BEHAVIORAL THERAPY

PRINCIPLES OF BEHAVIORAL THERAPY:

1. Faculty learning can result in psychiatric disorders.

2. Behavior is modified through the application of principles of learning.
3. Maladaptive behavior is considered to be excessive or deficient, thus behavior therapy
seeks to promote appropriate behavior and eliminates inappropriate behavior.
4. One’s social environment is a source of stimuli that support symptoms, therefore it can
also support changes in behavior through appropriate treatment measures.

BEHAVIORAL ASSESSMENT:

The behavioral therapist assess the patients actions, thoughts, and feelings in a particular
situations. Assessment includes-collecting information.

 Identifying problem from the data

 Defining problem behavior
 Review of patients strengths etc.
 The nurse should assess the frequency, intensity, and duration of the problem. She should
use behavioral analysis model to assess the patients problems. It consists of three parts.
(ABC of behavior)

1. Antecedent: The stimulus or we that occurs before the behavior and lands to its
occurrence. It includes physical environment social environment or the persons feelings,
behavior or thoughts. It is emotional/feeling response.
2. Behavior: refers to outward manifestations and actions. That is what a person does or
does not say or do. E. g. avoiding stores, restaurants, and public places.
3. Consequence: thoughts about the situation that is what type of effect (positive, negative,
or natural) the person thinks from the behavior.

E. g. restriction of child activities.

Treatment strategies:

Behavior therapy is the most heavily researched form of psychotherapy and has proven
effectiveness in the treatment of wide variety of clinical problems related to children,
adolescence, adults, elderly and families.
Behavioral treatments includes techniques aimed at the following:

Increasing activity
Reducing unwanted behavior
Increasing pleasure
Enhancing social skills

Behavior techniques includes:

Behavioral modification
Systemic desensitization
Aversion therapy
Assertiveness training
Flooding / implosive therapy
Social skill therapy
Role playing
Token economy

1. Relaxation techniques:

As a therapeutic tool, relaxation training effectively decrease tension, is related to

anxiety. If tense muscles can be made to relax, anxiety will be reduced.

 The relaxation training involves rhythmic breathing, reduced muscle tension, and an
altered state of consciousness.
 Systemic relaxation training involves tensing and relaxing voluntary muscles in an
orderly sequence until the body, as a whole is relaxed.

2. Meditation:

Meditation may be used to evoke the relaxation procedure. The fourth component refers to
visualization-the process in which the patient selects a cue word or scene with pleasant
connotations. The nurse then instructs the patient to close both eyes, relax each of the major
muscle groups, and begin repeating the word silently at each exhalation. Meditation promotes
relaxation, enhance sleep, reduce pain and increases creativity.

3. Systemic desensitization:

Systemic desensitization was designed to decrease the avoidance behavior linked to a specific
stimulus (E.g. heights, dogs airplane travel etc.) The goal of systemic desensitization is to help
the patient change his/her response to a threatening stimulus. This approach of behavior
 therapy eliminates a patients fears or anxieties by stressing relaxation techniques that inhibit
anxious responses.

For e. g: A postman is intensively afraid of dogs because he was bitten by once. He is taught
relaxation techniques and then is asked to visualize a dog several yards away. He is instructed
to imagine himself walking toward the dog and whenever he becomes anxious he is instructed
to divert his attention by using a relaxation technique. This imagined role playing situation
continues until the man no longer experiences anxiety. The next step would be to approach a
live dog slowly which using relaxation techniques to decrease anxiety.

4. Flooding:

Flooding involves exposing patient to phobic object/situation immediately instead of

being exposed gradually or systematically to a hierarchy of feared stimuli. For E.g. Agora phobia
clients (fear of crowded place)

5. Modeling:

Modeling is strategy used to form new behavior patterns, increase existing skills, or
reduce avoidance behavior. In modeling, patients learn a new behavior by imitation, primarily by
observation, without having to perform, the behavior until they fed ready. Just as irrational fears
may be acquired by learning. they can be unlearned by observing a fearless model comfort the
feared object. The patient observes a person modeling the behavior in a controlled environment.
The patient thus imitates the model’s behavior.

Modeling is often used for the treatment of phobia and obsessive compulsive disorders.

6. Shaping:

Shaping includes new behaviors by reinforcing behaviors that approximate desired behavior.
Each successive behavior is reinforced by praising the patient, whenever he takes a step in
hierarchy. Skillful use of technique requires that the nurse carefully look, wait and reinforce. The
nurse needs to look for the desired behavior, wait until it occurs, and then reinforce it when it
does occur. Shaping is useful for children with neurotic behavior, autism, aggressive and in
rehabilitation of mentally retarded and physically handicapped.

7. Token economy:

A token economy is a form of positive reinforcement used most often on a group basis with
children or psychiatric hospital in-patients. It consists of rewarding the patient in various ways
(e. g. Tokens, passed or points) for performing desired target behaviors. These target behaviors
might include performing hygiene, grooming, attending classes, or verbally expressing
prostration rather than striking out at other. Tokens may also be cashed in periodically for
rewards such as free time, off unit outings, games, or chocolates.

8. Social skills training:

Social skill training is based on the belief that skills are learned and therefore can be taught to
those who do not have them. The principles of skill acquisition

Include the following.

 Guidance
 Demonstration
 Practice
 Feed back

Social skill training involves four stages,

- Describing the new behavior to be learned.

- Learning the new behavior through the use of guidance and demonstration.
- Practicing the new behavior with feedback.
- Transferring the new behavior to the natural environment.

The types of behavior that are often taught in these programmes include asking questions, giving
compliments, maintaining eye contact, speaking in a clear tone of voice, and avoiding self
criticism.

9. Role playing:

Role playing allows patients to rehearse problematic issues and obtain feedback about their
behavior. It can provide practice for decision making and exploring consequences. A related
practice is role reversal, in which the patient switches role with someone else and thus
experiences the difficult situation from another point of view.

10. Aversion therapy:

Aversion therapy helps to reduce unwanted but persistent maladaptive behaviors. It uses
unpleasant or noxious stimuli to change inappropriate behavior.

The stimulus may be chemical such as ant abuse used to treat alcoholics, electrical, such as the
using of a pad and buzzer apparatus to treat a child who has urinary problems, visual, such as the
films of an auto accident shown to drivers who are arrested for speeding/driving under the
influence of alcohol or drugs.
Aversion therapy has been used in the treatment of alcoholism, or criminal social behavior.

11. Assertiveness Training:

It is behavior therapy techniques in which the patients are taught how to relate appropriately to
others using frank, honest and direct expressions whether these are positive or negative in nature.
In other words, one is encouraged not to be afraid of showing an appropriate response, negative
or positive to an Idea or situation. Many people are unable to say how they feel and hold back
their feelings others may show inconsiderable aggression and disrespect for the rights of others.

Assertive training teaches one to ask for what is wanted, take a position on various issues, and
take action to obtain what one wants while respecting the right of others.

The assertive training is given by the therapist first by role beneficial to mentally ill as well as
mentally healthy persons.

Summary:

Behavior Therapy is aimed at helping people to overcome difficulties in any area of human
experience. A variety of Behavioral treatment strategies may be used alone or combination. They
focus on anxiety reduction, cognitive reconstructing, and learning new behavior.

Bibliography:

1. Stuart and Laraia, “principles and practice of nursing” 7th edition. Pub: Mosby. 2001 .
pp:- 658-671.
2. Louise Rebraca Shives, “Basic concepts of psychiatric-mental health nursing”2 nd edition .
pub:ISBN. P.p:-87-89.
3. Keplan and Sodck’s, “Synopsis of psychiatry” 8th edition. Pub: willims and wilkins 2001.
Pp: 911-915.
4. M.S Bhatia,essentials of psychiatry 3rd edition pp: 32.1-32.13.