Behavioural Psychotherapy

Indications

• Phobias

• OCD

• Generalised anxiety disorder

• PTSD

• Sexual problems

• Habit disorder (tics, stammer, enuresis, pathological gambling)

• Anger control

• Nightmares

• Disturbed behaviour in learning disorders / chronic psychosis

Contraindications

• Severe depression

• Psychosis

• Severe organic disease

• Benzodiazepine, propranolol, alcohol, propranolol dependence

General Principles

• Exposure and response prevention lead to habituation and reduction of anxiety

• Thought stopping with anxiolytic thoughts

• Relaxation unnecessary

• Accompanied or unaccompanied

• Modelling may be helpful

Behavioural Management of anxiety disorders

1. Detailed behavioural history

   • antecedents

   • behaviour

   • consequences

   • observable behaviours

   • physiological and psychological symptoms

   • environmental cues

   • aggravating and mitigating factors

2. Explain to patient principles of treatment

3. With patient write down one or two problems to be treated (observable behaviours)

4. With patient write down one or two goals of treatment

5. Rate severity of problems on main problem, work, social adjustment scales

6. With patient prepare graded list of exposures and ritual prevention in order of difficulty

7. With patient write down 2 or 3 homework tasks

8. Patient to be told to keep homework diary noting exposures and ritual prevention before, after and during exposure

9. At next session 1/2 weeks later review homework and set new tasks

• Exposure can be fantasy initially but in vivo should be aimed for

• If ritually washing, cleaning should be told to recontaminate

• family should be told not to give reassurance

• compliance should be monitored & encourage patient to nominate co-therapist to monitor homework and progress

• If patient depressed antidepressant can be given

• as treatment draws to end relapse prevention should be emphasised

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