Behavioral Therapy for “Apathy” of Hospitalized Schizophrenics

Abstract

20 chronic schizophrenic adult female patients in a ward of a hospital for the mentally ill were placed on schedules of reinforcement designed to establish or strengthen behaviors incompatible with the diagnostic statement “apathetic.” Another 20 patients on the same ward received standard ward therapy. 30 behavioral samples, spaced evenly in ½-hr. intervals, were obtained for each of the patients for 3 5-day periods: before, during, and on termination of the program. Apathy was defined as the degree to which a patient at the time of any of the 30 daily observations engaged in one—and only one—clearly discernible behavior. While the degree of apathy was equal for experimentals and controls at the beginning of the experiment, those patients who were subjected to the schedules of reinforcement were significantly less apathetic at the termination of the experiment than the controls who were given normal ward therapy but who were not subjected to such schedules. The implications of these findings are discussed.

REWARDING PSYCHIATRIC AIDES FOR THE BEHAVIORAL IMPROVEMENT OF ASSIGNED PATIENTS1

“…Each of the psychiatric aides on the two daytime tours of duty was given exclusive responsibility for one or more patients (randomly assigned), and was freed of custodial duties that were performed by the patients as part of the therapy program. The aides were encouraged to develop a therapeutic relationship with their patients and to carry out specific, pre-arranged reinforcement schedules for their patients (Ayllon and Michael, 1959;Schaefer and Martin, 1966) in addition to the general transactions of the token economy. As part of their duties, the aides were asked to consult with the psychology staff about the design and feasibility of various treatment programs for their patients.…”

“…A promising line of growth for the token economy concept is the shift from an emphasis on self-care and participation in ward activities to an emphasis on modifying behaviors more closely associated with psychosis (Schaefer and Martin, 1966). This shift is supplemented by new trends in the experimental analysis of psychotic behavior, which take into account the interactions and potential social reinforcers provided by the various individuals who comprise a treatment environment (Ayllon and Michael, 1959;Saslow, 1968); in keeping with this line of inquiry are recent investigations on the use of psychiatric patients as therapists for other patients (Kale, Zlutnick, and Hopkins, 1970;Pomerleau, Bobrove, and Harris, 1972) and on increasing the number of structured interactions between therapists and patients through the use of behavioral contingencies (Panyan, Boozer, and Morris, 1970 (Pomerleau et al, 1972) to emphasize social interaction among patients, and was specifically designed to prevent institution-produced apathy and to reduce the frequency of the behaviors that had resulted in psychiatric commitment.…”

The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

“…The results of randomized controlled studies indicate that behavioral token economy programs, based on social learning principles, are effective in increasing the adaptive behaviors of patients with schizophrenia in hospital and residential treatment settings such as personal hygiene, social interactions, and hospital-based work tasks [121][122][123][124][125][126] though not all trials found a clear benefit of the token economy program. 127,128 The results of controlled studies that were not randomized trials also support the benefits of the token economy intervention.…”

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

“…INSTRUMENT (BOI) The BOI was derived from the Behavioral Study Form (BSF) developed by Schaefer and Martin (1966) and from the Location-Activity Inventory (Hunter, Schooler, and Spohn, 1962).…”