Behavior modification is a therapeutic approach involving the application of learning principles so as to change maladaptive behavior.

1. DEFINITIONS:
   conditioned avoidance(also aversion therapy) a technique whereby there is a purposeful and systematic production of strongly unpleasant responses in situations to which the client has been previously attracted but now wishes to avoid.
   desensitizationfrequent exposure in small but gradually increasing doses of anxiety-evoking stimuli until undesirable behavior disappears or is lessened (as in phobias).
   token economydesired behavior is reinforced by rewards, such as candy, money, and verbal approval, used as tokens.
   operant conditioninga method designed to elicit and reinforce desirable behavior (especially useful in mental retardation).
   positive reinforcementgiving rewards to elicit or strengthen selected behavior or behaviors.
2. OBJECTIVES AND PROCESS OF TREATMENT in behavior modification:
1. Emphasis is on changing unacceptable, overt, and observable behavior to that which is acceptable; emphasis is on changed way of acting first, not of thinking.
2. Mental health team determines behavior to change and treatment plan to use.
3. Therapy is based on the knowledge and application of learning principles, that is, stimulus-response; the unlearning, or extinction, of undesirable behavior; and the reinforcement of desirable behavior.
4. Therapist identifies what events are important in the life history of the client and arranges situations in which the client is therapeutically confronted with them.
5. Two primary aspects of behavior modification:
1. Eliminate unwanted behavior by negative reinforcement (removal of an aversive stimulus, which acts to reinforce the behavior) and ignoring (withholding positive reinforcement).
2. Create acceptable new responses to an environmental stimulus by positive reinforcement.
6. Useful with: children who are disturbed, victims of rape, dependent and manipulative behaviors, eating disorders, obsessive-compulsive disorders, sexual dysfunction.
3. ASSUMPTIONS OF BEHAVIORAL THERAPY:
1. Behavior is what an organism does.
2. Behavior can be observed, described, and recorded.
3. It is possible to predict the conditions under which the same behavior may recur.
4. Undesirable social behavior is not a symptom of mental illness but is behavior that can be modified.
5. Undesirable behaviors are learned disorders that relate to acute anxiety in a given situation.
6. Maladaptive behavior is learned in the same way as adaptive behavior.
7. People tend to behave in ways that "pay off."
8. Three ways in which behavior can be reinforced:
1. Positive reinforcer (adding something pleasurable).
2. Negative reinforcer (removing something unpleasant).
3. Adverse stimuli (punishing).
9. If an undesired behavior is ignored, it will be extinguished.
10. Learning process is the same for all; therefore, all conditions (except organic) are accepted for treatment.
4. NURSING CARE PLAN/IMPLEMENTATION in behavior modification:
1. Find out what is a "reward" for the person.
2. Break the goal down into small, successive steps.
3. Maintain close and continual observation of the selected behavior or behaviors.
4. Be consistent with on-the-spot, immediate intervention and correction of undesirable behavior.
5. Record focused observations of behavior frequently.
6. Participate in close teamwork with the entire staff.
7. Evaluate procedures and results continually.
8. Health teaching: teach preceding steps to colleagues and family.
5. EVALUATION/OUTCOME CRITERIA: acceptable behavior is increased and maintained; undesirable behavior is decreased or eliminated.