Four schizophrenic patients with paranoid and grandiose delusions who had been hospitalized for an average of 17 yr were exposed to social reinforcement contingencies in a multiple baseline design. During the baseline period, each patient was interviewed for four 10-min sessions each day. The elapsed time from onset of conversation to onset of delusional talk was recorded. At the end of each day, the patients engaged in a 30-min informal chat with a nurse-therapist while relaxing with coffee, snacks, and cigarettes. The intervention introduced two contingencies: (1) The 10-min interviews were terminated as soon as the patient began talking delusionally; (2) The patients earned time for their evening chat by talking rationally during their daytime interviews. Increases of from 200 to 600% in the amount of rational talk exhibited during the interviews occurred as the contingencies were introduced for each patient sequentially over time. These increases were maintained in three patients when the amount of reinforcement was halved, but declined when the patients were confronted directly with their delusional ideas. A modest amount of generalization occurred from the day-time interviews to the evening chats but did not extend to the behavior of the patients on the ward.The delusional speech of paranoid schizophrenic patients represents a response class of much clinical significance, but it has been studied little by behavior modifiers. Epidemiological studies indicate that the most frequent abnormal behavior leading to re-admission of previously hospitalized schizophrenics is verbalization of delusional and bizarre ideas (Hoenig and Hamilton, 1966;Wing, Monck, Brown, and Carstairs, 1964

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An operant conditioning approach was successful in getting a chronic psychotic patient to give factual answers to direct questions that had previously elicited only delusional responses. Multiple baseline and reversal controls established that the changes were due to the experimental procedure. The subject was a female patient classified as paranoid schizophrenic who had persisted in giving bizarre responses to direct questions regarding her identity, age, and personal history during 26 yr of hospitalization. She was discharged after factual answers to these questions had been obtained, but operant conditioning trials were continued in the community to promote generalization. Two follow‐up interviews were conducted 36 and 52 days after discharge to evaluate generalization. No generalization was found in the first interview, but the second gave evidence of some generalization.

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