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Transcript
 Cognitive 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.
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:
Positive reinforcers are favorable events or
outcomes that are presented after the behavior. In
situations that reflect positive reinforcement, a
response or behavior is strengthened by the addition
of something, such as praise or a direct reward.
Negative reinforces involve the
removal of an unfavourable events or
outcomes after the display of a
behaviour. In these situations, a
response is strengthened by the
removal of something considered
unpleasant.
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:
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.
Negative punishment, also known as
punishment by removal, occurs when
an favourable event or outcome is
removed after a behaviour occurs.
In both of these cases of punishment,
the behaviour decreases.
Behavioural Therapy:
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 modifying
existing symptoms & promoting
positive personality, growth &
development.
Modifying Client’s behavior
(CHART)
Techniques for modifying
client’s behaviour
1. Systematic Desensitization
2. Flooding
3. Aversion Therapy
4. Operant conditioning
procedures for increasing adoptive
behaviour
5. Operant conditioning
procedures to teach new
behaviours
6.Operant conditioning
procedures for decreasing
maladoptive behaviour
7.Contingency contracting8.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
Relaxation training
Hierarchy construction
Desensitisation of Stimulus
2. FloodingSometimes 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.
•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
behavioural 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
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 EconomyA 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.
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
•In shaping the behaviour 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 .
•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.
Extinction•In behaviour modification, extinction eliminates the
incentive for unwanted behaviour 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
behaviour.
•Aversive stimulus is presented
contingent upon undesirable
response.
•The punishment procedure should
be administered immediately &
consistently following the
undesirable behaviour with clear
explanation
•It is an aversive stimulus or
punishment during which client is
removed from the environment where
the unacceptable behaviour is being
exhibited .
•The client is usually isolated so that
reinforcement from the attention of
others is absent.
This technique named for its originator states that a
frequently occurring response (R1)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.
•It means restoring the disturbed situation to a state that is
much better than what it was before the occurrence of the
problem behaviour.
•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
•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 .
•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
•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
•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
•Psychiatric nurses provide direct patient care in both inpatient
& community settings, & the value of cognitive behavioural
therapy is evident throughout the continuum of the care. Most
treatments are ideally suited to community settings, & they can
include the interventions across the continuum of coping
responses- from promoting health , to intervening in acute
illness, to fostering rehabilitation
•Nurses may also function as planners & co-ordinators of
complex treatment programmes , consultants , & teachers of
other nurses , professionals, patients, & their families. It is clear
that with the current emphasis on cost- effective treatment &
documented outcomes of care , Behavioural therapy will be
growing area of expertise for all psychiatric nurses in next
decade
Behaviour therapy is a combination of the systematic
application of principles of learning theory to to the
analysis and treatment of behaviour. It involves more than
principles of learning and conditioning, however, and uses
the empirical findings of social and experimental
psychology. The emphasis is placed upon the observable
and confront able and not inferred mental states or
constructs. The doctors seeks to relate problematic
behaviours (symptoms) to other observable physiological
and environmental events. This involves behavioural
analysis of what is occurring (and has occurred) and means
of altering the behaviour.
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Stuart GW, Laraia MT. Principles and practice of psychiatric nursing. 8th ed. Missouri:
Mosby; 2008
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Encyclopaedia of Mental disorders. Covert-sensitization [Online].[2001?].[cited 2009 Sept
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Encyclopaedia of Mental disorders. Token-economy system [Online].[2001?].[cited 2009
Sept 10]; Available from:URL:http://www.minddisorders.com/Py-Z/Token-economysystem.html#ixzz0QfQ9vQUP
Encyclopaedia of Mental disorders. Behaviour modification [Online].[2001?].[cited 2009
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