SEMINAR

ON
BEHAVIOUR
THERAPY

SUBMITTED TO: SUBMITTED BY:

Mrs. Jayanthi. K, Ms.Dhivya R,
Assisstant Professor M.Sc(N) –I Year,
Department of Mental Health Nursing, KGNC.
KGNC.

SUBMITTED ON:
26.10.2017

INTRODUCTION:
 It is a form of treatment for problems in which a trained person deliberately
establishes professional relationship with the client , with the objective of
removing or modifying existing symptoms & promoting positive personality,
growth & development.

DEFINITION:
It is a type of psychotherapy which is based on theories on learning and aims
at changing maladaptive behaviour and substituting it with adaptive behaviour.

GOALS:
 To improve adaptive behaviour.
 To remove the symptoms.
 To increase the personal choice.
 To create new condition for learning.

INDICATIONS:
 Enuresis.
 Tic.
 Phobia.
 Stuttering.
 Obsessive compulsive behaviour.
 Eating disorders.
 Smoking and drinking.
 Drug addiction.

MAIN CONCEPTS:
The main concepts behaviour approach is to take the form of different types of
learning;
 Classical conditioning.
 Operant conditioning.
 Social learning.

Classical conditioning:
This is a type of learning ,when an unconditional stimulus such as food
produces an unconditional response such as salivation. If a netural stimulus such as
a bell is then paired with the unconditional stimulus to get unconditional response.
 This is repeated, the neutral stimulus will create the response of salivation. The
neutral stimulus is now the conditioned stimulus and the response is the
conditioned response.

Operant conditioning:
It is also known as instrumental learning. The process whereby learned
response are controlled by the consequences.
There are 2 main process is involved in operant conditioning;
 Reinforcement
It occurs when a response is strengthened by an outcome. There are 2 types
of it. Which are positive and negative reinforcement.
Positive reinforcement occurs when a behaviour is strengthened by a
positive reward and negative reinforcement is occurs when behaviour is
strengthened by the removal of negative stimulus.
 Punishment.
When a response to behaviour decreases the likelihood o the behaviour
reoccurring. There are 2 types of it. Positive punishment occurs when an
aversive response to behaviour and therefore the behaviour is less likely to
occur. Negative punishment is occur when something is take away and
therefore decrease the likelihood of the behaviour.

Social learning:
Social Learning (or modelling) occurs when an individual (or animal)
responds a certain way due to having observed the behaviour previously. Social
learning is an extension of classical and operant conditioning in that an individual
is conditioned indirectly by observing another’s conditioning. For example, a child
observes his or her older sibling setting the table for their parents. The older child
receives praise for setting the table .The younger child’s own tendency to set the
table for the parents is reinforced as a result of the praise the older child receives.

BEHAVIOUR TECHNIQUES:
1. Systematic desensitization:
In this, patients attain a state of complete relaxation and are then e\posed to
the stimulus that elicits the anxiety response. The negative reaction of
anxiety is inhibited by the relaxed state, a process called reciprocal
inhibition. It consists of three main steps:

I. Relaxation training
II. Hierarchy construction
III. Desensitization of the stimulus
  Relaxation training: There are many methods which can be used to induce
relaxation. Some of them are:
 Jacobson’s progressive muscle relaxation techniques
 Hypnosis
 Meditation or yoga
 Mental imagery
 Biofeedback

 Hierarchy construction: Here the patient is asked to list all the conditions
which provoke anxiety. Then he is asked to list them in a descending order .
of anxiety provocation. The list could look something like this:

 Taking off and flying in the air (most)

 Walking onto a plane.
 Going to an airport.
 Hearing or watching a plane fly in the sky.
 Looking at a toy plane (least).

Once the hierarchy has been developed and the client has learned
all of the relaxation techniques, the clinician would help him
associate the two. He might ask the client to get into a relaxed
state and then imagine the first level of the hierarchy - the toy
plane. Once the person is able to imagine that first level and stay
relaxed, he would move onto the next level, and so on. The
ultimate goal would be to reach the highest level while remaining
relaxed so that flying in a plane would be possible.
 Desensitization of the stimulus: This can either be done in reality or through
imagination. At first, the lowest item in hierarchy is confronted. The patient
is advised to signal whenever anxiety is produced; With each signal he is
asked to relax. After a few trials, patient is able to control his anxiety
gradually.

Indications:
Phobias
Obsessions Compulsions disorders
2.Flooding:
The patient is directly exposed to the phobic stimulus, but escape is made
impossible. By prolonged contact with the phobic stimulus, the therapist guidance
and encouragement and his modeling behaviour reduce anxiety.
Indication:
Specific phobias

3.Aversion therapy:
Pairing of the pleasant stimulus with an unpleasant response, so that
even in absence of the unpleasant stimulus becomes ciation. Punishment is ple
after a specific behavioural response is eventually in response is produced by elicit
social disapproval or even
Indications:
Alcohol abuse
Paraphilias
Homosexuality
Transvestism

4.Operant conditioning procedures for, increasing adaptive behaviour:

 Positive reinforcement:
When a behaviour response is followed by a generally rewarding event such
as food, praise or gifts, it tends it be strengthened and occurs more frequently than
before the reward. This technique issue to increase desired behaviour.
 Token economy:
This program involves gift token rewards for appropriate or desire get
behaviours performed by the patient The token can later be exchanged for 0th:
rewards. For example, in inpatient hospital wards, patients receive a reward for
performing a desired behaviour, such as token which they may use to purchase
luxury items or certain privileges.
5.Operant conditioning procedures to teach new behaviour:
 Modeling:
Modeling is a method of teaching by demonstration, wherein the therapist
shows how a specific behaviour is to be performed In modeling the patient
observes other patients indulging in target behaviours and getting rewards for those
behaviours. The will make the patient repeat the 5am? behaviour and earn rewards
in the same manner.
  Shaping:
In shaping the components oft particular skill, the behaviour is reinforced
at? by step. The therapist starts shaping bl reinforcing the existing behaviour. Once
established he reinforces the responses which are closest to the desired behaviour,
and ignores the other responses. For example, to establish eye-to-eye contact, the
therapist sits opposite the patient and reinforces him even it he moves his upper
body towards him. Once this is established, he reinforces the person’s head
movement in his direction and this procedure continues till eye-to-eye contact is
established.
 Chaining:
Chaining is used when a person fails to perform a complex task. The
complex task is broken into a number of small steps and each step is taught to the
patient. In forward chaining one starts with the first step, goes on to the second
step, then to the third and so on. In backward chaining, one starts with the last step
and goes on to the next step in a backward fashion. Backward chaining is found to
be more effective in training the mentally disabled.

6.Operant conditioning procedures for decreasing maladaptive behaviour:

 Extinction:
Extinction means removal of attention rewards permanently, following a
problem behaviour. This includes actions like not looking at the patient, not talking
to the patient, or having no physical contact with the patient, etc, following the
problem behaviour. This is commonly used when patient exhibits odd behaviour.
 Punishment:
Aversive stimulus (punishment) is presented contingent upon the
undesirable response. The punishment procedure should be administered
immediately and consistently following the undesirable behaviour with clear
explanation. Differential reinforcement of an adaptive or desirable behaviour
should always be added when a punishment is being used for decreasing an
undesirable behaviour. Otherwise the problem behaviours tend to get maintained
because of the lack of adaptive behaviours and skill defect.
 Timeout:
Timeout method includes removing the patient from the reward or the
reward from the patient for a particular period of time following a problem
behaviour. This is often used in the treatment of childhood disorders. For example,
the child is not allowed to go out of the ward to play if he fails to complete the
given work.
 Restitution :
 Restitution means restoring the disturbed situation to a state that is much
better than what it was before the occurrence of the problem behaviour. For
example, if a patient passes urine in the ward he Would be required to not only
clean the dirty area but also mop the entire/larger area of the floor in the ward.
 Response cost:
This procedure is used with individuals who are on token programs for
teaching adaptive behaviour. When undesirable behaviour occurs, a fixed number
of tokens or points are deducted from what the individual has already earned.
7. Assertiveness and social skill training:
Assertive training is a behaviour therapy technique in which the patient is
given training to bring about change in emotional and other behavioural pattern by
being assertive. Patient is encouraged not to be afraid of showing an appropriate
response, negative or positive, to an idea or suggestion; Assertive behaviour
training is given by the therapist, first by role play and then by practice in a real
life situation. Attention is focused on more effective interpersonal skills. Social
skills training helps to improve social manners like encouraging eye contact,
speaking appropriately, observing simple etiquette, and relating to people.

 COGNITIVE THERAPY:

Introduction :
Cognitive therapy has its roots in the early 1960's research on depression
conducted by Aaron Beck (1963-64). in his clinical research, he began to observe a
common theme of negative cognitive processing in thoughts and dreams of his
depressed clients .Behavioural techniques like expectancy of reinforcement and
modeling are used within the domain of cognitive therapy.

Definition:
Cognitive therapy is a type of psychotherapy based on the concept of
pathological mental processing. The focus of treatment is on the modification of
distorted cognitions and maladaptive behaviour.

Cognitive therapy or cognitive behavioural therapy is a type of

psychotherapy which aims at correcting the maladaptive methods of thinking, thus
providing relief from symptoms.

Cognitive behavioural therapy may be used because:

  It's your preferred treatment choice.
 You don’t want to take psychiatric medications.
 You’ve tried of other treatments and they haven't worked.
 Other treatments aren't appropriate for your situation -for instance, you can't
tolerate the side effects from antidepressants.
 You want to experience emotional growth and healing.
 You’re having a hard time overcoming negative moods and self-destructive
behaviour.
 You want to prevent a relapse of your condition after stopping other
treatment.

Indications :

1. Depression.
2. Emotional disorders.
3. Panic disorders.
4. Generalized anxiety disorders.
5. Social phobias,
6. Obsessive compulsive disorders.
7.Eating disorders and Personality disorders.
8,Substance abuse.

Goals of cognitive therapy

The client will:
1. Monitor his or her negative, automatic thoughts.
2. Recognize the connections between cognition, affect, and behaviour.
3. Examine the evidence for and against distorted automatic thoughts.
4. Substitute more realistic interpretations for these biased situations.
5. Learn to identify and alter the dysfunctional beliefs that predispose him or her
to distort experiences.
Principles of Cognitive Therapy
 Principle 1: cognitive therapy is based on an ever evolving formulation of
the client and his or her problems in cognitive terms.
The therapist identifies the event that precipitated the distorted cognition.
Current thinking patterns that serve to maintain the problematic behaviours are
reviewed. The therapist then hypothesizes about the developmental events and
patterns of cognitive appraisal that might have predisposed the client to specific
emotional and behavioural responses.
 Principle 2: cognitive therapy requires a sound therapeutic alliance.
 A trusting relationship between therapist and the client must exist for
cognitive therapy to succeed. The therapist must convey warmth, empathy, caring
and genuine positive regard.
 Principle 3: cognitive therapy emphasizes collaboration and active
participation.
Teamwork between therapist and the client is important. They decide
together what to work on during each session. how often they should meet, and
what homework assignments should be completed between sessions.
 Principle 4: cognitive therapy is goal oriented and problem focused
At the beginning of the therapy the clients is encouraged to identify his or
her problems. With the guidance from the therapist goals are established.
Assistance in problem solving is provided as required as the client comes to
recognize and correct distortions in thinking.
 Principles 5: cognitive therapy initially emphasizes the present.
it is more benefit to begin with current problems and delay shifting
attention to the past until.
(1) the client expresses the desire to do so.
(2) the work on current problems produce little or no change.
(3) the therapist decides it is important to determine how dysfunctional ideas
affecting the client’s current thinking originated.

 Principles 6: cognitive therapy is educative, aims to teach the clients to be

his or her own therapist, and emphasizes relapse prevention.
From the beginning of the therapy the client is thought about the nature and
course of his or her disorder, and about the process 'f cognitive therapy. The client
is taught how to set goals, plan behavioural changes, and intervene on his or her
own behalf.
 Principle 7: cognitive therapy aims to be time limited.
Clients often are seen weekly for a couple of months, followed by a number
of biweekly sessions. then possibly a few monthly sessrons.
 Principles 8: cognitive therapy sessions are structured.
1. Reviewing the clients week
2.. Collaboratively setting the agenda for this session
3. Reviewing the previous week session
4.Reviewing the previous week home work
5. Discussing this week’s agenda items
6. Establishing homework for next week
7. Summarizing this week session.
  Principles 9: cognitive therapy teaches client to identify, evaluate and
respond to their dysfunctional thoughts and beliefs.
Through gentle questioning and review of data, the therapist helps the client
identify his or her dysfunctional thinking, evaluate the validity of thought and
devise a plan of action
 Principles 10: cognitive therapy uses a variety of techniques to change
thinking, mood and behaviour.
Techniques from various therapies may be used within the cognitive
framework. Emphasis in treatment is guided by the client's particular disorder and
directed toward modification of the client's dysfunctional cognitions that are
contributing to the maladaptive behaviour associated with their disorder.

Basic Concepts:
Basic concepts include automatic thoughts and schemes or core beliefs.

1. Automatic thoughts:
Automatic thoughts are those that occur rapidly in response , to a situation
and without rational analysis. These thoughts are often negative. These thoughts
are also called as cognitive errors.
 Arbitrary inference:
it is a type of thinking error, the individual automatically comes to a
conclusion about an incident without the facts to support it, or even sometimes
despite contradictory evidence to support it.
 Overgeneralization (absolutistic thinking):
sweeping conclusions are overgeneralizations made based on one incidenta
type of ‘all or nothing’ kind of thinking.
 Dichotomous thinking:
an individual who is using dichotomous thinking views situations in terms of
all or nothing, black or white, or good or bad.
 Selective abstraction (mental filter):
a selective abstraction is a conclusion that is based on only a selected portion
of the evidence. The selected portion is usually the negative evidence or what the
individual views as a failure, rather than any successes that have occurred.
 Magnification:
Exaggerating the negative significance of an event is known as
magnification.
 Minimization:
undervaluing the positive significance of an event is called minimization.
 Catastrophic thinking:
 always thinking that the worst will occur without considering the possibility
of more likely positive outcomes is considered catastrophic thinking.
 Personalization:
with personalization the person takes full responsibility for situations
without considering other circumstances may have contributed to the outcomes.

2. Schemes (core beliefs)

They may be adaptive or maladaptive. They may be general or specific, and
they may be latent, becoming evident only when triggered by a specific stress
stimulus.
Techniques of Cognitive Therapy:
The three major components of cognitive therapy are didactic or educational
aspects. cognitive techniques, and behavioural interventions.
1. Didactic aspects
One of the basic principles of cognitive therapy is to prepare the client
eventually become his or her own cognitive therapist.

 The therapist will provide information to the client about the cognitive
therapy.
 Reading assignments are given in order to reinforce learning.
 Some therapist use audiotape or videotape to teach the clients.
 A full explanation about the relationship between depression and distorted
thinking patterns is an essential part of cognitive therapy.
2. Cognitive techniques:
Recognizing automatic thoughts and schemes.
 Socratic thinking (guided discovery):
the therapist questions the client about his or her situation. With Socratic
thinking. the client is asked to describe feelings associated with specific situations.
 Imagery and role play:
when Socratic thinking fails, the therapist may choose to guide the client
through imagery exercises or role-play in an effort to elicit the automatic thoughts.
Through guided imagery, the client is asked to “relive” the stressful situation
by imaging the settings in which it occurred. it is a technique that should be used
only when the relationship between the ciient and the therapist is exceptionally
strong. With role play, the therapist assumes the role of an individual Within a
situation that produces a maladaptive response in the client. The role is played out
in an effort to recognition of automatic thoughts.
 Thought recording:
This technique, one of the most frequently used method of recognizing
automatic thoughts, is taught to and discussed with the client in the therapy
session. Thought recording is assigned as homework, for the client outside of
therapy. In thought recording. The client is asked to keep a written record of
situations that occur and the automatic thoughts that are elicited by the situation.

Modifying automatic thoughts and schemes:

 Generating the alternatives:

To help the client see a broader range of possibilities than had originally been
considered, the therapist guides the client in generating the alternatives.
Examining the evidence:
With this technique, the client and therapist set forth the automatic thoughts as
the hypothesis, and they study the evidence both for and against the hypothesis.
 Decatastrophizing:
The therapist helps the client to examine the validity of a negative automatic
thought.
 Reattribution:
Through Socratic questioning and testing of automatic thoughts. this
technique is aimed at reversing the negative attribution of depressed clients from
internal and enduring to the more external and transient manner of non depressed
individual.
 Dally record of dysfunctional thoughts (DRDT) :
it is a common tool used to modify automatic thoughts. The clients are asked
to rate the intensity of the emotions and thoughts on a 0 to 100 point scale.
 Cognitive rehearsal:
This technique uses mental imagery to uncover potential automatic thoughts in
advance of their occurrence in a stressful situation. A discussion is held to identify
ways to modify these dysfunctional cognitions.

3.Behavioural interventions
 Activity scheduling:
with this intervention, clients are asked to keep a daily log of their activities on
hourly bases and rate each activity, for mastery and pleasure on a 0 to 10 scale.
 Graded task assignments:
this intervention is used with clients who are facing a situation that they
perceive as overwhelming. The task is broken down into subtasks that the client
can complete one step at a time. Successful completion of each subtask helps to
increase self esteem and decrease feelings of helplessness.
 Behavioural rehearsal:
this technique uses role-play to rehearse a modification of maladaptive
behaviours that may be contributing to dysfunctional cognitions.
  Distraction:
activities are identified that can be used to distract clients and divert them from
the intrusive thoughts or depressive ruminations that are contributing to the
maladaptive response.

RELAXATION THERAPY

Relaxation therapy is a technique to induce profound muscular relaxation

Purposes:
 To minimize the stress
 To improve the circulation
 To relieve muscle fatigue
 To improve the physical and mental health
 To improve the physiological function;

Physiological effects:
 Respiratory rate slows 4 to 6 breaths pen minute
 Heart rate to as low as 24 beats per minute
 Blood pressure decrease
 Metabolic rate slows down
 Muscle tension diminishes
 Pupil constrict
 Peripheral vasodilatation
 Cognitive and behaviour effects
 Mental alertness
 Active thinking
 increases the creativity & memory
 increases the ability to concentrate
 Improvement in adoptive functioning

Elements of relaxation therapy:

 Quiet environment
 Mental devices
 Passive attitude
 Comfortable position

Method of relaxation techniques :

 Jacobson progressive muscle relaxation
 Meditation
  Yoga
 Biofeedback
 Physical exercises

Jacobson progressive muscle relaxation:

often used relaxation training, developed by the psychiatrist Edmund

Jacobson. in this client must learn to relax through deep muscle relaxation training.
Patients relax major muscle group in a fixed order, beginning with the
small muscle group of the feet and Working cephal head or vice versa.

Procedure:
 Make the patient in a comfortable position
 Provide light or soft music I pleasant visual cues.
 Give a brief explanation about the progressive muscle relaxation.
 Instruct the client to tense each muscle group approximately for 10 seconds
 Explain the tension of the muscle and uncomfortable the body part feels.
 Ask the client to relax each muscles
 Make client to feel the difference between both the situation.

Meditation:

Meditation or contemplation involves focusing the mind upon a sound. phrase,

prayer, object, visualized image, the breath, ritualized movements or consciousness
in order to increase awareness of the present moment, promote relaxation,
reduce stress and enhance personal or spiritual growth.

Purpose:
 Promote Well being in healthy people
 Meditate regularly experience less anxiety and depression.
 Gives more enjoyment and appreciation of life;
 Facilitates a greater sense of calmness, empathy and acceptance of self and
others.
 Based upon clinical evidence, meditation is seen as an appropriate therapy
for panic disorder. generated anxiety disorder, substance dependence and
abuse. and dysthymic mood.
 It may improve function or reduce symptoms of patients with neurologic
disorders such as Parkinson's disease, multiple sclerosis and epilepsy.
Types of meditation:

o Concentration meditation
it involves focusing one's attention on the breath. an imagined or real
image. ritualized movement or on a sound, word. or phrase that is repeated silently
or aloud. The benefit of being fully present is that worries and anxieties fade, and a
feeling of peace ensues.

o Mindful meditation
it involves becoming aware of the entire triad of attention. There is an
awareness of all thought. feelings. perceptions or sensations as they arise from
moment to moment.

Yoga:

Yoga is an ancient system of breathing practice, physical exercise and postures

and meditation intended to integrate the practitioner’s body. mind and spirit.

Indication:
 Depression.
 Anxiety.
 Post traumatic stress disorder
 Substance abuse.

Purposes:

 The stretching, bending and balancing involved in the asanas

(physical postures that are part of a yoga practice) help to align the
head and spiral column, stimulate the circulatory system. endocrine
glands and other organs. and keep muscles and joints strong and
flexible.
 it is more effect in treating asthma, arthritis. heart disease. stress
related illness. high blood pressure, anxiety and mood disorder.
Methods of yoga:

 There are a large number of methods of yoga. They are broadly

classified into four streams

 (A) Path of Analysis: Juana Yoga (Philosophy).

 The age of science has made man a rational being Intellectual sharpness is
immanent Analyse; from the tool. The path of philosophy (Jnana yoga) Is most
apt for the sharp intellectuals

 It is centered around the analysis of Happiness, the Vital contribution

of Upanishads Also many others fundamental questions regarding life
and reality are taken up In this path, man learns to use the Intellect
 to overcome the Intellect and goes to the very basis of Intellectual
thinking

 (B) Path of Psychic Control [Raja Yoga ]:

 Culturing of mind is the key to success In almost all endeavours In

our lives The Yoga of mind culture (Raja Yoga) gives a practical and
easy approach to reach higher states of consciousness. it is based on
the Antaranga yoga of Pataniali's Asthanga yoga system. The eight
limbs of this yoga are:

 Yama (the disciplines, don’t, nisedhas)

 Niyama (the injunctions. 'DOS', 'vidhis')
 Asana (the posture of the body).
 Pranayama (the control of prana, the life-entity)
 Pratyahara (restraint of senses from their sense object)
These first five limbs come under a general heading 'BAHIRANGA YOGA'.
In this. the ‘Bahirindriyas' (the enema) voluntary sense organs) are used to gain
control over the mind indirectly The last 3 limbs are referred to as Antaranga yoga
here-in the mind is used directly to culture itself. The art of focusing and
defocusing the mind is mastered
 Dharana (focusmg of Mind)
 Dhyana (deconcentration)
 Samadhi (super consciousness)

(C) Control of Emotions: Bhakti yoga(Devotion)

 The control of emotions Is the key to the path of worship (Bhakti

yoga) In this modern world. man is tossed up and down in the ocean
or emotional conflicts and upsurges The path of Bhakti is a boon to
 gain control over these emotional Instabilities and suppressions by
property harnessing the energy Involved In It. by property harnessing,
the energy Involved In it. Bhakti Yoga Is the science of energy
culture to transform the crude forms of uncontrolled emotion al
energy upsurges to subtle harmonious form of energy .

 (D) The path of work: Karma Yoga

 This Involves doing action with an attitude of detachment to fruits of

action. This makes man release himself from strong attachment and
thereby brings in him a steadiness in mind which verify is Yoga
'Samatwam Yogah Ucyate'. The secret of Karma Yoga is to tactfully
use lust enough energy to accomplish the lab It Is the skill of
working, in deep relaxatron and peaceful awareness .

Biofeedback:

Biofeedback is a technique that uses monitoring instrument to measure and

feedback information about muscle tension. heart rate. sweat responses. skin
temperature or brain r activity.

Terms associated with biofeedback include applied psychophysiology or

behavioural psychology. It is also viewed as a mind-body therapy method used in
complementary and alternative medicine. Biofeedback is an important part of
understanding the relationship between physical state and thoughts, feelings and
behaviours.

Purpose:
 To enhance an individual’s awareness of physical reactions to physical,
emotional or psychological stress,
 Ability to influence their own physiological response.
 to develop self regulation skills that play a role in improving health and well
being.
Indication:

 High blood pressure

 Bruxism
 Post traumatic stress disorders
  Eating disorder
 Substance abuse
 Anxiety disorder
 Attention deficit disorder Migraine headache
 Depression
 Sleep disorders.
Biofeedback equipment:
Electronic instrument used to obtain immediate feedback to the patient
regarding his physiological activities (ECG, EEG, Pulse, BP. GSR (galvanic skin
response).

Physical exercises
Physical exertion provides a natural outlet for the tension produced by the
body in its state of aerosol for ‘fight or flight’.
 Following exercise physiological equilibrium restored.
 Resulting in a feeling of relaxation and revitalization.
 Aerobic exercise strengthen the cardio vascular system.

 ABREACTION THERAPY

Abreaction Therapy focuses on reliving a traumatic event and going through

the emotions associated with them to heal and move forward. Originally created by
Sigmund Freud the method gives patients a way to release their unconscious pain
and escape from the memories and feelings that have kept them from moving
forward. Therapists who work as Abreaction counselors use catharsis or the
cleansing of emotions to get rid of the spirit and thoughts associated with the
experience. As a process that brings out difficult emotions the client will go
through an emotional removal that takes away the burden of the traumatic event
after treatment.

Goals of Abreaction Therapy:

 Tto cleanse the patient’s body by going through their trauma yet again and
letting go of painful thoughts and emotions.
 When the client has completed their treatment they should be able to speak
Openly about the event without feeling uncomfortable or unable to cope.
 Therapy clears up what has happened and heals the individual so that they
can move forward and prevent the trauma from ruining their personal lives
and relationships.
 . As a traditional and direct form of therapy this is an awareness tool
  that helps clear up the conscious tension which can be extremely dramatic
when it is associated with heavy emotions and painful memories.

When is Abreaction Therapy Used? :

 when a client is in need of an emotional and spiritual breakdown.

 reliving the memories and feelings it releases fears and rejections
 It is used only for those who've dealt with trauma and hardship which is also
affecting their current lives and relationships with others.
 Traumatic events can ruin trust, love and security.
 It's common that the clients suffer from a lack of self esteem and assurance
in themselves because of what's happened to them. .

How Abreaction Therapy Works :

 As a form of "reliving" in psychotherapy, Abreaction Treatment may take

longer than other treatment plans.
 Currently Abreaction is not used in its current form but as a combination
approach which outlines the traumatic event to integrate the past and
constructively deal with the pain associated with it.
 Being that the trauma is complex and affects the patients in various ways the
counselor works with the technique carefully to relive memories and
overcome the patient's disassociation from the event and pain
 . The treatment works by acknowledging the flashbacks and distrust. It is
likely that the patient will also undergo disorientation toward the beginning
of treatment. The counselor has to be careful when they are reliving the
event being that it often promotes flashbacks as an unavoidable element in
working with trauma.
 The therapist will have to ensure that a trusting relationship has been put in
place with the patient before thoughts are expressed.
 Security between the two will create safety in the presence of the therapist
during Abreaction.
 Toward the beginning of the treatment the counselor creates stabilization in
the room
 provides the patient with a psychoeducation so that they can possess a
deeper understanding of what's happening and why.
 The moment when the event is relived could occur quickly because of
atrigger that's been made accidentally.
  Although it may feel like internal pressure and conflict for a period of time
the counseling will release the unprocessed emotions and material for the
purpose of bringing them closer to the surface.
 The pressure may feel like a power struggle although it results in conscious
and sub-conscious clarity.
 When the thoughts and feelings are released the client gains understanding,
clarity and a new identity.
 This is a beneficial strategy in working with hostile memories because it
creates a new role for the individual.
 This is a collaboration platform between the therapist and patient to rid of
disturbing memories, close them and move forward in life.
 Being that the counselor is a hand to hold during the process it acts as a
physical anchor.
 The creation and development of the relationship is essential and it could
take a lengthy session time until the client is ready to relive the event.For
patients that are severely damaged it can take many sessions before
internalizing the security and commitment.
 Although abreaction can be done with or without the use of medication, the
procedure can be facilitated by giving a sedative drug intravenously. A safe
method is the use of thiopentone sodium, 500 mg dissolved in 10 cc of
normal saline. It is infused at a rate no faster than

 RESEARCH STUDIES:
Emilia Winnebeck and Maria Fissler had conducted A randomised control
trail on chronic depression patients to reduce the symptoms by providing
mindfulness meditation.
 Background
Training in mindfulness has been introduced to the treatment of depression as a
means of relapse prevention. However, given its buffering effects on maladaptive
responses to negative mood, mindfulness training would be expected to be
particularly helpful in those who are currently suffering from symptoms. This
study investigated whether a brief and targeted mindfulness-based intervention can
reduce symptoms in acutely depressed patients.
 Methods:
Seventy-four patients with a chronic or recurrent lifetime history were randomly
allocated to receive either a brief mindfulness-based intervention (MBI)
encompassing three individual sessions and regular home practice or a control
condition that combined psycho-educational components and regular rest periods
using the same format as the MBI. Self~reported severity of symptoms,
mindfulness in every day life, ruminative tendencies and cognitive reactivity were
assessed before and after intervention.
 Results:
Treatment completers in the MBI condition showed pronounced and
significantly stronger reductions in symptoms than those in the control condition.
in the MBI group only, patients showed significant increases in mindfulness, and
significant reductions in ruminative tendencies and cognitive reactivity.
 Conclusions:
Brief targeted mindfulness interventions can help to reduce symptoms and buffer
maladaptive responses to negative mood in acutely depressed patients with chronic
or recurrent lifetime history.

ROLE OF NURSE IN THERAPY :

 Helps the individuals to recognize the source of stress .

 Help to identify the method of coping
 To identify the individual adaptation to stress.
 To assist the individual to achieve their highest potential for wellbeing.
 To evaluate the effectiveness of the therapy.
 To plan alternative/modification therapy.
 To identify the behaviour to be changed.
 To determine how behaviour is maintained.
 To determine in which setting the behaviour is elicited.
 To identify the things that can be used as reward and punishment.

SUMMARY:
Till now I discussed about ,
 Definition.
 Goals.
 Indication.
 Behaviour techniques.
 Other therapies.
 Role of nurse in therapies.

CONCLUSION:
 Here I conclude the topic, that the student can able to understand and gains
valuable information that she can utilize to therapeutic advantage in the working
phase of nurse patient relationships.

BIBLIOGRAPHY:

Book references:

1. D.elakkuvanabhaskara raj(2014), “debr’s mental health\psychiatric nursing”,

1st edition, bangalore, emmess publications, page no: 1-29
2. Gail.w.stuart, michele t. Laraia (2005),”principles and practice of
th
psychiatric nursing”, 8 edition, missouri, elsevier publications, page no:5-7
3. R. Sreevani (2010), “a guiode to mental health and psychiatric nursing”,3 rd
edition, bangalore, jaypee publications, page no:7-12
4. Dr.k.lalitha (2007), “mental health and psychiatric nursing on indian
perspective”.1st edition, bangalore, vmg book house, page no:3-12
5. M.s.bhatia (2004), “a concised textbook of psychiatric nursing”, 3 rd edition,
delhi, cbs publishers and distributors, page no:59-61
6. Bimlakapoor(d.elakkuvanabhaskara raj(2014), “debr’s mental
st
health\psychiatric nursing”, 1 edition, bangalore, emmess publications,
page no: 1-29
7. Gail.w.stuart, michele t. Laraia (2005),”principles and practice of
th
psychiatric nursing”, 8 edition, missouri, elsevier publications, page no:5-7
8. R. Sreevani (2010), “a guide to mental health and psychiatric nursing”,3 rd
edition, bangalore, jaypee publications, page no:7-12
9. Dr.k.lalitha (2007), “mental health and psychiatric nursing on indian
perspective”.1st edition, bangalore, vmg book house, page no:3-1
10. Bimlakapoor(2002), “textbook psychiatric nursing”,7thedition,vol ii,
delhi, kumar publishing house, page no:45-60.

Journal references:
 1. Indian psychiatry journal: vol-25, issue 2, Jul-Dec 2016.
2. Journal of mental health nursing: vol-5, issue 1, Jan-June 2017.

Net references:

1.http:// www.ncbi.nih.gov. psychotherapy.

2.http://www.slideshare.net/ behaviour therapies and techniques..

3.http://www.pdf.net/ behaviour therapy.