Family transactions and relapse in bipolar disorder

This study examined whether patient symptoms and relatives' affective behavior, when expressed during directly observed family interactions, are associated with the short-term course of bipolar disorder. Twenty-seven bipolar patients and their relatives participated in two 10-minute family interactions when patients were discharged after a manic episode. Results indicated that patients who showed high levels of odd and grandiose thinking during the interactions were more likely to relapse during a 9-month followup period than patients who did not show these symptoms during the family discussions. Relapse was also associated with high rates of harshly critical and directly supportive statements by relatives. Patients' odd thinking and relatives' harsh criticism were significantly more likely to be correlated when patients relapsed (r = .53) than when they did not relapse (r = .12). Results suggest that bipolar patients who show increased signs of residual symptomatology during family transactions during the post-hospital period are at increased relapse risk. The data also suggest that relatives of relapsing patients cope with these symptoms by increasing both positive and negative affective behaviors. Moreover, a bidirectional, interactional relationship between patients' symptoms and relatives' coping style seems to capture best the role of the family in predicting relapse in bipolar disorder.     

Effects of self-generated rules on the development of schedule-controlled behavior.

College students responded under a multiple differential-reinforcement-of-low-rate 5-s fixed-ratio 8 schedule, with components alternating every 2 min. After 40 programmed minutes of acquisition and 12 min of maintenance, without notice, both schedules changed to extinction for 28 min. During acquisition, between alternations of the multiple schedule, some subjects were asked to develop rules describing the schedule contingencies. Other subjects were given these same rules between alternations, and a third group neither received nor were asked to develop rules. By the end of the acquisition phase, self-generated-rule subjects were more likely to show schedule-typical behavior than were subjects not asked to generate rules. The behavior of those given rules was similar to those asked to generate rules at the end of acquisition, but yoked-rule subjects acquired schedule-typical behavior at a quicker rate. By the end of extinction, during the period corresponding to the previous fixed-ratio interval, all no-rule subjects who had earned points during acquisition and maintenance were responding at a rate of less than 30 responses per minute. Only 3 of the 9 self-generated-rule subjects and 2 of the 5 yoked-rule subjects were similarly responding at this low rate. Results suggest that asking subjects to develop self-rules facilitates acquisition, but can retard extinction. Results also suggest that self-generated rules function similarly to external rules.     

Race, family interactions, and patient stabilization in schizophrenia

This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play in important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.     

Escape from freedom: Choosing not to choose in pigeons

Preference for the availability of food-reinforcement alternatives was investigated with Rachlin and Green's (1972) concurrent-chains self-control paradigm. The terminal link of one chain made available a choice between immediate access to food for T seconds and delayed access to food for 4 seconds. The terminal link of the other chain provided only delayed access to food. When T was reduced to .25 seconds, pigeons began to select the delayed-access key in both terminal links. Even so, the pigeons strongly preferred constraint over choice. This effect could not be accounted for by differences in the actual amount of food obtained in the terminal links, by avoidance of the immediate-reinforcement key when not presented as part of a choice, or by avoidance of a multi-key terminal link. Rather, constraint was preferred over freedom. Apparently, the preference for choice is determined by the particular type of choice offered.     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.     

Rule-governed behavior and sensitivity to changing consequences of responding

Humans were presented with a task that required moving a light through a matrix. Button presses could produce light movements according to a multiple fixed-ratio 18/differential-reinforcement-of-low-rate 6-s schedule, with components alternating every 2 min. Moving the light through the maze earned points worth chances on money prizes. In Experiment 1 four conditions were assessed through between-subject comparisons: minimal instructions, instructions to press rapidly, instructions to press slowly, and instructions that sometimes rapid responding would work while at other times a slow rate would work best. Subjects responded in three successive sessions of 32 min each. The results suggested that instructions affected the nature of the contact made with the programmed consequences and thus subsequent performance. In some cases, responding seemed to result from added contingencies introduced by stating rules. In Experiment 2 the relative contribution of these two effects was assessed by presenting and then withdrawing two lights that had been paired with two specific instructions: “Go Fast” or “Go Slow.” There were three conditions. In one condition, only the Go Fast light was on; in a second, only the Go Slow light was on; and in a third, the lights alternated each minute. In each condition, half the subjects had all instruction lights turned off after the first session. The results once again showed an effect of instructions on contact with the programmed consequences. However, responding sometimes continued in a manner consistent with added contingencies for rule-following even when the programmed consequences had been contacted and would have controlled a different type of responding in the absence of instructions. The relevance of added contingencies for rule-following in determining the effects of explicitly programmed consequences is emphasized.     

SELF-REINFORCEMENT EFFECTS: AN ARTIFACT OF SOCIAL STANDARD SETTING?

Two studies were conducted to identify mechanisms responsible for observed "self-reinforcement" effects. In Experiment 1, using a studying task, self-reinforcement procedures did not work when they were private (i.e., when others are not aware of the goals or contingencies), but did work when they were public. Self-delivery of consequences added nothing to the effectiveness of the procedure. The data suggested that public goal setting was the critical element in the procedure's effectiveness. In Experiment 2, an applied extension, goal setting alone was effective in modifying over a long time period studying behaviors of people with significant studying difficulties, but only when the goals were known to others. Overall, the two experiments make more plausible the view that self-reinforcement procedures work by setting a socially available standard against which performance can be evaluated. The procedure itself functions as a discriminative stimulus for stringent or lenient social contingencies. The application of this mechanism to other problems of applied significance is briefly discussed.     

Expressed Emotion,Appraisal and Coping by Patients with Recent-onset Schizophrenia: A Pilot Investigation

This pilot study sought to follow up on indications that patients from households with high levels of expressed emotion (EE) differ from those from households with low levels of EE in ways not assessed in typical symptom rating profiles. We examined how patients appraised and coped with a prominent societal stressor. Soon after the start of the Gulf War, 22 patients with recent-onset schizophrenia living in Los Angeles appraised the stressor and completed a coping questionnaire. Results indicated that patients from high-EE homes were likely to use emotion-based confrontational methods to cope with the crisis, while patients from low-EE environments were likely to use avoidance and denial. Patients from high-EE homes thus coped with this non-familial, societal stressor in a way similar to the way in which they have been observed to cope with family conflict: they more readily expressed their anger and frustration than patients from low-EE homes. These pilot data suggest that increased attention should be directed toward those patient behaviours that may be associated with either an increase or decrease in negative affective behaviour from relatives. It may also be fruitful to consider more broadly the adaptive and maladaptive features of the preferred coping strategies of patients from high-EE and low-EE environments.     

A Functional Analysis of Schizophrenia

There has been a renaissance in research examining psychosocial risk factors for the development of schizophrenia, yet little work has been done to integrate these factors into a comprehensive psychological analysis of this disorder. This article highlights, from a Skinnerian functional analytic perspective, how the specific symptoms of schizophrenia may develop and be maintained. It is hypothesized that the early environment of an individual who later develops schizophrenia is socially isolating and defeating, which leads to excessive self-focused attention and deficient corrective social feedback for anomalous sensory experiences. Isolation and defeat also make it less likely that verbal behavior will come under the control of subtle interpersonal cues and more likely that such behavior will come under the control of internal stimuli. A history of social failure may also lead individuals to avoid goal pursuits and intense emotional expressiveness. The article also highlights the continuity between the effects of contingencies of survival in one’s ancestors, and contingencies of reinforcement in the individual in the development of schizophrenia, and how a functional analysis may aid in the psychosocial treatment of this disorder.