BEHAVIOR THERAPY
Behavior therapy is a set of wide ranging procedures that
differ in how they are applied to individuals with various emotional, physical,
and psychological difficulties.
Classical conditioning
It is a process of learning that was introduced by Russian
Physiologist Pavlov.
In his experiments with dogs, during which he hoped to learn
more about the digestive process, he inadvertently discovered that organisms
can learn to respond in specific ways if they are conditioned to do so.
Operant conditioning
Components of Operant Conditioning:
Some key concepts in operant conditioning:
·
A reinforce is any event that strengthens or
increases the behavior it follows.
·
There are two kinds of reinforcers:
o
Positive reinforcers are favorable events or
outcomes that are presented after the behavior.
o
In situations that reflect positive
reinforcement, a response or behavior is strengthened by the addition of
something, such as praise or a direct reward.
o
Negative reinforces involve the removal of an
unfavourable events or outcomes after the display of a behaviour.
o
In these situations, a response is strengthened
by the removal of something considered unpleasant.
o
In both of these cases of reinforcement, the
behavior increases.
·
Punishment, on the other hand, is the
presentation of an adverse event or outcome that causes a decrease in the
behaviour it follows.
·
There are two kinds of punishment:
o
Positive punishment, sometimes referred to as
punishment by application, involves the presentation of an unfavourable event
or outcome in order to weaken the response it follows.
o
Negative punishment, also known as punishment by
removal, occurs when an favourable event or outcome is removed after a
behaviour occurs.
o
In both of these cases of punishment, the
behaviour decreases.
o
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
existing symptoms & promoting positive personality, growth &
development.
Techniques for modifying client's
behaviour
1. Systematic Desensitization
2. Flooding
3. Aversion Therapy
4. Operant conditioning procedures for increasing adaptive
behaviour
5. Operant conditioning procedures to teach new behaviours
6. Operant conditioning procedures for decreasing
maladaptive behaviour
7. Contingency contracting
8.Assertiveness & Social skills training
Systematic desensitization is a technique used to
treat phobias , OCD's, Certain sexual disorders and other extreme or erroneous
fears based on principles of behaviour modification .
It consists of three main steps
1.
Relaxation training
2.
Hierarchy construction
3.
Desensitization of Stimulus
Flooding
Sometimes called Implosive therapy , is also used to
desensitize individuals to phobic stimuli. Here the individual is flooded with
a continuous presentation of phobic stimulus until it no longer elicits
anxiety.
3.Aversion Therapy
·
Pairing of unpleasant stimulus with an
unpleasant response , so that even in the absence of unpleasant response the
pleasant stimulus become unpleasant by association .
·
Punishment is presented immediately after
specific behavioral response & the response is evenly inhibited.
·
Unpleasant is produced by electric stimulus ,
drugs, social disapproval or even fantasy.
·
Indications are Alcoholic abuse, paraphilias,
Homosexuality, Transvestism.
Overt sensitization- It is a type of aversion therapy
that produces unpleasant consequences for undesirable behaviour. For eg,-
Disulfiram (Ant abuse)
Covert sensitization -Covert sensitization is a form
of behaviour therapy in which an undesirable behaviour is paired with an
unpleasant image in order to eliminate that behaviour
4.Operant conditioning procedures for increasing adaptive
behaviour
Positive Reinforcement:
·
When a behavioural response is followed by
generally rewarding event such as food , praise or gifts, it tends to be
strengthened & occurs more frequently than before the reward.
·
This technique is use to increase desired
behaviour.
Token Economy-
·
A token economy is a form of behaviour
modification designed to increase desirable behaviour and decrease undesirable
behaviour with the use of tokens.
·
Individuals receive tokens immediately after
displaying desirable behaviour.
·
The tokens are collected and later exchanged for
a meaningful object or privilege.
5. Operant conditioning procedures to teach new
behaviours
1. Modelling-
·
Modelling refers to the learning of new
behaviours by imitating the behaviour in others.
·
Role models are the individuals who have
qualities or skills that a person admires & wishes to imitate.
·
Modelling occurs in various ways. Children
imitate the behaviour pattern of the patient, teacher, friends & others.
·
Adults & children alike model many of their
behaviours after individuals observed on television & in movies .
·
Unfortunately , modelling can result in
maladaptive behaviour , as well as adaptive
2. Shaping-
·
In shaping the behavior of others ,
reinforcements are given for increasingly closer approximations to the desired
response.
·
For e.g.- In eliciting speech from an autistic
child, the teacher may first reward the child for (a) Watching the teacher's
lips , then (b) for making my sound in imitation of the teacher , then (c) for
forming sounds similar to the word uttered by the teacher .
3.Chaining:
·
It is used when a person failed to perform a
complex task.
·
The complex task is broken it to number of small
steps & each step is taught to the patient .
·
In forward chaining- one start with the first
step & accomplishes the task. In
backward chaining starts with the last step & accomplishes.
6. Operant
conditioning procedures for decreasing maladaptive
Extinction-
·
In behavior modification, extinction eliminates
the incentive for unwanted behavior by withholding the expected response.
·
A widespread parenting technique based on
extinction is the time-out, in which a child is separated from the group when
he or she misbehaves.
·
This technique removes the expected reward of
parental attention. This is commonly used when patient exhibits odd behavior.
Punishment:
·
Aversive stimulus is presented contingent upon
undesirable response.
·
The punishment procedure should be administered
immediately & consistently following the undesirable behavior with clear
explanation
Time out
·
It is an aversive stimulus or punishment during
which client is removed from the environment where the unacceptable behavior
is being exhibited .
·
The client is usually isolated so that
reinforcement from the attention of others is absent.
Premark Principle
·
This technique named for its originator states
that a frequently occurring response (Rl)can serve as a positive response for
response (R2) that occurs less frequently (Premack, 1959). Those is
accomplished by allowing R1 to occur only after R2 has been performed.
·
For e.g.. 13 yr old Jennie has been neglecting
her homework for the past few weeks. She spends great deal of time on telephone
talking to her friends. Applying the Premack principle being allowed to talk on
the phone to her friends could serve as a positive reinforcement for completing
her home work.
Restitution (Over correction):
·
It means restoring the disturbed situation to a
state that is much better than what it was before the occurrence of the problem
behavior.
·
For e.g.- If the patient passes urine in the
ward he would be required to not only to clean the dirty area but also mop the
entire/ larger area of the floor in the ward
Response cost:
·
This procedure used with individuals who are on
token programs for teaching adaptive behaviour .
·
When undesirable behaviour occurs , a fixed
number of tokens or points deducted from which individual has already earned .
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,
·
However , flexibility is important so that
renegotiations can occur if necessary
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.
·
Client is encouraged not be afraid of showing an
appropriate response , negative or
positive, to an idea or suggestion.
·
Assertive behaviour training is given by the
therapist , first by role play & then by practice in a real life situation.
·
Attention is focussed on more effective
interpersonal skills
·
Social skills training helps to improve social
manners like encouraging eye contact, speaking appropriately , observing simple
etiquette, & relating to people
Role of a Nurse -
·
There are three basic roles for the nurse
involved in Behavioural therapy. Each of these roles can be performed by all
nurses at various levels of expertise -
·
Providing direct patient care
·
Planning treatment programmes
·
Teaching others the use of behavioural
techniques
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