A therapeutic approach to schizophrenics of extreme pathology: An operant-interpersonal method.

Abstract

NE of the most severe forms of psychopathology is seen in cases culminating in a "vegetative" level of adjustment characterized by the patients being extremely withdrawn, anergic, and uncommunicative. Standard treatment procedures do not produce any appreciable benefits. It would seem that different, if not novel, therapeutic approaches need to be explored if changes are to be effected with this type of patient. This paper presents an evaluation of a therapeutic method that was devised for chronic schizophrenics with such extreme withdrawal symptoms.Given the label "operant-interpersonal," the method of therapy that is proposed stems from recent work employing learning techniques with schizophrenics. Peters and Jenkins (1954) attempted to retrain chronic schizophrenics by using first simple psychomotor tasks and then increasing their complexity. To increase motivation, subcoma injections of insulin were given with fudge as a reward. Tilton (1956), employing instrumental motor and verbal techniques with even more debilitated patients, found that candy was an adequate reward in

Conditioning in Psychotics1

“…A performance differentiai between normals and chronic psychotics during response acquisition has also been reported by Mednick and The lower operant emission behaviour o.f the chronic psychotics has been reported (Lindsley, 1956b, p. 152) to correl.ate significantly (p <.01) with severity of ward behaviour when using the L-M FergusFalls sca1e (Lucero and Meyer, 1951 The suggestion of a linear relationship between these two variables (severity of behaviour disorder and operant rate) with chronic psychotics has been confirmed by King, Armitage and Tilton (1960).…”

Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness

“…This demonstration set the the stage for examining whether contingency management (CM) interventions, which reinforce drug abstinence or other therapeutic goals with vouchers, cash, clinic privileges or another tangible reinforcer (Higgins, Silverman & Heil, 2008), would reduce drug use in these patients. CM techniques have long been used to modify a variety of behaviors in people with SMI (e.g., Ayllon & Azrin 1965; Kale et al, 1968; King et al, 1960; Ullman & Krasner, 1965) – ironically, some of these study used cigarettes as reinforcers. However, using CM to reduce health risk behaviors in people with SMI is a fairly recent development.…”

Learning Theory and Child Psychology: Therapeutic Possibilities

“…Baer (1962), for example, was able to reduce thumb-sucking in three children during experimental sessions but the habit promptly returned when the relevant conditions were withdrawn. King et al (1960), however, were able to record significant general improvements in a group of (adult) acute schizophrenics who were treated by operant methods. By comparison with three control groups, the operant-treated patients improved in the following areas: "level of verbalization, motivation to leave the ward, less resistance to therapy, more interest in occupational therapy, decreased enuresis, and transfers to better wards".…”

“…The possibilities of response-building are illustrated by the study of King et al (1960), who shaped the behaviour of adult schizophrenics (of extreme pathology) in a Lindsley-type situation. They were able to develop the initial lever-pulling response into relatively complex problem-solving and social behaviour.…”