process is known as extinction.

8. ABA for mentally/emotionally
handicapped children.
Here is the basic approach for ABA:
First, complex tasks or behaviors are broken down into smaller steps. For
instance, suppose a student needs to learn to raise his hand before speaking
in a classroom. This might be broken down into five steps:
 1) Raise the hand.
 2) Raise the hand while remaining silent.
 3) Keep the hand raised, remaining silent, until the teacher acknowledges you.
 4) Once the teacher acknowledges you, put the hand down.
 5) After the hand is down, speak.

9. Basic approach for ABA
 Skills are systematically introduced in small steps. As one small skill is
mastered, the next step is introduced.
 Students learn by making simple associations between cause and effect. If
they respond correctly for that step, they are immediately rewarded. If
they respond incorrectly, nothing happens.
 Once a step is consistently mastered, the next step is rewarded, instead
of the previously mastered step. This process is known as chaining.

10. Basic approach for ABA
 As students become familiar with the instruction and reward process, a more
abstract "token" reward system can be introduced.
 Token reward systems use visual representations. Common examples are stickers
placed on a chart, or beads placed on a bracelet.
 These represent a student's progress towards an ultimate, concrete reward. For
example, once the child earns five stickers he can play a game or watch a program.
 The token reward system is a little more complex and abstract than immediate and
concrete rewards. However, it is very effective for increasing on-task behavior.
Furthermore, it teaches students to delay their gratification.

11. Basics of ABA
 Dangerous behaviors are considered "non-negotiable." These types of behavior may
require immediate negative consequences. For obvious reasons, dangerous behavior cannot
be ignored. Ignoring someone who is starting a fire is a bad idea! Dangerous behaviors
include any behaviors that threaten, or cause significant harm to anyone.
 Some examples are banging one's head against the wall, or biting other children.
 The other non-negotiable behaviors are ones that cause significant damage to property.
This might include setting fires or throwing computer equipment off a desk.
 Common consequences include time-outs, or loss of preferred play items and activities.
 In the case of self-harm, the least restrictive rule prevails. Physical restraints or protective
devices (such as a helmet) may be used.

12. Basics of ABA
 Patients with chronic conditions often have to adjust their aspirations,
lifestyle, and employment.
 Many grieve about their predicament before adjusting to it. But others
have protracted distress and may develop psychiatric disorders, most
commonly depression or anxiety.
 Chronic disease is associated with high levels of uncertainty. Patients need
to change their behavior as part of a new lifestyle of self-care. They also
have to endure debilitating and demanding treatments. These are some of
the factors that make adjustment to chronic medical illness psychologically
demanding.

13.  The differences in patient psychological responses can be understood by
examining patients' thoughts about their illness.
 This is a fundamental principle behind cognitive therapy—a focused,
structured, collaborative, and usually short-term psychological therapy that
aims to facilitate problem solving and to modify dysfunctional thinking and
behavior.
 CBT for psychological problems like depression and fatigue.
 An active self-management approach and the need for patients to establish
collaborative relationships with health care staff.
 The emphasis on building skills for the management of psychological
problems for helping with the management of physical illness too.

14. CBT approach
 A number of simple cognitive therapy techniques can be used by primary
care physicians to care for their patients with chronic diseases—
 Agenda setting,
 Self-monitoring,
 Experimentation, and
 Changing distressing thoughts.

15. Agenda Setting
 Setting an agenda is one method for maximizing the chance that a consultation will
make some progress toward solving a patient's problems. For example:
We have about 15 minutes today, and I want to make sure that we use the time we have to the
best effect. The best way I have found to do this is to set an agenda that highlights the main things
we want to talk about. Is there something that you particularly wanted to cover today?
 Agenda setting reflects the collaborative stance of cognitive therapy in that both
physician and patient can assign agenda items.

16. Self-monitoring
 Cognitive therapy usually involves a series of tasks (“homework”) that are completed
outside sessions and at various phases of therapy. During assessment, this often
involves self monitoring in the form of diary keeping.
 Examples of this might be recording mood fluctuations, discrete episodes of problem
behavior, or the thoughts and images associated with a negative mood state or any
medical issues such as side-effects of a drug, symptom severity etc.

17. Self-monitoring
 Inviting them to write a brief
account of their understanding of
a particular condition may reveal
inaccurate beliefs that require
correction or thoughts that
mediate psychosocial difficulties
(or both).It could help in the
discussion about improving the
self-management of a patient's
disease, or it might identify the
need for information and support.

18. Experimentation
 Indeed, some homework tasks can be assigned primarily as a therapeutic intervention.
 If you suspect that a patient's symptoms are being triggered by a certain event, you could
ask that patient to keep a symptom diary to note any triggers.
 You say to the patient that the monitoring is “an experiment.” This can be of particular
benefit when you have differing views from your patient as to the precise trigger behind
certain symptoms.
 I have been wondering if there is a link between the times that you take your medication and
when you are feeling anxious. I know you don't think that there is a strong link (patient agrees). I
may be wrong. It could be that there is no link at all. Or perhaps there is a link only some of the
time. Will you consider keeping a diary to look at this in more detail? Can you note down the
times that you take your medication and at the same time keep a rating of your anxiety? This
way, we can check out which of our views is more accurate.

19. Changing distressing thoughts
 Cognitive therapy usually involves the modification of thoughts and
behaviors that seem to be contributing to a patient's symptoms. Clearly,
the application of a simple strategy cannot change a major psychological
disorder. However, the application of simple techniques based on
cognitive therapy may alleviate some distress.

20. Supportive psychotherapy
 Supportive psychotherapy is the attempt by a therapist bv any practical
means whatever to help patients deal with their emotional distress and
problems in living. It includes comforting, advising, encouraging,
reassuring, and mostly listening, attentively and sympathetically.
 The therapist provides an emotional outlet, the chance for patients to
express themselves and be themselves. Also the therapist may inform
patients about their illness and about how to manage it and how to adjust
to it.

21. Supportive measures
 Every individual has special needs, more so in the physically or
mentally disabled.
 Assistive measure in which the nurse/staff facilitates activities of
daily
living (such as hygiene, exercise, rest, or grooming), provides phys
ialcomfort, and maintains a therapeutic environment.
 Examples may be sign language interpretor, Wheel-chair, hearing
aids, etc.