Behaviourist Treatments and Therapies

Unit 5: Treatment and Therapies

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We identified and discussed treatments and therapies offered from the biological perspective

Task: write on a post it note- 1 thing you remember and place on white board

Must: identify treatments and therapies offered from the biological perspective

Should: explain these treatments and therapies

Could 1. Weigh up the success of these treatments 2.compare and contrast these with those offered from the biological perspective

Identify and discuss treatments and therapies offered from the humanistic perspective

Compare and contrast with the others (Biological and Behaviourist)

Behaviourism introduction

• What do we remember?• What do they believe about human

behaviour?

The basic principles: why do people experience mental illness?

• See psychological disorders as the result of maladaptive learning- example self harming?

• Acquired through classical and operant conditioning- reinforcement/association

• Treatment focuses on helping the child unlearn this conditioning

• Teaching patient alternative responses to stress and within situations

• Mainly treats phobias • In Some cases can treat behaviours associated with

psychoticism

We are going to look at

• Flooding• Systematic Desensitisation• Token economy • Flooding• Behaviour modification

Procedure in treatments other then token Economy

• Functional analysis: • Therapist analysis the patient’s problem in

terms of:• 1. which behaviours are actually the problem• 2. which environmental stimuli trigger the

behaviour..• For example, panic attacks due to being in a

social environment

Flooding (Implosion):Discovering the stimulus is harmless…

http://www.mindfulexposurebook.com/exposure-therapy-implosion

• fear exposure therapy• Developed by Levis &

Stampl• The underlying theory

behind flooding is that a phobia is a learned fear, and needs to be unlearned by exposure to the thing that you fear.

• Total immersion: • forced, prolonged exposure

to the actual stimulus that provoked the original trauma- not possible for every phobia

Link: http://www.psychologistworld.com/behavior/flooding.php

In the mid-1960s, Thomas Stampfl, pioneered a technique called 'implosion therapy' to treat phobias. He found that phobic patients who were bombarded with detailed descriptions of the situations that they feared for six to nine continuous hours lost their fear of those situations. His research was expanded upon and refined by Zev Wanderer, who used biofeedback machines to monitor patients listening to verbal descriptions of what they most feared. By concentrating on the phrases that sparked the most intense reactions, Wanderer reduced the time needed for the first flooding session from nine hours to about two hours. Patients then returned for further sessions, usually as short as half an hour

Info slide: to read later

AN EXAMPLE:

Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who was scared of cars, and drove her around for hours. Initially the girl was hysterical but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars.

• The initial hysteria and panic is time constrained because the physical arousal (feelings of hysteria) will subside eventually

• At this point the patient will relax, and hence that new behaviour and calmness will be associated with the once fearful stimulus!

• How it works

So. How would I treat by phobia of cows?

Is this treatment effective and appropriate

• Effective-Harris (1992) wrote that flooding is an effective treatment and is more cost effective than other methods due to the treatment length

• Harris, C.V. (1992). An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 23, 107-115. doi: 10.1016/0005-7916(92)90008-7

• Appropriate: because it is a quick result with no prolonged therapy and chances are there is no relapse

• Patients hold this therapy in high esteem (Olatunji et al 2009)

However…

The problems with Flooding s

• Ethical: Can be a very stressful situation for the patient.

• You have to keep them with the stimulus for a long period.

• Could be linked to human rights (torture)

• However- Informed consent!

Systematic Desensitisation

• Developed by Joseph Wolpe in the 1950s

• Relaxation responses are trained to occur through progressive relaxation training , a technique initially perfected by Edmund Jacobson during the 1930s.

• Read more: http://www.minddisorders.com/Py-Z/Systematic-desensitization.html#ixzz3ZO5c5hBf

Systematic Desensitisation: Intro http://www.minddisorders.com/Py-Z/Systematic-desensitization.html

• Handout:• Mostly used for treatment of phobias/OCD • Aims to substitute a anxiety response with a relaxation

response• Happens gradually on average 6-8 lessons (more if its an

intense phobia)• Goals are met but patient could still leave with a phobia• Constructing an hierarchy of fearful situations, ranked by

both patient and therapist• But first: learn relaxation techniques --------

Relaxation techniques

• Trained in methods of relaxation:• Control of breathing• Visualisation techniques • An example: Handout-

http://www.simplypsychology.org/Systematic-Desensitisation.html

Systematic Desensitisation: how it works

Lets do another example• A volunteer…

Effectiveness

• Handout:

appropriateness

• Works for:• Simple phobias- arachnophobia• Social phobias – if anxiety is the problem, not

if the behaviour is due to lack of social skills! • Eating disorders: help overcome anxiety

associated with eating, but wont tackle the core problem

However

Ethics

• Because of the potential for extreme panic reactions to occur, which can increase the phobia, this technique should only be conducted by a well-qualified, trained professional. Also, the relaxation response should be thoroughly learned before confronting the anxiety-provoking hierarchy.

Read more: http://www.minddisorders.com/Py-Z/Systematic-desensitization.html#ixzz3ZO4n5KU

• Successful treatment is not based solely on success in terms of cure- only if you met the goals!

• Does not treat underlying causes- chromosome disorders and behaviour stemming from brain trauma

• Could the therapist intentionally cause harm?• Takes a lot of trust

Token economy:http://vkc.mc.vanderbilt.edu/assets/files/tipsheets/tokeneconomytips.pdf

https://www.youtube.com/watch?v=kfygN6zKGYI

• Used in:• Nurseries• Schools• Prison• Institutions• In your own home

• Used for:• Autism/ ADHD• Child behaviour (typical)• Violent behaviour

associated with wither criminal (prisons) or mental (institutions)

• Learning (schools)

Token economy: Intro • Based on the works of

B.F Skinner :• https://www.youtube.com/

watch?v=wW7pvVMmZ6k• Montrose Wolf (1935-2004)• Inventor of ‘time-out’, first

workable token economy system amongst many more:

• Less aggressive ways (hence more fun) of teaching expected behaviour

• Read more here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1226164/

Token Economy: institutions

• Functional analysis:• Management of institution decides:• 1. Which specific behaviours they wish to

promote• 2. Which( if any) specific behaviours they wish

to extinguish • Any examples?

How it works

• Handout• Monitor patient’s behaviour• When patient displays desired behaviour, they

receive a token• Different number of tokens can be exchanged

for different reinforcers (sweets, access to TV, Trips out, increased freedom)

Effectiveness and Appropriateness

• Handout

However

Ethics

• Is it dehumanising?• Does it make people dependant?• Requires in most cases to deprive humans of

basic rights (link to human rights)• Goals are not set by therapist- they control the

patient• Is it done for the patient or the institution?