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    188宝金博页面版: Reducing delusional speech in chronic, paranoid schizophrenics

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    内容提示： JOURNAL OF APPLIED BEHAVIOR ANALYSIS1973, 6, 57-64 NUMBER 1 (SPRING 1973)REDUCING DELUSIONAL SPEECH IN CHRONIC,PARANOID SCHIZOPHRENICS'ROBERT PAUL LIBERMAN, JAMES TEIGEN, ROGER PArrERSON,AND VAL BAKERCENTER FOR THE STUDY OF BEHAVIORAL DISORDERSCAMARILLO STATE HOSPITALFour schizophrenic patients with paranoid and grandiose delusions who had been hos-pitalized for an average of 17 yr were exposed to social reinforcement contingencies in amultiple baseline design. During the baseline period, each patient was ...

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    JOURNAL OF APPLIED BEHAVIOR ANALYSIS1973, 6, 57-64 NUMBER 1 (SPRING 1973)REDUCING DELUSIONAL SPEECH IN CHRONIC,PARANOID SCHIZOPHRENICS'ROBERT PAUL LIBERMAN, JAMES TEIGEN, ROGER PArrERSON,AND VAL BAKERCENTER FOR THE STUDY OF BEHAVIORAL DISORDERSCAMARILLO STATE HOSPITALFour schizophrenic patients with paranoid and grandiose delusions who had been hos-pitalized for an average of 17 yr were exposed to social reinforcement contingencies in amultiple baseline design. During the baseline period, each patient was interviewed forfour 10-min sessions each day. The elapsed time from onset of conversation to onsetof delusional talk was recorded. At the end of each day, the patients engaged in a 30-mininformal chat with a nurse-therapist while relaxing with coffee, snacks, and cigarettes.The intervention introduced two contingencies: (1) The 10-min interviews were ter-minated as soon as the patient began talking delusionally; (2) The patients earnedtime for their evening chat by talking rationally during their daytime interviews. In-creases of from 200 to 600% in the amount of rational talk exhibited during the inter-views occurred as the contingencies were introduced for each patient sequentially overtime. These increases were maintained in three patients when the amount of reinforce-ment was halved, but declined when the patients were confronted directly with theirdelusional ideas. A modest amount of generalization occurred from the day-time inter-views to the evening chats but did not extend to the behavior of the patients on the ward.The delusional speech of paranoid schizo-phrenic patients represents a response class ofmuch clinical significance, but it has beenstudied little by behavior modifiers. Epidemio-logical studies indicate that the most frequentabnormal behavior leading to re-admission ofpreviously hospitalized schizophrenics is verbal-ization of delusional and bizarre ideas (Hoenigand Hamilton, 1966; Wing, Monck, Brown,and Carstairs, 1964). While there is widespreadbelief that reinforcement contingencies controlthe content of psychotic speech, this conclusionis based primarily on uncontrolled reports(Kennedy, 1964; Rickard and Dinoff, 1962;Rickard, Digman, and Horner, 1960; Schaefer'The interpretations and conclusions in the paperare those of the authors and are not to be construed asofficial or as necessarily reflecting the policy of theCalifornia Department of Mental Hygiene. Theauthors are indebted to the nursing staff of theClinical Research Unit whose efforts made possibleboth treatment and data collection for thestudy.Particular acknowledgement goes to M. Whitehead,B. Wollitzer, W. Moon, and E. Ramirez. Reprintsmay be obtained from Robert Paul Liberman, M.D.,Clinical Research Unit, Camarillo State Hospital,Box "A," Camarillo, California 93010.and Martin, 1969). Only two studies have uti-lized control procedures in the measurement andmodification of delusional speech.In a now classic study, Ayllon and Haughton(1964) reported the effectiveness of contingentattention, approval, and tangible reinforcers onincreasing and then decreasing grandiose de-lusions in a single patient. This was paralleledby a decrease followed by an increase in neutraltalk when the respective contingencies werefocused on the rational speech. Ayllon andHaughton reported no reliability data for their21 nurses who carried out the observations andinterventions. The number of trials per day andthe use of instructions were not kept constant asthe nurses evidently interacted with the patientsin a casual, informal manner.Wincze, Leitenberg, and Agras (1972) pre-sented well-controlled data on 10 paranoidschizophrenic patients. They found that instruc-tions were effective with only four patients whiletoken reinforcement reduced the observed per-centage of delusional verbal behavior in sevenpatients. Generalization did not occur fromtherapy sessions to the behavior of the patients57

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