BEHAVIOR THERAPY

Introduction
It is a form of treatment for problems in which a trained person deliberately establishes a professional relationship with the client, with the objective of removing or modifying existing symptoms and promoting positive personality, growth and development. Behaviour therapy involves identifying maladaptative behaviours and seeking to correct these by applying the principles of learning derived from the following theories. Classical conditioning model by Ivan Pavlov (1936) Operant conditioning model by BF Skinner (1953)

Major Assumptions of Behavior Therapy

Based on the above-mentioned theories, the following are the assumptions of behaviour therapy: All behavior is learned (adaptive and maladaptive) Human beings are passive organisms that can be conditioned or shaped to do anything if correct responses are rewarded or reinforced. Maladaptative behavior can be unlearned and replaced by adaptive behaviour if the person receives exposure to specific stimuli and reinforcement for the desired adaptive behaviour. Behavioral assessment is focused more on the current behaviour rather than on historical antecedents. Behavioural therapy is a short duration therapy, therapists are easy to train and it is cost-effective. The total duration of therapy is usually 6-8 weeks. Initial sessions are given daily but the later sessions are spaced out. Unlike psychoanalysis where the therapist is a shadow person, in are equal participants. There is no attempt to unearth an underlying conflict and the patient is not encouraged to explore his past.

A. CLASSICAL CONDITIONING
Ivan P. Pavlov(1849-1936); Pavlovian or respondent conditioning. The essential operation in classical conditioning(CC) is a pairing of two stimuli.

A neutral conditioned stimulus (CS) is a paired with an unconditioned stimulus (US) that evokes an unconditioned response (UR) . as aresult of this pairing, the previously neutral conditioned stimulus begins to call forth a response similar to that evoked by the unconditioned stimulus. This is what is learned in classical conditioning. After learning, when the conditioned stimulus produces the response, the response is called a conditioned response(CR).

Terms Used

Extinction. The weakening of a conditioned response occurs in CC when the CS is repeatedly presented without the US. After a response has been extinguished, it covers some of its strength spontaneous recovery. Stimulus Generalization. Tendency to give CR to stimulus which are similar in some way to the CS but which have never been paired with the3 passage of time. Discrimination. Process of learning to make one respond to one stimulus and another response or no response to another stimulus. It can be obtained in CC by pairing one CS with an US and never pairing another CS with an US. Classical Conditioning (CC). With respect to human behaviour, CC seems to play a large role in the formation of conditioned emotional response the conditioning of emotional states to previously neutral stimuli.

SEQUENCE OF CONDOTIONING OPERATIONS:

1. UCS
unconditioned stimulus (eating food)
2.

UCR
unconditioned response (salivation)

UCS

CR
conditioned response (salivation)

Conditioned stimulus (sight or food) 3. CS Conditioned stimulus (bell)

4.

NR
no response response unrelated to salivation

UCS+CS
Unconditioned + conditioned stimuli (food) (bell)

CR
conditioned stimuli ( salivation)

5.

CS
Conditioned stimulus (bell)

CR
conditioned response (salivation)

B. OPERANT CONDITIONING

(OC) (By B.F. Skinner, 1953).In OC, a reinforcer is any stimulus or event which when produced by a response, makes that response more likely to occur in future.
Terms Used
Shaping. Process of learning a complex response by first learning a number of similar response which are steps leading to complex response. Extinction. In OC, extinction of learned behavior a decrease in likelihood of occurrence of the behaviour is produced by omitting reinforcement following the behaviour. Discrimination.Develops in OC when differences in the reinforcement of a response accompany different stimuli. Continuous reinforcement. Reinforcement follows every occurrence of a particular response called Continuous reinforcement. Primary Reinforcer. In OC, it is one which is effective for an untrained organism; no special previous training is needed for it to be effective. Secondary Reinforcer.Is a learned reinforcer; stimuli become Secondary Reinforcer; stimuli which become paired with Primary Reinforcer. Negative Reinforcer. Are noxious or unpleasant , stimuli or events which terminate contingent up[on the appropriate response being made.

Classical Conditioning Versus Operant Conditioning

(CC Versus OC )
*.In OC reinforcement is contingent on what the learner does while in CC reinforcement is defined as the pairing of the conditioned and unconditioned stimuli and is not contingent on the occurrence of a particular response. *.The responses which are learned in CC are stereotyped, reflex likes ones which are elicitated by the unconditioned stimulus while in OC response is voluntary.
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*.In CC--- Consequences of behaviour are relatively unimported while in OC they are impottant.

C. COGNITIVE LEARNING
Cognitive Learning is learning in which without explicit reinforcement, there is a change in the way information is processed as a result of some experience a person or animal has had.

D. BIOFEEDBACK OR BEHAVIOURAL MEDICINE

Early 1980s refers to treatment of medical disorders rather than a theory of such disorders used in treatment of hypertension, tension headaches, post operative cases,methods to ensure intake of medicine.It provides points with information of the current state of physiological system that needs to be controlled to alleviate symptoms.

Principles

* Close observation of behaviour.

* Concentration on symptoms as thetarget for therapy. * An empirical approach to innovation. * A commitment to objective evaluation of efficacy.

Indications
Behaviour therapy is used for the relief of: * Any discrete anxiety linked behaviour. * Control of impulse disorders. * Phobias * Nocturnal Enuresis * Sexual Dysfunction * Tics * Anorexia Nervosa * Compulsions * Tension Headaches * Maladaptive habits * Drinking
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* Smoking

Contraindications
Those psychiatric disorders in which symptomatology is acute, pervasive or non circumscribed and in which triggering environmental events or external reinforcement are not obvious or capable of definition.

Techniques

Behaviour techniques
A. SYSTEMATIC DESENSITIZATION It was developed by Joseph Wolpe, based on the behavioural principle of counter conditioning. In this patients attain a state of complete relaxation and are then exposed to stimulus that elicit the anxiety response. The negative reaction of anxiety is inhibited by the relaxed state, a process called reciprocal inhibition. It consists of three main steps: 1. Relaxation training 2. Hierarchy construction
3. Desensitization of the stimulus

1. Relaxation training: There are many methods which can be used to induce relaxation, some of them are: Jacobsons progressive muscle relaxation Hypnosis Meditation or yoga Mental imagery Biofeedback

2. Hierarchy construction:

here the patient is asked to list all the conditions which provoke anxiety. Then he is asked to list them in a descending order of anxiety provocation. 3. Desensitization of the stimulus: this can either be done in reality or through imagination.At first, the lowest item in hierarchy is confronted. The patient is advised to 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.

Indication
Phobias Obsessions Compulsions Certain sexual disorder B. Flooding: The patient is directly exposed to the phobic stimulus, but escape is made encouragement and his modelling behaviour reduce anxiety. Indication: specific phobias C. Shapping: In shapping the components of a particular skill, the behaviour is reinforced step by step. The therapist starts shapping by reinforcing the existing behaviour. Once it is established he reinforces the responses which are closest to the desired behaviour and ignores the other responses D. Modelling : Modelling is a method of teaching by demonstration, wherein the therapist shows how a specific behaviour is to be performed. In modelling the patient observes other patients indulging in target behaviours and getting rewards for those behaviours. This will make the patient repeat the same behaviour and earn rewards in the same manner. E. Response prevention and restraint : when combined with flooding, it is the treatment
of choice in obsessive compulsive neurosis. The technique involves exposing the patient to a contaminating objects, such as soiled towel and subsequently preventing him from carrying out his ususal cleansing ritual. F. Aversion therapy: Pairing of the pleasant stimulus with an unpleasant response, so

that even in absence of the unpleasant response the pleasant stimulus becomes unpleasant by association. Punishment is presented immeadiately after a specific behavioural response and the response is eventually inhibited. Unpleasant response is produced by electric stimulus, drugs, social disapproval or even fantasy. Indication : Alcohol Paraphilias Homosexuality Transvestism
learn to control their own behaviour and feelings. It consists of two stages:

G. SELF-CONTROL TECNIQUES: All behavioural treatments encourage patients to

1. self monitoring: it refers to keeping daily records of the problem behaviour and the

circumstances in w hich it appears. Once the problem behaviour has been identified, self-reinforcement is tried e.g. the patient rewards himself in some way when he has controlled behaviour successfully. 2. Self-evaluation: it refers to making records of progress and this also helps to bring about change. H. Contingency management: this group of procedure is based on the principle that if
behaviour persists, it is being reinforced by certain of its consequences and if these consequences can be altered, the behaviour should change. Contingency management has four stages: The behaviour to be changed is defined and another person(e.g. a nurse in a case of a schizophrenic) is trained to record it. The events that immediatiely follow the behaviour are identified e.g. a nurse paying more attention to a schizophrenic patient when the shouts than when he is quiet. Alternative reinforcements are devised. e.g tokens that can be exchanged for privileges, signs of approval by other people. Staff or relatives must be trained to provide these reinforcements immediately after the desired behaviour and it withhold them at other times.

Token economy: This program involves giving token rewards for appropriate or desired target
behaviours performed by the patient. The token can later be exchanged for other rewards. For example on inpatient hospital wards, patients receive a reward for performing a desired behaviour, such as token which they may use to purchase luxury items or certain privileges K. Biofeedback : it is a special type of feedback that refers to information provided externally to a person about normally subthreshold bodily processes. TYPES: Intrinsic biofeedback: intrinsic biofeedback of neuro

(D)OPERANT CONDITIONING PROCEDURES FOR INCREASING ADAPTIVE BEHAVIOR:

1. Positive reinforcement: when a behavioural response is followed by a generally rewarding event such as food, praise or gifts, it tends to be strengthened and occurs more frequently than before the reward. This technique is used to increase desired behaviour.
2. .

OPERANT CONDITIONING PROCEDURES TO TEACH NEW BEHAVIOR

1. Chaining:

(E)

chaining is used when a person fails to perform a complex task. The complex task is broken into a number of small steps and each step is taught to the patient. In the forward chaining one starts with the first step, then to the third and so on. In backward chaining, one starts with the last step and goes on to the next step in a backward fashion. Backward chaining is found to be more effective in training the mentally disabled.

(F) OPERANT CONDITIONING PROCEDURES FOR DECREASING MALADAPTIVE BEHAVIOR

1. Extinction/ignoring: Extinction means removal of attention rewards permanentally, following a problem behaviour. This includes actions like not looking at the patient, not talking to the patient, or having no physical contact with the patient etc,following the problem behaviour. This is commonly used when patient exhibits odd behaviour. 2. Punishment : Aversive stimulus (punishment) is presented contingent upon the undesireable response. The punishment procedure should be administered immeadiately and consistently following the undersirable behaviour with clear explanation.
3. Timeout :

Timeout method includes removing the patient from the reward or the reward from the patient for a particular period of time following a problem behaviour. This is often used in the treatment of childhood disorder.
4. Restitution (over-correction):

restitution means restoring the disturbed situation to a state that is much better than what it was before the occurance of the problem behaviour. 5. Response cost: This procedure is used with individuals who are on token programme for teaching adaptive behaviour. When undesirable behaviour occurs, a fixed number of tokens or points are deducted from what the individual has already earned.

(G)ASSERTIVENESS AND SOCIAL SKILL TRAINING:

Assertive training is a behaviour therapy technique in which the patient is given training to bring about change in emotional and 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. Social skills training helps to improve social manners like encouraging eye contact, speaking appropriately, observing simple etiquette, and relating to people.