APPLICATION OF BEHAVIOURAL PRINCIPLES IN

HEALTH AND DISEASE DPT LNH DR HARIM

Objectives

Mentally /emotionally handicapped Physically handicapped Chronically ill Homebound Medically compromised.

What Is Applied Behavior Analysis?

Applied Behavior Analysis is the science of human behavior. The best definition available is still the one written about in 1968 by Baer, Wolf, & Risley:

“Applied Behavior Analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior“

ABA basics

Understanding (and modifying) behavior in the context of environment is the basis for ABA therapies.

"Behavior" refers to all kinds of actions and skills (not just misbehavior).

"Environment" includes all sorts of physical and social events that might change or be changed by one's behavior.

ABA therapy techniques

ABA therapy includes many different techniques. All of these techniques focus on

Antecedents (what happens before a behavior occurs) and on Consequences (what happens after the behavior).

One technique is “positive reinforcement.” When a behavior is followed by something that is valued (a reward), that behavior is more likely to be repeated.

Basis of ABA

The ABA approach utilizes two, well-researched learning theories.

These are:  1) classical conditioning and  2) operant conditioning. 

The ABA does not require great intellectual ability in order for learning to be successful. Thus, ABA is ideally suited for people with intellectual disabilities.

Basis of ABA

In its most basic form, ABA is very simple and common sense. It rewards a person for making a correct choice. Incorrect choices are ignored, or not rewarded. Therefore, students learn by making simple associations between cause and effect.

With repetition, a student learns to associate a correct action with a reward. As such, this correct choice will be repeated.

An incorrect action does not earn a reward. When not rewarded, behaviors begin to slowly fade away. This process is known as extinction.

ABA for mentally/emotionally handicapped children.

Here is the basic approach for ABA:First, complex tasks or behaviors are broken down into smaller steps. For instance, suppose a student needs to learn to raise his hand before speaking in a classroom. This might be broken down into five steps:

1) Raise the hand. 2) Raise the hand while remaining silent. 3) Keep the hand raised, remaining silent, until the teacher

acknowledges you. 4) Once the teacher acknowledges you, put the hand down. 5) After the hand is down, speak.

Basic approach for ABA

Skills are systematically introduced in small steps. As one small skill is mastered, the next step is introduced.

Students learn by making simple associations between cause and effect. If they respond correctly for that step, they are immediately rewarded. If they respond incorrectly, nothing happens.

Once a step is consistently mastered, the next step is rewarded, instead of the previously mastered step. This process is known as chaining.

Basic approach for ABA

As students become familiar with the instruction and reward process, a more abstract "token" reward system can be introduced.

Token reward systems use visual representations. Common examples are stickers placed on a chart, or beads placed on a bracelet.

These represent a student's progress towards an ultimate, concrete reward. For example, once the child earns five stickers he can play a game or watch a program.

The token reward system is a little more complex and abstract than immediate and concrete rewards. However, it is very effective for increasing on-task behavior. Furthermore, it teaches students to delay their gratification.

Basics of ABA

Dangerous behaviors are considered "non-negotiable." These types of behavior may require immediate negative consequences. For obvious reasons, dangerous behavior cannot be ignored. Ignoring someone who is starting a fire is a bad idea! Dangerous behaviors include any behaviors that threaten, or cause significant harm to anyone.

Some examples are banging one's head against the wall, or biting other children. The other non-negotiable behaviors are ones that cause significant damage to

property. This might include setting fires or throwing computer equipment off a desk.

Common consequences include time-outs, or loss of preferred play items and activities.

In the case of self-harm, the least restrictive rule prevails. Physical restraints or protective devices (such as a helmet) may be used.

Basics of ABA

Patients with chronic conditions often have to adjust their aspirations, lifestyle, and employment.

Many grieve about their predicament before adjusting to it. But others have protracted distress and may develop psychiatric disorders, most commonly depression or anxiety. 

Chronic disease is associated with high levels of uncertainty. Patients need to change their behavior as part of a new lifestyle of self-care. They also have to endure debilitating and demanding treatments. These are some of the factors that make adjustment to chronic medical illness psychologically demanding.

The differences in patient psychological responses can be understood by examining patients' thoughts about their illness.

This is a fundamental principle behind cognitive therapy—a focused, structured, collaborative, and usually short-term psychological therapy that aims to facilitate problem solving and to modify dysfunctional thinking and behavior.

CBT for psychological problems like depression and fatigue. An active self-management approach and the need for patients to

establish collaborative relationships with health care staff. The emphasis on building skills for the management of

psychological problems for helping with the management of physical illness too.

CBT approach

A number of simple cognitive therapy techniques can be used by primary care physicians to care for their patients with chronic diseases—

Agenda setting, Self-monitoring, Experimentation, and Changing distressing thoughts.

Agenda Setting

Setting an agenda is one method for maximizing the chance that a consultation will make some progress toward solving a patient's problems. For example:

We have about 15 minutes today, and I want to make sure that we use the time we have to the best effect. The best way I have found to do this is to set an agenda that

highlights the main things we want to talk about. Is there something that you particularly wanted to cover today?

Agenda setting reflects the collaborative stance of cognitive therapy in that both physician and patient can assign agenda items.

Self-monitoring

Cognitive therapy usually involves a series of tasks (“homework”) that are completed outside sessions and at various phases of therapy. During assessment, this often involves self monitoring in the form of diary keeping.

Examples of this might be recording mood fluctuations, discrete episodes of problem behavior, or the thoughts and images associated with a negative mood state or any medical issues such as side-effects of a drug, symptom severity etc.

Self-monitoring

Inviting them to write a brief account of their understanding of a particular condition may reveal inaccurate beliefs that require correction or thoughts that mediate psychosocial difficulties (or both).It could help in the discussion about improving the self-management of a patient's disease, or it might identify the need for information and support.

Experimentation

Indeed, some homework tasks can be assigned primarily as a therapeutic intervention.

If you suspect that a patient's symptoms are being triggered by a certain event, you could ask that patient to keep a symptom diary to note any triggers. 

You say to the patient that the monitoring is “an experiment.” This can be of particular benefit when you have differing views from your patient as to the precise trigger behind certain symptoms.

I have been wondering if there is a link between the times that you take your medication and when you are feeling anxious. I know you don't think that there is a strong link

(patient agrees). I may be wrong. It could be that there is no link at all. Or perhaps there is a link only some of the time. Will you consider keeping a diary to look at this in more

detail? Can you note down the times that you take your medication and at the same time keep a rating of your anxiety? This way, we can check out which of our views is more

accurate.

Changing distressing thoughts

Cognitive therapy usually involves the modification of thoughts and behaviors that seem to be contributing to a patient's symptoms. Clearly, the application of a simple strategy cannot change a major psychological disorder. However, the application of simple techniques based on cognitive therapy may alleviate some distress.

Supportive psychotherapy

 Supportive psychotherapy is the attempt by a therapist bv any practical means whatever to help  patients deal with their emotional distress and problems in living. It includes comforting, advising, encouraging, reassuring, and mostly listening, attentively and sympathetically.

The therapist provides an emotional outlet, the chance for patients to express themselves and be themselves. Also the therapist may inform patients about their illness and about how to manage it and how to adjust to it.

Supportive measures

Every individual has special needs, more so in the physically or mentally disabled.

Assistive measure in which the nurse/staff facilitates activities of daily living (such as hygiene, exercise, rest, or grooming), provides physialcomfort, and maintains a therapeutic environment.

Examples may be sign language interpretor, Wheel-chair, hearing aids, etc.