This document discusses behavioral therapy (BT), which aims to change maladaptive behaviors through conditioning principles. BT utilizes techniques like systematic desensitization, flooding, aversion therapy, modeling, shaping, and operant conditioning to treat various conditions like phobias, depression, OCD, anxiety disorders, schizophrenia, and more. The nurse's role is to provide a calm environment, help the patient understand the therapy, encourage expression of feelings, record important information, and continue sessions until improvements are seen.

1. PROF (DR) RAMANDEEP KAUR

2. introduction
This therapy is applied to psychological treatments
based on experimental psychology and intended to
change symptoms and behaviour.
It refers to a particular group of procedures based on
operant conditioning.

3. DEFINITION
It is the systematic application of scientific principles of
learning and a form of psychotherapy, aims at
changing maladaptive behaviour by substituting it
with adaptive behaviour.

4. PURPOSES
 Permanent change in behavior occurs as a result of
practice or experience.
 Correction of the abnormal psycho-dynamics which
are contributing to the illness.
 Helpful even in those conditions which are refractory
to other forms of therapy.

5. PRINCIPLES
 General reliance on principles of learning,i.e. by
learning by doing,learning by trial and error,learning
by condioning.
 Close observation of behaviour
 Concentration on the symptoms as they are target for
therapy.
 A commitment to objective evaluation of efficacy.

6. INDICATIONS
 Panic
 Phobia
 Obsessive compulsion neurosis
 Genaralized compulsion neurosis
 Post traumatic stress
 Neuotic depression
 Bipolar disorder
 Major depression

7. CONTD……
 Shizophrenia
 Tics,maladaptive behaviour
 Obesity
 Anorexia nervosa
 Headache
 Hypertension
 Chronic pain
 Asthma
 Insomnia

8. CONTD…..
 Paraphilia
 Alcohlic dependence
 Conduct disorders
 Hyperkinesia
 Habit disorders
 Mental retardation
 Autism
 Dementia
 crimniality

10. SYSTEMATIC DESENSITIZATION
 This is used in Reciprocal Inhibition.
If a response incompatible with anxiety is made to
occur at the time an anxiety provoking stimules, then
anxiety is reduced by reciprocal inhibition. It involves
3 stages:

11. CONTD…..
 Training the patient to relax.
 Constructing with the patient a hierarchy of anxiety
arousing situation(stimuli).
The patient is asked to list all the conditions which
provoke anxiety. Then he is asked to list them in a
desending order of anxiety provation. Thus a hierarchy
of anxiety producing stimuli is produced.

12.  Patient is advised to give a 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 the hierarchy is climbed till
the maximum anxiety-provoking stimules can be faced
in absence of anxiety.
example: phobia, anxiety, neurotic patients.

13. CONTD…..

14. FLOODING
It is a therapeutic process in which the client must
imagine situations or participate in real-life situations
that he or she finds extremely frightening for a
prolonged period of time. Plenty of time must be
allowed for these sessions because brief periods may
be ineffective or harmful. A session is terminated
when the client responds with considerably less
anxiety than at the beginning of the session.

15. CONTD…..
It involves exposing patients to a phobic object or situation
in a non-graded manner with no attempt to reduce
anxiety.
It is usually given in non-graded manner or in reverse
hierarchy(starting from most phobic to least phobic).

16. CONTD…..
Example:
Obsessive compulsive neurosis
stammering

17. AVERSION THERAPY
(IMPULSION THERAPY)
It involves producing an unpleasant sensation in the
patient, usually by influencing pain in association with
a stimulus.
Pairing of pleasant stimulus with an unpleasant
response, so that even in absence of the unpleasant
response (after therapy is over)
the pleasant stimulus becomes unpleasant by
association.

18. CONTD….
The unpleasant aversion is produced by:
 Electric stimulus low voltage.
 Drugs (apomorphine disulfirm)
 Fantasy
Typically 20-40 sessions are given with each session
lasting about 1 hour. After completion
of sessions booster sessions may be given.

19. Modelling
The origin of new behaviours by the process of
imitation. In this form of treatment the patient
observes someone else (may be thetherapist) carrying
out an action which the patient currently finds
difficult to perform.

20. SHAPING
 The successive approximations to the required
behaviour with contingent positive behaviour.
example: rehabilitation of physically handicapped
children with neurotic behaviour, autism.

21. RESPONSE PREVENTION AND
RESTRAINT
Exposing patient to a contaminating object.
Example:
Obsessive compulsive neurosis.

22. CONTD….
Exposing the patient to a contaminated soil towel from
carrying out his usual cleaning ritual. Thought
stopping is sometimes used in the control of
obsessional thoughts

23. SELF CONTROL TECHNIQUE
 It divides into three types
 Self-monitoring:- Keeping the daily records of the
problem behaviour and the circumstances in which it
appears.
 Reinforcement:- Identifying stressor thought
stopping.
 Self-evaluation:- Making records of progress and it
helps to bring about change.

24. CONTINGENCY MANAGEMENT
If behavior persists, it is being reinforced by certain of
the consequences and if these consequences can be
altered, the behaviour should change.

25. TOKEN ECONOMY
 an operant conditioning procedure
that rewards desired behavior
 patient exchanges a token of some
sort, earned for exhibiting the
desired behavior, for various
privileges or treats

26. ASSERTIVENESS TRAINING
 It is designed to encourage direct but socially
acceptable expression of thoughts and feelings by
people who are shy.

27. CONTD….
example:
Chronic depression
Being ignored by a gossiping shop assistant, by a
combination of coaching, modelling .

28. NEGATIVE PRACTICE
 It will be used in the treatment of involuentary
movements.
 This sets up a state of inhibition which impairs or
prevents the appearance of the movements.

29. CONTD…..
Example
 Tics
 Stammering
 Thumb sucking
 Nail biting

30. RECIPROCAL INHIBITION
Enquire the stimulus or situations which provoke anxiety
in the patient and to rank these stimuli in order from
the most to the least disturbing. i.e. a hierarchy of
stimulus situation.
Then the patient is asked to visualize the least disturbing
stimulus when he is a state of relaxation produced by
hypothesis or I.V. anesthetic like methohexitone.

31. CONTD…..
Whenever marked disturbance occurs the therapist
withdraws the stimuli and calms the patient.
Each stimulus is visualized for 5-10 seconds and 2-4
items are presented in each session, each item
usually being presented one.
As soon as the patient is able to visualize the items
without disturbance the therapist moves on to the
next item in the next session.

32. CONTD……
 Example:
 Severe OCD
 Depression

33. OPERANT CONDITIONING
 It affects the environment and generates stimuli which
‘feedback’ to the organism.
 Example:
 Child mental illness
 Hysteria
 Stammering

34. PROCEDURES FOR INCREASING
THE BEHAVIOUR
 Positive reinforcement:-
The desirable behaviour is reinforced by a reward,
material or symbolic. Any response or behaviour which
is rewarding and increase the likelihood of further
response.
 Shaping(positive reinforcement):-
The patient is systimatically instructed to do what he
fears and is rewarded by the therapist with praises
when he succeeds and with no response if he fails.

35. CONTD……
 negative reinforcement:-
On performance of the desirable bahaviour, punishment
can be avoided.
 Modelling:-
The person is exposed to the ‘model’ behaviour and is
induced to copy it.

36. PROCEDURES USED FOR
DECEARING BEHAVIOUR
 Time out:-
The reinforcement is withdrawn for sometime, upon the
undesired behaviour.
 example:- therapy with children
The child is not allowed to go out of the ward to play,
when he fails to complete the given work.

37. CONTD….
 Punishment:-
stimulus is presented, upon the undesirable behaviour i.e.
whenever undesirable response occurs punishment is
given.
 satiation:-
The undesired response is positively reinforced,
So that tiring occurs. It is a negative practice procedure.

38. RELAXATION TRAINING
 Progressive relaxation to bring about reduction of
tonus in individual groups of skeletal muscles and to
regulate breathing.

39. ROLE OF NURSE
 Accept the client as he is.
 Assessment of psychosocial behaviour of client.
 Active listening of the client.
 Nurse assists the therapist to observe which technique
is suitable for client.
 Provides calm environment and proper seating
arrangement.

40. CONTD…….
 Help the patient to improve insight and reduce
negative symptoms.
 She should explain the whole session.
 Maintain good IPR with client.
 She should encourage to ventilate feelings and painful
experiences.
 She can give suggestions to patient.

41. CONTD……
 Nurse records the essential information.
 During interaction she should analyze the problem.
 Continue the session until there is satisfactory
improvement in the clients situation.