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The theory suggests a response is learned and repeated through immediate association Behavioral therapies based on classical conditioning aim to break the association between stimulus and undesired response (e.g. phobia, additional etc.)
Counterconditioning - fear reduction technique in which pleasant stimuli are associated with fear-evoking stimuli so that the fear-evoking stimuli lose their aversive significance is called as counterconditioning
Aka desensitisation of the stimulus
Overt and covert sensitization
For positive reinforcement, try to think of it as adding something positive in order to increase a response. For negative reinforcement, try to think of it as taking something negative away in order to increase a response.
Negative reinforcement should not be thought of as a punishment procedure. With negative reinforcement, someone is increasing a behavior; whereas with punishment, someone is decreasing a
When thinking about reinforcement, always remember that the end result is to try to increase the behavior, whereas punishment procedures are used to decrease behavior.
Flooding in its purest form involves forced, prolonged exposure to the actual stimulus that provoked the original trauma. In real practice, that can be problematic, if not completely impossible. It isn't really practical to fill a room with snakes and spiders, for example, and force someone to sit in it for hours.
BIOPSYCHOSOCIAL MANAGEMENT OF
Psychotherapies and social interventions
Nur Fadzlina Zabri
Treatment by psychological means, of the problems of an
emotional nature, in which a therapist deliberately establishes
a professional relationship with patient to :
I. Remove, modify or retard existing symptoms
II. mediate disturbed patterns of behavior
III. promote positive personality growth and development
The approaches used in Psychotherapy
• Psychodynamic: insight-oriented therapy. An approach to
therapy that involved delving into a patients thoughts and past
experiences to seek out unconscious desires or fantasies.
• Cognitive-behavioural: A type of psychotherapy that involves
cognitive and behavioural techniques to change negative
thoughts and maladaptive behaviours.
• Humanistic: A form of therapy that focuses on helping people
maximize their potential.
• A type of psychotherapy which is based on theories of
learning that all behaviors are acquired or received through
“conditioning” (state of shaping behavior)
• Aims at modifying maladaptive behavior and substituting with
• Conditioning occurs through interaction with the
environment. Behaviorists believe that our responses to
environmental stimuli shapes our behaviors
2 major types of conditioning
Technique used in behavioral training in which a
naturally occuring stimulus is paired with a response
Technique of learning that occurs through
reinforcement for behavior
In order to understand how each of these behavior modification
techniques can be used, it is also essential to understand how
classical conditioning and operant conditioning differ from
• First described by Ivan Petrovich Pavlov, a Russian physiologist.
• Involves placing a neutral signal (stimulus) before a reflex (response).
• Focuses on involuntary (unconditional or automatic) behaviors.
• First described by Burrhus Frederic Skinner, an American
• Involves applying reinforcement after a behavior.
• Focuses on strengthening or weakening voluntary (conditional)
• Short duration : 6-8weeks
• Easy to train and cost-effective
• Initial sessions are scheduled daily, later session are
• Behavioural analysis
Classical conditioning model (Pavlov)
• Derived from principles of Ivan Pavlov’s experiment
• Mowrer’s bell and pad method helped children learn to
stop wetting the bed
• Learned response can be unlearned through
Behavioral therapy Psychodynamic therapy
Trying to uncover unresolved
conflicts from childhood (i.e. the
cause of abnormal behavior
Focus on current problems and
Attempts to remove behavior the
patient finds troublesome
Examples of classical condition :
a) Systematic desensitisation
• Principle based on reciprocal inhibition (Wolpe)
• Associates a pleasant relaxed state with gradually
increasing anxiety-triggering stimuli until anxiety towards
stimuli is eliminated (Graduated Exposure Theory)
• Comprise of 3 steps
i. Relaxation training
ii. Hierarchy construction
iii. Systematic desensitisation proper
I. Relaxation therapy
– Characterised by immobility of the body, control over the
focus of attention, low muscle tone, cultivation of a specific
frame of mind
– Methods used ;
• Jacobson’s progressive muscular relaxation
• Yoga, zen
II. Hierarchy construction
– List of fears related to phobia from least to most terrifying
– Eg ; school phobia
• Thinking about school
• Riding the bus
• Sitting in class
iii. Systematic desensitisation proper
– Patients proceed systematically through the list from least to
the most anxiety-provoking scene in a deeply relaxed state
– Treatment of choice in phobia or obsessive compulsive
b) Aversion therapy
• Used for the treatment of conditions which are pleasant
but felt undesirable by the patient
• Principle : pairing the pleasant stimulus (alcohol) with an
unpleasant response (low voltage electric, drugs,fantasy),
the pleasant stimulus becomes unpleasant by association
• The use has decline as it violate the human rights of
• Usually used in treatment of phobias and
• The patient is directly exposed to the phobic
stimulus and escape is made impossible.
• By prolonged contact with the phobic
stimulus, therapist’s guidance and
encouragement, the therapist’s modeling
behaviour, anxiety decreases and the phobic
• Flooding can lead to extinction of fear
• Reinforcement is a term used in operant conditioning which
refers to anything that increases the possibility that a response
• Reinforcement increases or strengthens the behavior.
Operant conditioning model (Pavlov)
Operant conditioning procedures
• Common methods :
Operant conditioning procedures
I. Time out -
There are Two Different Types of Reinforcement
Involves the addition of something to increase a response, such as
giving a bit of candy to a child after she cleans up her room or token is
given to patient with mental disorder for performing desired behaviour
Negative reinforcement is when a certain stimulus/item is removed
after a particular behavior is exhibited.
The likelihood (possibility) of the particular behavior occurring again in
the future is increased because of removing or avoiding the negative
Patient learn new behaviour by imitation , primarily by observation
Useful in phobic children who are placed with other children of their age
Irrational fears can be unlearned by observing fearless model confront the
A hierarchy of activities is established, with least anxiety-provoking
Is designed to stop behavior, not to make it occur more often
When undesired response occurs, punishment is given
Time out :
Reinforcement is withdrawn for some time
COGNITIVE THERAPY OR COGNITIVE
• Definition : Type of psychotherapy which aims at correcting the maladaptive
methods thinking , thus providing relief from consequent symptoms.
• Developed separately by Beck and Meichenbaum.
• Indication :
2) anxiety disorder
3) panic disorder
5) eating disorder
6) anticipatory anxiety
7) teaching problem-solving method.
8) delusion and hallucination ( rarely )
Typically the CBT consist of about 15 visit over 3 months.
Important techniques in CBT :
• COGNITIVE TECHNIQUES – recognising and correcting negative
autonomic thoughts, identifying and testing maladaptive
• BEHAVIOURAL TECHNIQUES – activity scheduling, homework
assignments, graded task assignment, behavioural rehearsal, role
• TEACHINGPROBLEM- SOLVING SKILLS.
EXPOSURE AND RESPONSE PREVENTION (ERP)
• ERP is a type of cognitive behavioural therapy which is used
for a variety of anxiety disorder especially the obsessive
compulsive disorder (OCD) and phobias.
• How the ERP works ?
It works by breaking the link between your obsessional
thoughts, images, urges or impulses and the compulsive
things that you do to reduce the distress or anxiety that they
cause. During ERP exercises you gradually expose yourself to
situations that bring on or cue your obsessions, whilst not
carrying out your compulsions.
Remember the five conditions:
Condition 1: Graded
List things in your exposure hierarchy that give you at least 50-60% anxiety from the easier things up to more difficult things.
Remember not to grade an exercise by time. When you have been repeating an exercise and it no longer gives you at least 40%
anxiety at the start of
the exercise, you are then ready to move up to the next item on your exposure hierarchy.
Condition 2: Prolonged
Stay in the exposure exercise situation, without using distraction until your anxiety drops by 50% from the start of the exercise. So for
example if you were 80% anxious, you would stay in the situation until your anxiety drops to 40%. You would then repeat the exercise
until it no longer gets above 40% at the start of the exercise.
Condition 3: Repeated
Expose yourself to each step on the hierarchy at a time. You should repeat each step until the exercise no longer makes you feel
anxious, say if it no longer goes above 40% anxiety at the start of the exercise. Then it is time to move up to the next exercise on
your hierarchy ladder. On average you should aim to do exposure treatment 4-5 times per week (these may be different exercises
depending on your ratings).
Condition 4: Without Distraction Try to remove things from your hierarchy that reduce your anxiety artificially or
distract you from how you are feeling during your exposure exercises. Whist these may seem like the give temporary relief from
feeling anxious, they
are keeping you stuck in that vicious circle.
Condition 5: Without Compulsion Each time you expose yourself to an exercise
on your hierarchy, you need to remain in the situation, resisting the urge to carry out a compulsion to reduce your distress (either one
that you have done before, or a new one).
• Kaplan & Sadock’s concise Textbook of Clinical Psychiatry
• A Guide to Treatments That Work by Peter E. Nathan
• 7th Edition, A Short Textbook of Psychiatry by Niraj Ahuja