BEHAVIOUR THERAPY

Behaviour therapy is a type of psychotherapy which is based on theory of learning. It focus of changing
or modifying maladaptive behaviour.

Definition:-

 It is the systematic application of scientific principles of learning and a form of psychotherapy

aim it changing maladaptive behaviour by substituting it with adaptive behaviour.
 It is a form of treatment for problems in which a trained person deliberately established
professional relationship with the client, with the objective of removing or modifying existing
symptoms and promoting positive personality, growth and development.

Purpose:-

 Permanent change in behaviour occurs as a result of practice or experience.

 Correction of the abnormal psychodynamics which are contributing to the illness.
 Helpful in those conditions which are refractory to other form of therapy.

Indications:-

 Anxiety disorder-Panic, OCB, post traumatic stress, phobia, neurotic depression.

 Mood disorder
 Schizophrenia
 Eating disorder-Anorexia bulimia, anorexia nervosa, obesity
 Psychosomatic disorder-Insomnia, hypertension,asthma,headache
 Psychosexual disorder- Paraphilia, gender identity, homosexuality.
 Substance abuse
 Childhood disorder- Enuresis, conduct, autism, mental retardation

Theories of learning:- There are many theories of learning given:-

1) Trial and error theory

2) Theories of condition reflex-
 Classical conditioning
 Operant conditioning
3) Cognitive learning-
 Insight learning

General principle of behaviour therapy:-

 Learning by doing, learning by trial and error, learning by conditioning.

 Close observation of behaviour.
 Concentration on the symptoms as they are target for therapy.
 A commitment to objective evaluation of efficacy.
Techniques in behaviour therapy:-

A. Systematic desensitization:-

Indication:-

 Phobia
 OCD

Principles:-

 It is based on the principle of reciprocal inhibition. It means a response that does not match
with anxiety, occurs with anxiety provoking stimulus. The anxiety is reduced by that
incompatible response.
 The theory behind systematic desensitization is that the relaxation response competes with
previously learned anxiety response (fear, phobia).
 It begins with induction of a relaxed state. When he/she is relaxed, he starts to face or imagine
scene related to fear. Beginning is always done with mild fear arousing stimulus. Once the
patient is able to relax, progressively more upsetting stimulus confronted.

Steps:- it has three steps:-

 Training of relaxation techniques before main therapy

 Hierarchy formation:- Here the patient is asked to list all condition which provoke anxiety. Then
he is asking to list them in a descending order of anxiety provocation.
 Desensitization of the stimulus:- This can either be done in reality or through imagination. At
first the lowest item in hierarchy is confronted. He is interacted to feel relax whenever anxiety
occur. After few trial, patient become able to control the anxiety.
B. Flooding:- Patient is directly exposed to phobic stimulus but escape is made impossible.By
prolonged contact with the phobic stimulus therapist guidance and encouraged his modeling
behaviour reduce anxiety.

Indication:- Phobia

It is the similar for systematic desensitization but the differences are:-

 Patient is not given relaxation training before therapy.

 Patient is directly exposed to the phobic stimulus, there is hierarchy formation or step by step
exposure.
 In this techniques only therapist guidance is used to reduce anxiety.
C. Aversion therapy:-
Indication:-
 Alcohol dependence
 Homosexuality
 Child disorder

It involves producing an unpleasant sensation in the patient.

Principles:-
  Pairing of the pleasant stimulus with an unpleasant response.
 20-40 session are given.
 Duration of session is about one hour.
 Booster session are given after completion of treatment.
 Ex. Pairing of alcohol (pleasant) with drug apomorphine disulfiram (unpleasant).
 Pairing of thumb sucking (pleasant) with low voltage electric current (unpleasant).
D. Reinforcement:-
I. Positive reinforcement:- According to this method it is possible to modify the behaviour buy
provoking him reward, when rewards are used to with hold a desired response it is called
omission training.

Ex. A child is offered a candy for giving up nail biting.

II. Negative reinforcement:- Here modification in behaviour is done by providing punishment on

negative reinforcement. It is also called escape training. Punishment training is used to make the
learner stop performing an undesired bahaviour.

Ex. Scolding a child for his impolite language.

COGNITIVE BEHAVIOUR THERAPY

Definition:- Cognitive therapy is a psychotherapeutic approach based on the idea that behaviour is
secondary thinking. It focus on how patient think about themselves and their world, make changes in
current way of thinking and behaviour.

Indication:-

 Depression
 Eating disorder
 Anxiety disorder

Purpose of cognitive Behaviour therapy:-

 Therapist help the patient to correct and revise his perception and thought process.
 He develops insight of patient. This insigy help in further improvement of cognitive functioning.
 Cognition include the concept of knowledge, thinking, planning, interference.

Techniques:- The techniques used by therapist are:-

 Cognitive techniques
 Behaviour techniques
 Problem solving techniques
A. Cognitive techniques are:-
a) Cognitive rehearsal:- Cognitive rehearsal is useful for problems that cannot be conveniently
solved in clinical setting.Ex.
 Behavioural rehearsal of social skills by social phobic individual
  Recognizing negative thoughts
 Correcting negative thoughts
 Increasing objectivity (insight)

b) Thought stopping:- It work on assumption that sudden disturbing stimulus will serve to
terminate obsessive thoughts.
Ex. The patient is asked to get the thoughts firmly in mind and therapist suddenly says ‘stop’
likewise of obsessional thoughts is followed by stop.Finally simply mentally says stop.
c) Cognitive restructuring:- A cognitive therapist help the patient concentrate on adaptive type of
thought.
Ex. A person with examination things in following way- This test is very easy for everyone. It is
simple, for other people who have more knowledge then me.

After therapy:- Patient think in this way. I studies hard, I will just try to answer one question at a time. If
I do not know the answer, I will go on to the next one.

B. Behaviour techniques:-
 Activity scheduling
 Role playing
 Behavioural rehearsal
 Diversion techniques
C. Problem solving techniques:- These involve several steps and consist of:-

Defining the problem more clearly

Dividing it into small sub problem which can be better managed

Finding out alternate methods of solving each problems

Considering the merits and demerits of each methods

OCCUPATIONAL THERAPY

Introduction:- Occupational therapy is rehabilitative therapy. In occupational therapy, focus is laid upon
the use of activities of as treatment medium.

It's short term goal is improvement of quality of life and long term goal is a rehabilitation.

Definition:-

According to Clark:- Occupational therapy is an active methods of treatment with profound

psychological justification.

According to Reed and Sanderson:- any activity which engages a person’s resources of time, energy and
is composed of skills and values.
Occupational therapy is planned, goal oriented collaborative interaction between therapist, patient and
his environment by which new skills are learned through various activities.

Occupational therapy defined as a professional concerned with promoting health and wellbeing through
occupation.

Objective of occupational therapy:- The major goal of patient is rehabilitation. It help the patient to re-
establish or regain his interest to do useful activities.

 Increasing functioning and independence.

 To identify the needs and skills of the patient.
 To remove and modify maladaptive behaviour.
 To improve mood and reduce anxiety.
 Adapting environment to meet the unique needs of an individuals.
 Maintain lifestyle activities after discharge.
 Improve the attention, concentration, time and quality work for the patient.
 To increase socialization and communication.
 Develop more healthy and integrated group.

Basic requirement for occupational therapy:- Occupational therapy is based on following factors:-

 knowledge level of patient

 Background/habits of patient
 Capacity or skills of patient
 Therapeutic nurse patient relationship
 Interest of patient
 Continuous evaluation of progress
 Continuous reinforcement

Indication:-

 Traumatic injuries
 Autism
 Schizophrenia
 Antisocial personality disorder
 Mania
 Depression
 Substance abuse
 Child psychiatric disorder

Types of services/activities in occupational therapy:- main occupational therapy provide many

interesting and rewarding jobs for some of the activities are:-

 Relaxation techniques:- Meditation technique, swimming, dance technique, exercise

(walking,running, jogging)
 Task oriented activities:- Mother craft, kitchen work,bakery,pantry.
 Work adjustment programme:- Child rearing practices, handloom section, soap making, basket
making, carpenter work, plastic moulding, printing and stationery.
  Prevocational activities:- Jumping, skipping, hopping, crawling, rolling,throwball.
 Design and fabrication:- Weaving, mat making, doll preparation, sewing, leather work,
woodwork.
 Group participation activities

Occupational therapy process:-

Initial evaluation of patient

Development of short term and long term goal

Development of therapy plan

Implementation of plan

Continuous monitoring of progress

Call for review meeting with patient and staff

Resetting of new goals

Discharge planning of patient

ACTIVITY THERAPY

An activity therapy is an effort to redirect their energy into useful or meaningful activity. The example of
activity therapies are:-

 Occupational therapy
 Recreational therapy
 Dance therapy
 Music therapy
 Art therapy
 Play therapy
 Biblio therapy
 Education therapy

Aims of activity therapy:-

 To facilitate emotional expression.

 To improve interaction and communication.
 To release tension and pent up emotion.
 To increase attention span and concentration power.
 To improve Cognitive skills.Ex.Learning, listening.
 To increase self confidence and feeling of self worth.
 To provide socially acceptable way of fantasy and wish fulfillment through art and play.
 To decrease withdrawal tendencies.
 RECREATIONAL THERAPY

Introduction:- Recreational program will be developed by therapeutic team specially by recreational

therapist with the help of community resources to encourage the clients by participating in socializing
activities.

Definition:- It is a form of activity therapy, where an individual enjoys pleasurably, the leisure time
through recreating or renewing the body and mind by relieving emotional tension or internal conflicts
and thereby releases monotonous life of mentally sick or ill person.

Indication:- Clients who have difficulty in relating to others:-

 Schizophrenia
 Anxiety
 Excitement
 Depression
 OCD
 Substance abuse

Types of recreational activities:-

 Indoor activities:- Craft, chess, carom board, singing, dance, painting, gardening, participating in
birthday for family function, table tennis, etc.
 Outdoor activities:- Picnic trip, visit (friendly visit or visit to interested place-zoo, garden,flower
show), shopping.
 Activities for Intellectual expression:- Reading book, magazine, newspaper, painting, drawing,
celebrating the days of global importance eg. World health day, enjoying festivals, Christmas,
New year, writing story and poem, jokes.
 Activities for psychosexual expression:- Singing, dancing, painting, drawing.
 Activities for expression of love and tenderness:- Taking care of kids with play material, pets,
gardening etc.
 Activity for expression of muscular strength:- Sports and games eg. Table tennis, badminton,
basketball.
 Activities increasing sensory power:-
Visual:- Watching pictures, moving objects.
Auditor form:-Listening music, radio
Kinesthetic:- Painting, art, drawing, taking care of pet.

Purpose of recreational therapy:-

 To relieve from stress, anxiety, tension, internal emotional conflicts, loneliness.

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