Behavioral, Cognitive-Behavioral, and Sensory Modulation Approaches

Behavioral FOR

• The frequency of a behavior depends on its reinforcement contingencies, analyzed as an A-B-C sequence (antecedent, behavior, and consequence)

• OT’s Role: To organize the factors that influence behavior so the client learns and maintains adaptive behavior.

• Behavioral Intervention: behavior management and skill building.

• Goal: Relevant, observable, understandable, measurable, behavioral, and attainable within a reasonable length of time

The Four Quadrants of Operant Conditioning

Behavioral Strategies and Techniques

1. Behavior-Management Techniques

2. Skill-Building Techniques

Behavioral-Management Techniques

1. Forms of Reinforcement

2. Reinforcement Schedules

3. Positive Reinforcement and the Premack Principle

4. Token Economy, Contact Setting, and Response Cost

5. Differential Reinforcement of an Alternative Behavior

6. Planned Ignoring (extinction)

7. Satiation

8. Overcorrection

9. Systematic Desensitization

BMT: Forms of Reinforcement

Primary Reinforcers: Meet a physiological need

Secondary Reinforcers: Learned and take their value from buying access to primary ones

Social Reinforcers: Attention, praise, and gesture

BMT: Reinforcement Schedule

Set how often reinforcement follows the behavior.

• Continuous establishes a new behavior

• Intermittent (ratio or interval, fixed or variable) maintains it.

BMT: Positive Reinforcement and the Premack Principle

• Strengthens a behavior by following it with something that person values.

• First do low-probability [non-preferred], then high-probability

BMT: Token Economy, Contact Setting, and Response Cost

Make the contingency explicit, visible, and negotiable. Response cost removes an agreed number of tokens when the problem behavior occurs.

BMT: Differential Reinforcement of an Alternative Behavior

Builds a replacement that cannot happen at the same time as the problem behavior.

BMT: Planned Ignoring (extinction)

• Withholds the reinforcer that is maintaining an attention-maintained behavior.

• Note: If not productive → don’t acknowledge

BMT: Satiation

• Removes the motivation for a behavior by allowing it until it stops being rewarding.

BMT: Overcorrection

Follows the behavior with effortful correction:

• Restitutional (restore the situation)

  • Nagkalat ka → ikaw maglinis

• Positive practice (rehearse the correct behavior repeatedly).

  • Hand-to-hand (won’t flick, will wash hand)

BMT: Systematic Desensitization

Pairs relaxation with graded exposure so the anxiety response is inhibited.

Note: Gradual involvement (nood sa malayo → nasa gilid → nagkuha na ng gamit)

Least to most-anxiety response is inhibited.

Skill-Building Techniques

1. Shaping

2. Modelling

3. Forward Chaining

4. Backward Chaining

5. Prompting and Fading

SBT: Shaping

• Reinforces successive approximations until the terminal behavior is reached.

• Every step may reinforcement

SBT: Modelling

Teaches through observation of a competent performance before the client attempts it.

SBT: Forward Chaining

• Teaches the first step first and adds steps in order, each learned step cueing the next.

• E.g., Pagluluto ng itlog: Step 1: buksan kalan, Step 2: lagay kawali, Step 3: lagay mantika. Master muna step 1, then add step 2, etc. Mahaba ang task kaya step-by-step forward.

SBT: Backward Chaining

• Teaches a multi-step routine from the last step, so the finished product is the natural reinforcer.

• E.g., Same pagluluto itlog — OT na gagawa ng lahat, si client ang maglalagay ng itlog sa plato [last step]. Next session, siya na magpiprito + mag-plate. Nafi-feel niya agad yung success: "Ako nakatapos!"

SBT: Prompting and Fading

• Supplies the least intrusive cue that will produce the behavior: verbal → gestural → visual/modeling → physical [hand-over-hand]

• Withdrawing the prompt in steps until the client can perform the skill independently.

Cognitive-Behavior FOR

• Cognition affects behavior; cognition can be monitored and altered; and behavior change is mediated by cognitive change.

• Cognitive change is evidenced by what the client does.

• Goal: Name the occupation the belief is affecting, not the belief on its own.

Five Aspects of Experience Interact

Three Levels of Cognition

1. Automatic Thoughts

2. Intermediate Beliefs

3. Core Schemas

Automatic Thoughts

Superficial, habitual, and situation-specific; the thought that arrives unconsciously in the middle of the task.

Intermediate Beliefs

Unarticulated rules, attitudes, and assumptions, usually taking an “if–then” or “should/must” form.

Core Schemas

Global, rigid, early-formed beliefs about the self, others, the world, and the future; the least accessible of the three, and the level that requires specialist training to change.

Common Distortion in Mental Health Practice

1. Filtering

2. Polarized (All-or-Nothing) Thinking

3. Overgeneralization

4. Mind Reading

5. Catastrophizing

6. Personalization

7. Shoulds

8. Emotional Reasoning

9. Global Labeling

10. Blaming

Distortion: Filtering

Magnifying the negative details of a situation while screening out the positives.

Distortion: Polarized (All-or-Nothing) Thinking

No middle ground: perfect or a failure, good or bad.

Distortion: Overgeneralization

A sweeping conclusion drawn from a single incident.

Distortion: Mind Reading

Assuming you know what others are thinking and why, without any evidence.

Distortion: Catastrophizing

Expecting disaster; hearing of a problem and going straight to the worst outcome.

Distortion: Personalization

Taking everything others say or do as a reaction to you, or comparing yourself to everyone.

Distortion: Shoulds

Rigid rules about how you and others ought to act; anger when others break them, guilt when you do.

Distortion: Emotional Reasoning

Treating what you feel as proof of what is true: “I feel useless, so I am.”

Distortion: Global Labeling

Turning one quality or one event into a total judgment of the person.

Distortion: Blaming

Holding others responsible for your pain, or yourself responsible for every problem.

Cognitive-behavioral Strategies and Techniques

1. Core Cognitive-Behavioral Methods

2. Techniques Integrated into Occupation

CBM:Thought Record and Self-Monitoring

Captures the situation, thought, emotion rating, behavior, and outcome as data the client collects themselves.

CBM: Socratic Questioning and Guided Discovery

Leads the client to re-evaluate a belief using their own evidence, without the therapist supplying the conclusion.

CBM: Behavioral Experiment

• Turns a belief into a testable prediction and runs it in a real activity.

• E.g., Social Phobia > 7/11 > list ilan tumingin > compare & contrast > who are them & bakit ka tinignan

CBM: Graded Task Assignment

Rebuilds engagement through a stepwise series from simple to complex.

CBM: Activity Scheduling with Mastery and Pleasure Ratings

• Increases positive reinforcement and removes decision-making as an obstacle.

• E.g., Pumunta sa dentist to visit and assess how it felt

CBM: Cognitive Rehearsal

Runs the task in imagination first, surfacing the detail that would otherwise cause failure.

CBM: Relaxation and Arousal Control

• Contains physiological arousal so the cognitive work is possible at all.

• Decrease the arousal before CBT work

CBM: Distress Tolerance Practice (DBT)

• Builds the capacity to sit with a negative state without acting on the impulse.

• Goal: Distress wont go away that easily but they are capable to not react impulsively

• Note: Cx won’t be impulsive to respond with sensory technique

Techniques Integrated into Occupation

Integrate techniques into occupation rather than conducting pure talk therapy.

The following are delivered inside self-care activities, pleasurable or motivating activities, and goal-oriented activities:

1. Benefit-Finding

2. Fast-Forwarding

3. Positive Imagery

4. Responsibility Jigsaw

5. Distraction and Medication

6. Thought Stopping

7. Problem Solving

8. Self-Advocacy Training

9. Planning

10. Stress Management Coaching

TIO: Benefit-Finding

Locating positive change that has come with the impairment

TIO: Fast-Forwarding

Picturing oneself at a future point that differs from now.

TIO: Positive Imagery

• Imagining the self coping effectively

• E.G., You inside the circle and circle as the things or people that you consider as protectors — paano papasok kung may circles or maraming circles (“malayo naman sila”)

TIO: Responsibility Jigsaw

Separating what the client is and is not responsible for

TIO: Distraction and Medication

• Reducing rumination and physiological arousal

• E.g., When worrying, incorporate with highly engaging occupation

TIO: Thought Stopping

Actively clearing negative verbal messages or images.

TIO: Problem Solving

• Handling the practical consequences of the condition

• Pick, try, and evaluate (while doing ADLs)

TIO: Self-Advocacy Training

• Acting in one’s own interests with staff, employers, family

• Teach how to talk for themselves without being aggressive and passive.

TIO: Planning

Anticipating change in the condition and preparing for it.

TIO: Stress Management Coaching

Listing and then adjusting stress-promoting and stress-reducing situations, people, and environments

Sensory Integration

“The neurological process that organizes sensations from one’s body and from the environment and makes it possible to use the body effectively in the environment.”

“The Organization of Sensation for Use”

Sensory Processing

• The coordinated activity of sensory receptors and neurological centers that receive and conduct, register (unconscious noticing), recognize (conscious awareness), discriminate (attention to qualities), and modulate the sensation and its effects.

• Occupational performance is polysensorial.

Sensory Modulation

The ability to comfort, calm, or alert oneself and to regulate responses to sensory stimuli in order to engage in goal-directed behavior.

Sensory Modulation Disorder

“Sensory Reactivity or Responsivity”

Atypical sensory reactivity occurs when the child routinely shows dysregulated responses to typical sensory experiences

Dunn’s Framework

It crosses a neurological threshold continuum with a self-regulation continuum, producing four patterns that vary by sensory system and by context and are relatively stable over time.

Sensory Processing and Modulation Approaches: Function

Taking in sensory information, modulating it, and using it to support participation.

Sensory Processing and Modulation Approaches: Dysfunction

It appears as over-responsivity, under-responsivity, or craving, which translate into arousal

Sensory Processing and Modulation Approaches: Hypoarousal

• Flat affect, detachment, withdrawal, passivity

• Relevant environmental stimuli is not noticed or does not “register”

• Interferes with the child’s ability to attach meaning to an activity or situation

• Child may lack the inner drive to master ordinary childhood occupations

• Consider underlying perceptual or cognitive ability

Sensory Processing and Modulation Approaches: Hyperarousal

• Meltdowns, hypervigilance, anxiety, overreaction to perceived threat)

• May be to all sensory input, few, or one

• Common examples:

  • Tactile Defensiveness – tendency to overreact to ordinary touch sensations

  • Auditory Defensiveness

  • Gravitational Insecurity – a form of over responsiveness to vestibular sensations characterized by excessive fear during ordinary movement activities

Modulation

It is the means while participation is the outcome.

Sensory Strategies & Techniques

Sensory Strategies & Techniques: Applications