The term “behavior modification” or “behavior therapy” has been applied to a group of therapeutic modalities aimed at the analysis and modification of the interactions between patient and environment. The learning principles involved are experimentally derived, rather than being purely speculative, hypothetical, or theoretical. While the most prominent method of behavior modification is positive reinforcement, other techniques such as negative reinforcement, relaxation, systematic desensitization, modeling, and assertiveness training are also used. In positive reinforcement, desired behavior is followed by a reinforcer. Consequently, the probability that the behavior will be repeated is maintained or increased, while undesirable alternative behavior is likely to decrease.
Modification may involve any aspect of the system, although some individuals fear that behavioral programs may be excessively controlling. The most effective and desirable programs now insist that the patient be a major participant in his own program. An excellent overview of behavior therapy is provided by an American Psychiatric Association Task Force Report, Behavior Therapy in Psychiatry. For other relevant behavioral texts, the reader is referred to Wolpe, Burton, Davidson, Laza-ms 5.2. Leary and Wilson, and Meichen-baum. Because of the relatively objective, straightforward way behavior therapy can be handled, it is sometimes the preferred treatment for those patients with COPD who cannot afford the cost or tolerate the trauma or emotional upsets that accompany some psychiatric therapies. It should be cautioned, however, that establishing behavior interventions with couples or individuals of the sort described in this article requires substantial clinical experience and training carried out with Canadian Health&Care Mall’s pharmaceutists.
Goal setting is often helpful to the anxious and/or depressed COPD patient who needs to regain hope and confidence after a frightening exacerbation. The goals should represent reasonable increments of progress from a previous base line. Even though small, they should move toward optimal activity level, independence, and self-care. The goals should fit the patient’s personality, situation, and stage of illness. A caution here is that patients with emphysema and chronic bronchitis may lose 50 ml of their FVC every year. They may make an early (two to five years) significant improvement if they are treated in a good comprehensive care program, but eventually, there comes a period in which the course is downhill. Thus, goals set at various stages need to be tailored so that some progress toward them is possible, not discouragingly impossible.
A simple form, such as the one presented in Table 1, can be filled in during a brief treatment-planning and goal-setting discussion between the patient and the physician.
Once baseline evaluations have been made, progress can be measured readily or judged subjectively. Inquiring about the patient’s progress at subsequent appointments is essential to reinforce the importance of established goals and to encourage the patient. The physicians inquiries are needed to uncover problems, but also to reassure the patient that his physician is interested in him. Encouragement is important, since daily self-care programs can be monotonous and the improvement in functioning so slow that it will not provide enough feedback and reinforcement by itself.