Transcript Document

Chapter 18
Behavior Therapy
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Introduction
• A behavior is considered to be maladaptive
when:
– It is age-inappropriate
– Interferes with adaptive functioning
– It is misunderstood by others in terms of cultural
inappropriateness
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Introduction (cont.)
• The behavioral approach to therapy is that
people have become what they are through
learning processes or through the interaction
of the environment with their genetic
endowment.
• The basic assumption is that problematic
behaviors occur when there has been
inadequate learning and therefore can be
corrected through the provision of appropriate
learning experiences.
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Classical Conditioning
• It was introduced by Russian physiologist
Pavlov in his experiments with dogs.
• Pavlov found that dogs salivated when
presented with food (unconditioned
response).
• He learned that dogs salivated when food
came into view (conditioned response).
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Classical Conditioning (cont.)
• He introduced an unrelated stimulus (the
sound of a bell) with presentation of food.
• He learned that the dogs soon began
salivating (conditioned response) at the
sound of the bell alone (conditioned
stimulus).
• When a similar response is elicited from
similar stimuli, it is called stimulus
generalization.
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Operant Conditioning
• Introduced by American psychologist B. F.
Skinner
• The basic assumption is that the connection
between a stimulus and a response is
strengthened or weakened by the
consequences of the response.
• A stimulus that follows a behavior (or
response) is called a reinforcer.
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Operant Conditioning (cont.)
• When the reinforcing stimulus increases the
probability that the behavior will recur, it is
called a positive reinforcer.
• When the reinforcing stimulus increases the
probability that a behavior will recur by
removal of an undesirable reinforcing
stimulus, it is called a negative reinforcer.
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Operant Conditioning (cont.)
• A stimulus that follows a behavioral response
and decreases the probability that the
behavior will recur is called an aversive
stimulus or punisher.
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Techniques for Modifying Client
Behavior
• Shaping. In shaping the behavior of another,
reinforcements are given for increasingly
closer approximations to the desired
response.
• Modeling. Modeling refers to the learning of
new behaviors by imitating the behavior of
others.
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Techniques for Modifying Client
Behavior (cont.)
• Premack Principle. This principle states that a
frequently occurring response can serve as a
positive reinforcement for a response that
occurs less frequently.
• Extinction. The gradual decrease in frequency
or disappearance of a response when the
positive reinforcement is withheld.
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Techniques for Modifying Client
Behavior (cont.)
• Contingency Contracting. A contract for behavioral
change is developed. Positive and negative
reinforcers for performing the desired behaviors, as
well as aversive reinforcers for failure to perform, are
stated explicitly in the contract.
• Token Economy. A token economy is a type of
contingency contracting in which the reinforcers for
desired behaviors are presented in the form of
tokens. The tokens may then be exchanged for
designated privileges.
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Techniques for Modifying Client
Behavior (cont.)
1. The nurse is encouraging a child, diagnosed with
autism, to verbalize needs. Which nursing
intervention reflects the behavior therapy of shaping?
A. The nurse provides no rewards to the child to
encourage independence.
B. The nurse rewards the child regardless of speech
improvement.
C. The nurse rewards the child at the conclusion of the
therapy.
D. The nurse rewards the child incrementally as
improvement in speech occurs.
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Techniques for Modifying Client
Behavior (cont.)
• Correct answer: D
– In shaping the behavior of another, reinforcements
are given for increasingly closer approximations to
the desired response. In this situation, the nurse is
providing rewards incrementally as the child’s speech
begins to improve.
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Techniques for Modifying Client
Behavior (cont.)
• Time Out. An aversive stimulus or punishment
whereby the client is removed from the environment
where the unacceptable behavior is being exhibited;
the client is usually isolated so that reinforcement
from the attention of others is absent.
• Reciprocal Inhibition. Also called counterconditioning,
this technique serves to decrease or eliminate a
behavior by introducing a more adaptive behavior but
one that is incompatible with the unacceptable
behavior.
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Techniques for Modifying Client
Behavior (cont.)
• Overt Sensitization. Overt sensitization is an
aversion therapy that produces unpleasant
consequences for undesirable behavior.
• Covert Sensitization. This is a mental imagery of an
aversive stimulus to divert an individual from an
undesirable behavior.
• Systematic Desensitization. This is a technique to
assist an individual to overcome fear of a phobic
stimulus; a systematic hierarchy of events associated
with the phobic stimulus is used to gradually
desensitize the individual.
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Techniques for Modifying Client
Behavior (cont.)
• Flooding. Sometimes called implosive
therapy, this technique is used to desensitize
an individual to a phobic stimulus. It differs
from systematic desensitization in that
instead of working through a hierarchy of
anxiety-producing stimuli, the individual is
“flooded” with a continuous presentation of
the phobic stimulus until it no longer elicits
anxiety.
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Techniques for Modifying Client
Behavior (cont.)
2. A client diagnosed with alcoholism has
recently been prescribed disulfiram
(Antabuse). The nurse recognizes this as
which type of behavior therapy?
A.
B.
C.
D.
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Overt sensitization
Flooding
Reciprocal inhibition
Systematic desensitization
Techniques for Modifying Client
Behavior (cont.)
• Correct answer: A
– The nurse recognizes the use of Antabuse as overt
sensitization behavior therapy. This is a type of
aversion therapy that produces unpleasant
consequences for undesirable behavior. Instead of
the euphoric feeling normally experienced from
alcohol (the positive reinforcement for drinking),
an individual taking Antabuse will experience
nausea, vomiting, palpitations, and headache if
alcohol is consumed. The client receives a severe
punishment that is intended to extinguish the
unacceptable behavior (drinking alcohol).
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Role of the Nurse
• The nursing process is the vehicle for delivery
of nursing care to clients requiring assistance
with behavior modification.
• An assessment is conducted
to identify behaviors
that are unacceptable
because of age or cultural
inappropriateness.
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Role of the Nurse (cont.)
• Nursing diagnoses are formulated, and
outcome criteria are established.
• A plan for behavior modification is devised,
using techniques thought to be most
appropriate for the client.
• The plan may be devised by the nurse alone,
the physician alone, the nurse and physician
together, or with input from the client and
various members of the treatment team.
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Role of the Nurse (cont.)
• All members of the treatment team must be
made aware of the behavior modification
plan.
• Consistency among all staff is required for
implementation to be successful.
• Evaluation of care is based on achievement of
the outcome criteria.
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Role of the Nurse (cont.)
3. A nurse is using covert sensitization to help a
client control compulsive overeating. Which
nursing intervention reflects this behavior
therapy?
A. Asking the client to visualize and imagine smelling
a rotting potato
B. Encouraging the client to practice relaxation
exercises when tempted to eat
C. Introducing the client to a peer who has
overcome obesity
D. Providing small rewards for periodic weight loss
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Role of the Nurse (cont.)
• Correct answer: A
– Covert sensitization relies on the individual’s
imagination to produce unpleasant symptoms as
negative stimuli. The mental image (rotting
potatoes) is visualized when the individual is
about to succumb to an attractive (ice cream
sundae) but undesirable behavior (compulsive
eating). The technique is under the client’s control
and can be used whenever and wherever it is
required.
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