Principles of behavioral therapy for pts with physical disability

1. Principles of behavioral therapy for pts with physical disability Dr. Ramez N. Bedwani

2. General intervention strategies: • The goal of behavioral therapy is to eliminateيحذف maladaptive غير سويةbehaviors and replaceتعويضها them with constructiveبناءة and appropriateمناسبة behaviors. • To achieve this goal, follow the principles of behavioral learning: reinforcementالتعزيز, extinctionالإنقراض and punishmentالعقاب.. etc. to stop unwanted غير مرغوب فيهاbehaviors (e.g. aggressive reactionsردود الفعل العنيفة, fearالخوف, and anxiety) and gradually acquire new appropriate behaviors of coping, that harmonize with the functional limitations of the disability.

3. The Basic steps for behavioral modificationتعديل سلوكى needed to manage unwanted behaviors in a patient with disability are: • Define behavioral goals الأهدافand skillsالمهارات that will be mastered, make place for future readjustments. • Analyze تحليلthe stimulating المنبهةconditions under which these unwanted behaviors occur • Teach the pt. the skill of self-monitoringمتابعة الذات by working out the positive and negative consequencesالتبعيات of not changing عدم التغييرand of changingالتغيير.

4. Shapeتشكيلthe new, desired behaviors by rewardingمكافأة the patient. Gradually approximate تقريب تدريجىmore skilful behaviors; • Targeted behaviorsالسلوكيات المستهدفة as: self-careرعاية النفس, better job-related performancesأداء وظيفى أفضل, and appropriate social interactionsتفاعلات إجتماعية مناسبة ..etc. • Reinforce only targeted behaviors and ignore any other behavior • Adjust the rehabilitation plan by continuously assessing the patients level of skilled performance. • Teach the pt. to continue self-monitoring and self-reinforcement (mentioned later).

5. Additional procedures to stop undesired behaviors • 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.

6. 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.

7. c. Covertخفى conditioning إرتباط شرطى: • Associateextremely unpleasant thoughts with mal adaptivebehaviors: • Teach the pts. to vividly imagine extremely unpleasant consequences (e.g. pain, image of cirrhotic liverكبد متليف ) each time they think of a certain maladaptive or undesirable behavior (drugs etc.) • This will gradually lead to extinction of the maladaptive behavior.

8. Associatepositiveimages with desirable behaviors. • a mental image causing a feeling of well being (e.g., visualizing oneself functioning independently and better social approval) .

9. Self reinforcement (reward): • if any progress toward performance of rehabilitation goal is achieved. • Especially needed in rehabilitation setting, with pts. suffering from negative self regardصورة سلبية للذات and highly dependentسلوكيات إعتمادية behaviors. • Often includes positive self- statements (e.g., "I am doing great“. ..i’ll do my best…),