PRINCIPLES OF BEHAVIORAL THERAPY

FOR PTS WITH PHYSICAL DISABILITY

Dr. Ramez N. Bedwani

General intervention strategies: The goal of behavioral therapy is to

eliminateذف�س�وية maladaptive يح behaviorsغ�يرand replaceتعويضها them with constructiveبناءة and appropriateمناسبة behaviors.

To achieve this goal, follow the principles of behavioral learning: reinforcementز���� ,التعزيextinctionراض� .etc ..العق�ابand punishment اإلنقto stop unwanted ا�فيه مرغ�وب .behaviors (e.gغ�يرaggressive reactions العنيف�ة الفع�ل ,الخ�وفfear ,ردودand anxiety) and gradually acquire new appropriate behaviors of coping, that harmonize with the functional limitations of the disability.

The Basic steps for behavioral modification سلوكى needed to تعديلmanage unwanted behaviors in a

patient with disability are:

1. Define behavioral goals داف����� andاألهskillsارات�� that will be mastered, make المهplace for future readjustments.

2. Analyze تحليلthe stimulating ة� conditionsالمنبهunder which these unwanted behaviors occur

3. Teach the pt. the skill of self-monitoring متابعة�ذات�� by working out the positive and الnegative consequencesات����� of not التبعيchanging التغيير .التغييرand of changingعدم

4. Shape كيل� the new, desired behaviors byتشrewardingأة���� the patient. Gradually مكافapproximate دريجى����ت �ريب��� more skilfulتقbehaviors;

5. Targeted behaviors �تهدفة ��المس �لوكيات�� :as السself-care النفس �ة���� better job-related ,رعايperformances �ل ����������أفض وظيفى and ,أداءappropriate social interactions إجتماعية تفاعالت.etc.. مناسبة

6. Reinforce only targeted behaviors and ignore any other behavior

7. Adjust the rehabilitation plan by continuously assessing the patients level of skilled performance.

8. Teach the pt. to continue self-monitoring and self-reinforcement (mentioned later).

Additional procedures to stop undesired behaviors

A. Time out : Discuss with the pt effects of

undesired behaviors on himself and others

Agree that if repeated removal of the pt. from the area (e.g. workshop, rehabilitation unit) in which the inappropriate or destructive behavior happened will happen.

isolating him/her for several minutes in a proper separate room.

repeat this as long as these unacceptable behaviors occur.

B. Overcorrection Two sequential steps follow the inappropriate

behavior. First, the pt. corrects the effects of the wrong

doing ("restitution"). and, second overcorrects it, by extensive

rehearsal of the appropriate behavior. Used frequently in institutionalized settings.

c. Covertخفى conditioning إرتباط:شرطى

1. Associate extremely unpleasant thoughts with mal adaptive behaviors:

Teach the pts. to vividly imagine extremely unpleasant consequences (e.g. pain, image of cirrhotic liver متلي�ف each time they think of ( كب�دa certain maladaptive or undesirable behavior (drugs etc.)

This will gradually lead to extinction of the maladaptive behavior.

2. Associate positive images with desirable behaviors.

a mental image causing a feeling of well being (e.g., visualizing oneself functioning independently and better social approval) .

D. Self reinforcement (reward):

if any progress toward performance of rehabilitation goal is achieved.

Especially needed in rehabilitation setting, with pts. suffering from negative self regard

للذات سلبية سلوكيات and highly dependent صورة .behaviors إعتمادية

Often includes positive self- statements (e.g., "I am doing great“. ..i’ll do my best…),