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OF mental health care and mentally ill

Models of mental disorder-The behavioural model

The behavioural model has a scientific basis in Learning Theory. Symptoms are considered to be learned habits arising from the interaction between external events or stressors and an individual’s personality. Persistent, distressing symptoms are considered maladaptive responses rather than being markers for some underlying disease or illness. For the behaviour therapist the symptoms and their associated behaviours are the disorder.

Learning theory posits that two forms of conditioning are responsible for the formation of symptoms; classical and operant. Classical conditioning refers to a neutral stimulus that becomes associated with an unrelated but established stimulus response sequence. Seminal experimental work in this area was conducted by the Russian physiologist Pavlov (1927) who conditioned dogs to salivate in response to a bell rather than to the established stimulus of food. Initially food was provided to the animals when a bell sounded. After several such trials the animals would salivate at the sound of the bell even when unaccompanied by food. Operant conditioning results from behaviour rather than as the consequence of a stimulus. Skinner (1972) conducted seminal work in this field with a box in which one or more levers could be pressed. Rats would be placed in the box and through natural curiosity they would eventually press one or all of the levers. When the appropriate lever was pressed food would be deposited in the box.

Gradually the rats would learn to continually press the appropriate lever until their appetites were satisfied. Thus it is not a neutral stimulus or the manipulation of an experimenter that conditioned the rats, but their own behaviour. But how do these theories relate to the development of human behavioural problems? Take a simple example involving a phobia or fear of spiders in a parent of a family with children. When the parent encounters a spider their response may be at odds with the threat that a spider poses. They may appear to panic, perhaps scream and will certainly try to avoid the spider. It is possible that the children in this family will also develop a similar response since they have been subject to the classical conditioning of the parent.

Thus they may learn to fear and avoid spiders, which can become self-perpetuating as their fear confirms the danger spiders pose, and their avoidance obviates any opportunity to realize that spiders pose no threat. The behaviour therapist is interested in replacing maladaptive responses with adaptive behaviour patterns. This is usually done by gradually removing the fear response through such techniques as graded exposure and systematic desensitization. So the parent in our example may first be encouraged to imagine spiders, then view pictures of them in a book, followed by seeing them in a jar across the room, then holding the jar and f inally holding the spider. Each of these stages will invoke a fear response but these will gradually subside if the person is encouraged to remain with the present situation through which they learn that spiders are actually quite harmless. An important principle of behaviour therapy is a collaborative working partnership between client and therapist.

 A person’s behaviour is part of their own responsibility and not something that can be handed over to a doctor to sort out. The therapist does not view the person as being abnormal or ill, but regards them as an equal partner in an unlearning, or new learning process. Furthermore, behaviour therapists see this partnership as critical if the individual is to maintain and develop their new adaptive behaviours once therapy has finished. This approach to managing human behaviour has had a major influence on mental health nursing, for example, through the work of Isaac Marks who, though not a nurse, has championed nurse behaviour therapists.

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