Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

TABLE 29-2. Some Common Clinical Applications of Behavior Therapy Disorder Comments Agoraphobia

Graded exposure and flooding can reduce the fear of being in crowded places. About 60% of patients so treated have improved. In some cases, the spouse can serve as the model while accompanying the patient into the fear situation; however, the patient cannot get a secondary gain by keeping the spouse nearby and displaying symptoms. Aversion therapy, in which the patient is made to vomit (by adding an emetic to the alcohol) every time a drink is ingested, is effective in treating alcohol use disorder. Disulfiram (Antabuse) or acamprosate (Campral) can be given to patients when they are alcohol-free. Such patients are warned of the severe physiologic consequences of drinking (eg, nausea, vomiting, hypotension, collapse) with disulfiram in the system. Acamprosate does not produce these effects. Systematic desensitization has been effective in treating specific phobias, such as fears of heights, animals, and flying. Social skills training has also been used for shyness and fear of other people. Electric shocks or other noxious stimuli can be applied at the time of a para philic impulse, and eventually the impulse subsides. Shocks can be adminis tered by either the therapist or the patient. The results are satisfactory but must be reinforced at regular intervals. The token economy procedure, in which tokens are awarded for desirable behavior and can be used to buy ward privileges, has been useful in treating inpatients with schizophrenia. Social skills training teaches patients with schizophrenia how to interact with others in a socially acceptable way so that negative feedback is eliminated. In addition, the aggressive behavior of some patients with schizophrenia can be diminished through those methods. Sex therapy, developed by William Masters and Virginia Johnson, is a behav ior therapy technique used for various sexual dysfunctions, especially male erectile disorder, orgasm disorders, and premature ejaculation. It uses relax ation desensitization and graded exposure as the primary techniques. Inability to void in a public bathroom . Therapies include relaxation exercises. Observe eating behavior; contingency management; record weight. Record bulimic episodes; log moods. Hyperventilation test; controlled breathing; direct observation

Alcohol use disorder

Anorexia nervosa

Bulimia nervosa

Hyperventilation Specific phobias

Paraphilias

Schizophrenia

Sexual dysfunctions

Shy bladder

Type A behavior

Physiologic assessment of muscle relaxation, biofeedback (on electromyogram)

unpleasant with the undesired behavior. It has been used to treat substance use disorders or compulsive behaviors (eg, sex addiction, gambling addiction, video game addiction). Systematic desensitization Systematic desensitization is based on the behavioral principle of counter conditioning, whereby a person overcomes maladaptive anxiety elicited by a situation or object by approaching the feared situation gradually and in a psy chophysiologic state that inhibits anxiety. Rather than use actual situations or

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