REDUCING DELUSIONAL SPEECH IN CHRONIC, PARANOID SCHIZOPHRENICS¹

Abstract

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

CONDITIONING AND POST‐HOSPITAL GENERALIZATION OF NONDELUSIONAL RESPONSES IN A CHRONIC PSYCHOTIC PATIENT1

“…This present study extends work (Liberman, Teigen, Patterson, and Baker, 1973) that demonstrated that the duration of rational talk during time-sample interviews increased when the length of a free conversation and snack period was made contingent on the duration of rational talk during daily time-sample interviews. The subject of the present report, Mary N., had shown increased rational talk under these conditions, but continued to answer with 1The interpretation and conclusions in the paper are those of the authors and are not to be construed as official or as necessarily reflecting the policy of the California Department of Mental Hygiene bizarre, incorrect responses when asked direct questions concerning her personal history.…”

“…This unit (Liberman, et al, 1973) is a 12-bed token economy ward in which patients are treated with specific behavior modification programs. Mary N. had been living on the unit for 10 months.…”

Sharing in Preschool Children: Facilitation, Stimulus Generalization, Response Generalization, and Maintenance

“…One way that researchers have brought the transfer of treatment gains to other settings has been to manipulate antecedent stimuli (Horton, 1975). Furthermore, other investigators have reported greater stimulus generalization to transfer settings as the similarity to the training setting was increased (Liberman, Teigen, Patterson, and Baker, 1973). Many of the stimuli used in the present study in the generalization setting were different from those in the training setting; a different room, materials, experimenter, and observers were used.…”

“…The use of praise rather than tangibles such as tokens may have been important. Liberman et al (1973) have noted that "social reinforcement may possibly facilitate generalization because it is the relevant factor in the settings where generalization is tested" (p. 63).…”

Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach

“…A number of psychologists applied reinforcement techniques to try to reduce the time that patients spoke about delusions (e.g. Wincze et al, 1972;Liberman et al, 1973). However, there has been a remarkable transformation in how delusions are viewed.…”