3. Introduction
Psychotherapy is defined as a treatment for problems
of an emotional nature in which a trained person
deliberately establishes a professional relationship with
the patient to remove, modified or retarded existing
symptoms, disturbed pattern of behavior and promote
positive personality growth and development.
4. Definition
According to Lego S. defines psychotherapy – “A
method of treatment based on the development of
therapeutic relationship between client and
therapist for the purpose of exploring and
modifying the patient’s behavior in a satisfying
direction.”
5. Aims
Psychotherapy aims to improve an
individual’s well-being and mental health, to
resolve or mitigate troublesome behaviors,
beliefs, compulsions, thoughts, or emotions
and to improve relationships and social skills.
6. Objectives
• To establish therapeutic relationship between the patient and
therapist.
• To modify, remove or reduce the factors causing a disturbed behavior.
• To help the patient to grow and develop coping mechanism to face
the problem in future and improve in social functioning.
• To improve family relationship with spouse and other family
members.
• To improve emotions, behavior and try to be safe and well-being.
• To help to improve behavior, self-esteem and mood.
7. Goals
• Changing maladaptive behavior
• Modifying environment causing maladaptive behavior
• Improve IPR skills
• Helping the patient to overcome a feeling of handicap.
• Helping him to make an accurate assessment of himself and develop
self- identity.
13. Contraindication
• Psychotic patient with severe behavior disturbance
like excitement
• Organic psychosis, hysteria, and personality disorder
(malingering)
• Patient who are unmotivated and unwilling to accept
it.
15. Introduction
Emphasized the overriding importance of the
environmental events, rejecting covert aspects of
the individual. He claimed that all behavior could
be understood as a result of learning. (Nature vs.
Nurture)
16. HISTORY
• B.F. Skinner (1904 – 1958)
• Skinner developed the theory of operant reinforcement theory which
is the notion that how often a behaviour is executed depends on the
events that follow the behaviour (Seligman,2006). For example, if the
behaviour is reinforced, the behaviour is more likely to be repeated.
• He emphasized observable behaviour and rejected the notion of
“inner causes” for behavior.
17. • Albert Bandura (1925)
• Bandura applied the principles of classical and operant conditioning
to social learning. Basically, people learn behaviours through
observation of other’s behaviour, also known as modelling (Seligman,
2006).
18. Current Focus
•The traditional behavioural approach is no
longer used as it once was. It has moved towards
a more collaborative treatment with cognitive
therapy and as such this has meant a more
applicable approach (Seligman, 2006).
19. Definition
•Behavior therapy (behavior modification) is an
approach to psychotherapy based on learning
theory which aims to treat psychopathology
through techniques designed to reinforce desired
and eliminate undesired behaviors.
21. Common elements of behavioral approaches
• An emphasis on the present rather than on the past
• Attention to changing specific dysfunctional behaviors
• Reliance on research as an integral partner for developing and testing
interventions
• Principles of learning can account for the development and treatment
of maladaptive behaviors.
• A preference for carefully measuring treatment outcomes
22.
23. Goals of behavioral therapy
• To create new conditioning of learning
• Client and therapist work collaboratively to specific
treatment goals
• Goals must be specific and measurable
• It is fundamental to behavior therapy that the client should
have the major say in setting treatment goals, it is important
that the client is fully informed, and consents to and
participates in setting goals.
24. Goals
• Provide a direction to counseling
• Provide a basis for selecting and using
• strategies & interventions.
• Provide a framework for evaluating the outcome
26. Process of behavioral therapy
• Counselor explains the purpose of goals.
• Client specifies the positive changes desired as a result of counseling.
• Together they explore whether the goals are realistic.
• They discuss advantages and disadvantages of the goals.
• On the basis of the information obtained about client-stated goals,
the counselor and the client make one of the following decisions: to
continue counseling, to reconsider the client’s goals, or the seek a
referral
27. Scientific basis
• Scientific basis
• Behavior therapy is based upon the principles of
• Classical conditioning developed by Pavlov
• Operant conditioning developed by B. F skinner
28. CLASSICAL CONDITIONING
Classical conditioning is a type of learning when an unconditioned
stimulus (UCS) such as food produces an unconditioned response (UCR)
such as salivation. If a neutral stimulus such as a bell is then paired with
the UCS to get the UCR and this is repeated, the neutral stimulus will
create the response of salivation. The neutral stimulus is now the
conditioned stimulus (CS) and the response is a conditioned response
(CR).
31. Systematic desensitization
It is a technique to overcome their fear of a phobic
stimulus. It is “systematic’ in that there is a hierarchy of
anxiety- producing events through which the individual
progresses during therapy.it is based on reciprocal
inhibition principle.
32. The process of systematic desensitization is
applied to an example.
• Discuss riding an elevator with therapist.
• Look at the picture of an elevator.
• Work into the lobby of a building and see the elevators.
• Push the button for the elevator.
• Walk into an elevator with a trusted person, disembark before the
doors close.
33. • Walk into the elevator with a trusted person, allow doors to close,
then open the doors and walk out.
• Ride one floor with a trusted person and then walk back down the
stairs.
• Ride one floor with a trusted person and ride the elevator back down.
• Ride the elevator alone.
35. Time out
It is an aversive stimulus or punishment during which the client is
removed from the environment where the unacceptable behavior is
being exhibited. The client is usually isolated so that the reinforcement
from the attention of others is absent.
36. Reciprocal inhibition
• It is also called counter conditioning reciprocal inhibition decreases or
eliminate a behavior by introducing a more adaptive but one that is
incompatible with the unacceptable behavior, e.g. relaxation exercise
are given to reduce anxiety.
37. Overt sensitization
• Overt sensitization is a type of aversion therapy that produces
unpleasant consequences for undesirable behavior.
e.g. disulfiram is drug that is given for individuals who wish to stop
drinking alcohol.
38. Covert sensitization
• It relies on the individual’s imagination to produce unpleasant
symptoms rather than on mediation.
• The technique is under the clients control and can be used whenever
and wherever it is required.
• The individual learns through mental imagery, to visualize nauseating
scenes and even to introduce a mild feeling of nausea.
39. Covert sensitization
• This mental image is visualized when the individual is about to
succumb to an attractive but undesirable behavior.
• The primary advantage of covert sensitization is that the individual
does not have to perform the undesired behaviors but imagines
them.
41. Introduction
Operant conditioning can be described as a process that attempts to
modify behavior through the use of positive and negative
reinforcement. Through operant conditioning, an individual makes an
association between a particular behavior and a consequence (Skinner,
1938).
42. Techniques of operant conditioning with examples
Reinforcement occurs when a response is strengthened by an
outcome. These are two type of reinforcement, negative and positive
reinforcement.
43. Positive Reinforcement
• Positive reinforcement strengthens a behavior by
providing a consequence an individual finds
rewarding. For example, if your teacher gives you Rs 5
each time you complete your homework (i.e., a
reward) you will be more likely to repeat this behavior
in the future, thus strengthening the behavior of
completing your homework.
44. PROCESS BEHAVIOUR CONSEQUENCE EFFECT ON
BEHAVIOUR
Positive Child behaves well Rewarded with a Tendency to behave
Reinforcement at shops chocolate well at the shops
Negative Stress Relaxation exercise Tendency to not get
Reinforcement as stressed
Positive Punishment Child misbehaves Given chores Tendency to not
Misbehave
Negative PunishmentFails to secure bike Bike is stolen Tendency to secure
personal property in
the future
45. Negative Reinforcement
The removal of an unpleasant reinforce can also strengthen behavior.
This is known as negative reinforcement because it is the removal of an
adverse stimulus which is ‘rewarding’ to the animal or person. Negative
reinforcement strengthens behavior because it stops or removes an
unpleasant experience.
46. For example,
• If you do not complete your homework, you give your
teacher Rs 5. You will complete your homework to
avoid paying Rs 5, thus strengthening the behavior of
completing your homework.
47. Punishment
•Punishment occurs when a response to
behavior decreases the likelihood of the
behavior reoccurring. There are also two
types of punishment, negative and positive
punishment.
48. Positive punishment occurs when an aversive response to behavior is
used and therefore the behavior is less likely to occur.
For example, a child is given chores when he or she has been naughty.
The child therefore, has been given a punishment to reduce the
likelihood of the bad behavior continuing.
49. Negative punishment occurs when something is taken away and
therefore decreases the likelihood of the behavior reoccurring.
For example, a person fails to secure a bike and this leads to the theft
of the bike. This therefore decreases the likelihood of the person
leaving property unsecured in the future.
50. Flooding
Flooding involves the client being exposed to the actual or
imagined fearful situation for a prolonged period of time.
The example of the client with the spider fear would be that
the client would be exposed to the spider or the thought of a
spider for a prolonged period of time and uses relaxation
techniques to cope.
51. Aversion Therapy -
The most controversial of the behavioral treatments and is used by
therapists as a last resort to an aversive behavioral .
This treatment involves pairing the aversive behavioral (such as
drinking alcohol) with a stimulus with an undesirable response (such as
a medication that induces vomiting when taken with alcohol).
52. Token economy
Token economy is a system in which targeted behaviors are reinforced
with tokens (secondary reinforcers) and later exchanged for rewards
(primary reinforcers).
Tokens can be in the form of fake money, buttons, poker chips, stickers,
etc. While the rewards can range anywhere from snacks to privileges or
activities.
For example, teachers use token economy at primary school by giving
young children stickers to reward good behavior.
53. Shaping
• In shaping the behavior of another, reinforcements are given for
increasingly closer approximately to the desired response. For
example, in eliciting speech from an autistic child, the teacher may
first reward the child for
(a) watching the teacher’s lip, then for
(b) making any sound in imitation of the teacher, then for
(c) forming sounds similar to the word uttered by the teacher. Shaping
has been shown to be an effective way of modifying behavior for task
that a child has not mastered on command.
54. Modeling
• It involves learning of new behavior by imitating the behavior in other
models are individuals who have qualities or skills that a person
admires and wishes to imitate children imitate the behavior patterns
of their parents, teachers and friends.
• In therapeutic community it can occur in a therapy session in which
the clients watch a model demonstrate appropriate behavior in a role
play of the clients problem.
• The client is instructed to imitate the models behavior in similar role
play and is positively reinforced for appropriate limitation.
55. SOCIAL LEARNING
• Social learning (or modeling) occurs when an individual (or animal)
responds a certain way due to having observed the behavior
previously.
• Social learning is an extension of classical and operant condition in
that an individual is conditioned indirectly by observing another’s
conditioning.
56. Social learning examples
For example, a child receives praise for setting the table. The younger
child’s own tendency to set the table for parents is reinforced as result
of the praise the older child receives.
57. Social learning
(i)Modeling : learning by observing others
• It serves two purpose: (a) person can learn new behavior
(b) behavior that is inhibited become less
(ii) vicarious learning :
• Observing other peoples behaviors being rewarded or punished leads
to reinforcement of those behaviors in an observer.
58.
59. Principles of behavioral therapy
• Although genetics play a role. Individual differences are derived
primarily from different experiences.
• Behavior is learned and acquired largely through modeling,
conditioning, and reinforcement.
• Behavior has a purpose.
• Behavior is the major determinant of habits, thoughts, emotions, and
other aspects of personality.
• Behavior therapy seeks to understand and change behavior.
60. Principles
• Therapy should be based on the scientific method and be systematic,
empirical, and experimental. Goals should be stated in behavioral,
specific, and measurable terms, with progress assessed regularly.
• The focus of treatment should generally be on the present. Even if
behaviors are longstanding, they are maintained by factors in the
current environment.
• However, behavior must be viewed in context, and some exploration
of the past is appropriate to provide that context and help people feel
understood.
61. Principles
• Education, promoting new learning and transfer of learning, is an
important aspect of behavior therapy.
• Strategies of behavior therapy need to be individualized to the
particular person and problem.
• Clients have primary responsibility for defining their goals and
completing homework tasks. The treatment plan is formulated
collaboratively, with both client and clinician participating actively in
that process.
62. AREAS OF APPLICATION
Behavioral therapy can be used to treat many psychological disorders
including anxiety disorders, sexual disorders, depression, interpersonal
and marital problems, chronic mental conditions, childhood disorders,
eating and weight disorders as well as prevention and treatment of
cardiovascular disease .
63. STRENGTHS WEAKNESSES
When using in therapy, it accomplishes Overdependence on animal research
what the theory predicts will happen
Treatment outcomes have been Denies the existence of free will and the
scientifically and empirically validated importance of cognitive processes
Emphasizes ethical accountability Treats symptoms rather than underlying
Wide variety of techniques that may be Does not provide insight (Corey, 2005).
utilized in therapy
Personality structure only focuses on
Stimulus-response associations. There is
no emphasis on underlying concepts
64. Role of nurse
• Nurses can implement behavior therapy techniques to help clients
modify maladaptive behavior patterns.
• Nursing process is a systematic method of directing care for clients
who acquire this type of assistance.
• As the role of the psychiatric nurse continue to expand, the
knowledge and skills associated with a variety of therapies will need
to be broadened.
• The psychiatric nurse is vital in making nursing process in context to
behavior therapy.
65. • The nursing process is the vehicle for delivery of nursing care with the
client requiring assistance with behavior modification.
• The clinical nurse specialist plays an essential role in the treatment of
patients with functional bowel disorders, a group of patients who are
traditionally difficult to manage medically or surgically.
• A nurse of the psychiatry department is the primary person
responsible for providing the requirements of the therapeutic
environment in clinics.
67. Journal of Behavior Therapy and Experimental Psychiatry
Upright posture improves affect and fatigue in people with depressive symptoms
• Background and objectives
Slumped posture is a diagnostic feature of depression. While research
shows upright posture improves self-esteem and mood in healthy
samples, little research has investigated this in depressed samples. This
study aimed to investigate whether changing posture could reduce
negative affect and fatigue in people with mild to moderate depression
undergoing a stressful task.
68. Methods
• Sixty-one community participants who screened positive for mild to
moderate depression were recruited into a study purportedly on the
effects of physiotherapy tape on cognitive function. They were
randomized to sit with usual posture or upright posture and
physiotherapy tape was applied. Participants completed the Trier
Social Stress Test speech task. Changes in affect and fatigue were
assessed. The words spoken by the participants during their speeches
were analysed.
69. Results
At baseline, all participants had significantly more slumped posture
than normative data. The postural manipulation significantly improved
posture and increased high arousal positive affect and fatigue
compared to usual posture. The upright group spoke significantly more
words than the usual posture group, used fewer first person singular
personal pronouns, but more sadness words. Upright shoulder angle
was associated with lower negative affect and lower anxiety across
both groups.
70. Limitations
The experiment was only brief and a non-clinical sample was used.
Conclusions
This preliminary study suggests that adopting an upright posture may
increase positive affect, reduce fatigue, and decrease self-focus in
people with mild-to-moderate depression.
Future research should investigate postural manipulations over a
longer time period and in samples with clinically diagnosed depression.
71. Summary
• In this chapter we have discussed about the psychotherapy,
behaviorism, history, adaptive and maladaptive behavior, classical
conditioning, operant conditioning, techniques and examples,
principles, treatment types and role of nurse in behavior therapy.
72. CONCLUSION
Overall, behavioral therapies are not generally used on their own in
treating psychological disorders however the techniques used in
behavioral therapies are applicable to treatment in a wide variety of
settings.
Behavioral therapies have contributed to greater understanding of the
learning processes and have also significantly influenced measurement
strategies for identifying psychological problems such as anxiety
disorders.
73. Bibliography
• Sadock, B.J., & Sadock, V.A .synopsis of psychiatry: behavioral science / clinical
psychiatry (10th edition), wolters Kluwer pg-423-424
• Mary C. Townsend, Psychiatric mental health nursing concepts of care in
evidence-based practice , Jaypee publication, pg-321-324
• I clement ,Textbook of Psychology ,jaypee publication pg 12-13
• Skinner, B.F The behavior of organisms. New York: macmillan.
• Manish gupta, a textbook of treatment modalities in psychiatric nursing, first
edition jaypee publication page no.83-93
• S.k mangal , advanced educational psychology, second edition eastern economy
edition, page no.192-201
• Raymond J. corsini, current psychotherapies , fourth edition, peacock publication,
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