Chapter 37

Behavior and Somatic Therapies

Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

Learning Objectives
Identify three techniques for increasing a behavior. Describe two schedules of reinforcement. Identify four techniques for decreasing a behavior. Understand the principles of a token economy program. Discuss three techniques for helping patients deal with disturbing stimuli.

Keltners Psychiatric Nursing Philippine edition

Learning Objectives
Identify the major indications for electroconvulsive therapy (ECT). Compare modern ECT with traditional ECT depicted in some movies. Name and understand the purpose of the drugs used in conjunction with ECT. Describe the nurses role in caring for patients before and after ECT.

Keltners Psychiatric Nursing Philippine edition

Foundations of Behavior Therapy

Classical Conditioning Respondent conditioning is the process of pairing a neutral stimulus with an eliciting stimulus; thus, ultimately, the neutral stimulus alone elicits the response. Operant Conditioning Attention is directed to events that immediately precede and/or follow a specific behavior.
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Behavior Modification: Helping Patients Change Behavior

Conditioning Strengthening of a response by reinforcement. Premack Principle When a person is observed often enjoying a particular activity, the opportunity to engage in that activity can be used as a reinforcer for other behaviors that occur less frequently. Shaping A process of reinforcing successive approximations of responses to increase the probability of a behavior.
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Schedules of Reinforcement
Continuous Reinforcement Presentation of reinforcing stimuli following each occurrence of the selected response. Intermittent Reinforcement The presentation of the reinforcer following the target response according to a selected number of responses (ratio schedule).
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Decreasing the Probability That a Behavior Will Occur

Differential reinforcement of other behaviors Extinction

Negative consequence

Time-out

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Modern ECT
During ECT, an electric current is passed through the brain for 0.28.0 s, causing a seizure.

Seizures are timed and subdivided into motor convulsions (at least 20 s required), increased heart rate (for 3050 s), and a brain seizure as monitored by an electroencephalogram (for 30150 s).

The patient is given an oximeter-monitored anesthetic to ensure optimal oxygenation.

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Three Basic Medications Used for ECT

1. Atropine, the prototype anticholinergic, to reduce secretions 2. Methohexital (Brevital) intravenously to cause immediate anesthesia

3. Succinylcholine (Anectine) intravenously for its neuromuscular blocking effect

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Nursing Responsibilities after ECT

1. The nurse or anesthesiologist mechanically ventilates the patient with 100% oxygen until the patient can breathe unassisted. 2. The nurse monitors for respiratory problems. 3. ECT causes confusion and disorientation; thus, it is important to help with reorientation as the patient emerges from this groggy state.

Keltners Psychiatric Nursing Philippine edition

Nursing Responsibilities after ECT

4. Because approximately 510% of these patients awake in an agitated state, the nurse might need to administer a benzodiazepine, PRN. 5. Observation is necessary until the patient is oriented and steady, particularly when the patient first attempts to stand. 6. All aspects of the treatment should be carefully documented for the patients record.

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Psychosurgery
Also known as lobotomy. A controversial brain surgery is performed to provide relief from mental disorders that have been resistant to other treatment forms.

Keltners Psychiatric Nursing Philippine edition