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Chapter: Psychiatric Mental Health Nursing : Psychosocial Theories and Therapy

Behavioral Theories

Behaviorism grew out of a reaction to introspection models that focused on the contents and operations of the mind.

Behavioral Theories

Behaviorism grew out of a reaction to introspection models that focused on the contents and operations of the  mind. Behaviorism is a school of psychology that focuses on observable behaviors and what one can do externally to bring about behavior changes. It does not attempt to explain how the mind works.

Behaviorists believe that behavior can be changed through a system of rewards and punishments. For adults, receiving a regular paycheck is a constant positive reinforcer that motivates people to continue to go to work every day and to try to do a good job. It helps motivate positive behavior in the workplace. If someone stops receiving a paycheck, he or she is most likely to stop working. 

If a motorist consistently speeds (negative behavior) and does not get caught, he or she is likely to continue to speed. If the driver receives a speeding ticket (a negative reinforcer), he or she is likely to slow down. However, if the motorist does not get caught for speeding for the next 4 weeks (negative reinforcer is removed), he or she is likely to resume speeding.

Ivan Pavlov: Classical Conditioning

Laboratory experiments with dogs provided the basis for the development of Ivan Pavlov’s theory of classical condi-tioning: Behavior can be changed through conditioning with external or environmental conditions or stimuli.

Pavlov’s experiment with dogs involved his observation that dogs naturally began to salivate (response) when they saw or smelled food (stimulus). Pavlov (1849–1936) set out to change this salivating response or behavior through conditioning. He would ring a bell (new stimulus), then produce the food, and the dogs would salivate (the desired response). Pavlov repeated this ringing of the bell along with the presentation of food many times. Eventually he could ring the bell and the dogs would salivate without seeing or smelling food. The dogs had been “conditioned,” or had learned a new response—to salivate when they heard the bell. Their behavior had been modified through classical conditioning, or a conditioned response.


B. F. Skinner: Operant Conditioning


One of the most influential behaviorists was B. F. Skinner (1904–1990), an American psychologist. He developed the theory of operant conditioning, which says people learn their behavior from their history or past experiences, particularly those experiences that were repeatedly rein-forced. Although some criticize his theories for not con-sidering the role that thoughts, feelings, or needs play in motivating behavior, his work has provided several impor-tant principles still used today. Skinner did not deny the existence of feelings and needs in motivation; however, he viewed behavior as only that which could be observed, studied, and learned or unlearned. He maintained that if the behavior could be changed, then so too could the accompanying thoughts or feelings. Changing the behav-ior was what was important.

The following principles of operant conditioning described by Skinner (1974) form the basis for behavior techniques in use today:


·    All behavior is learned.


·    Consequences result from behavior—broadly speaking, reward and punishment.


·    Behavior that is rewarded with reinforcers tends to recur.


·    Positive reinforcers that follow a behavior increase the likelihood that the behavior will recur.


·    Negative reinforcers that are removed after a behavior increase the likelihood that the behavior will recur.


·    Continuous reinforcement (a reward every time the behavior occurs) is the fastest way to increase that behavior, but the behavior will not last long after the reward ceases.


·        Random intermittent reinforcement (an occasional reward for the desired behavior) is slower to produce an increase in behavior, but the behavior continues after the reward ceases.


These behavioral principles of rewarding or reinforcing behaviors are used to help people change their behaviors in a therapy known as behavior modification, which is a method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative. Forexample, if the desired behavior is assertiveness, whenever the client uses assertiveness skills in a communication group, the group leader provides positive reinforcement by giving the client attention and positive feedback. Nega-tive reinforcement involves removing a stimulus immedi-ately after a behavior occurs so that the behavior is more likely to occur again. For example, if a client becomes anx-ious when waiting to talk in a group, he or she may volun-teer to speak first to avoid the anxiety.


In a group home setting, operant principles may come into play in a token economy, a way to involve residents in performing activities of daily living. A chart of desired behaviors, such as getting up on time, taking a shower, and getting dressed, is kept for each resident. Each day the chart is marked when the desired behavior occurs. At the end of the day or the week, the resident gets a reward or token for each time each of the desired behaviors occurred. The resident can redeem the tokens for items such as snacks, TV time, or a relaxed curfew.

 Conditioned responses, such as fears or phobias, can be treated with behavioral techniques. Systematic desensiti-zation can be used to help clients overcome irrational fears and anxiety associated with phobias. The client is asked to make a list of situations involving the phobic object, from the least to the most anxiety provoking. The client learns and practices relaxation techniques to decrease and man-age anxiety. He or she is then exposed to the least anxiety-provoking situation and uses the relaxation techniques to manage the resulting anxiety. The client is gradually exposed to more and more anxiety-provoking situations until he or she can manage the most anxiety-provoking situation.

Behavioral techniques can be used for a variety of prob-lems. In the treatment of anorexia nervosa, the goal is weight gain. A behavioral contract between the client and the therapist or physician is initiated when treatment begins. Initially, the client has little unsupervised time and is restricted to the hospital unit. The contract may specify that if the client gains a certain amount of weight, such as 0.2 kg/day, in return he or she will get increased unsuper-vised time or time off the unit as long as the weight gain progresses. When working with children with attention deficit hyperactivity disorder, goals include task comple-tion for homework, hygiene tasks, turn-taking when talk-ing, and so forth. The child is given a “star” or sticker when tasks are completed. Upon reaching a specified num-bers of stars, the child receives a reward.

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