Assessment of delusional beliefs during the modification of delusional verbalizations

This study examined the strength of delusional beliefs during the modification of delusional verbalizations of a 51 year-old chronically mentally ill inpatient. The changing-criterion design was used to document the effectiveness of a behavioral treatment package to alter the rate of delusional responses to personal background questions. The results revealed a stepwise decline in the frequency of delusional responses. Generalization effects to novel interviewers were obtained. No changes were obtained on the subject's ratings of delusional beliefs, with the subject assigning ratings of absolute conviction to his beliefs throughout the duration of the study.     

Auditory hallucinations and delusional thinking: A review and critique of outcome studies

This paper reviews the literature in which behavioral interventions were applied in an attempt to reduce hallucinatory and delusional verbalizations in psychiatric patients. Subject characteristics, dependent variables and treatment variations, as well as generalization of effects, are considered. It is concluded that even though operant procedures, such as extinction, aversive stimulation, and token reinforcement, have been successful in decreasing hallucinatory-delusional verbalizations, further research examining generalization is needed. Methodological issues influencing interpretation are discussed and suggestions for further research are offered.     

The modification of delusional beliefs: A single-subject evaluation

The multiple-baseline across responses design was used to assess the effectiveness of a belief-modification treatment package to alter the intensity of three delusional beliefs of a chronically mentally ill inpatient. Results revealed reductions in belief intensity to zero levels for all three beliefs. Generalization effects were obtained for an individualized interview and psychiatric rating scale. These results were maintained through a 6-month follow-up period.     

Abnormal Certainty: Examining the Epistemological Status of Delusional Beliefs

ABSTRACT

This article intends to reconsider the epistemological status of delusional beliefs on the basis of Wittgenstein’s conception of certainty. Several works over the last two decades have compared delusional beliefs with so-called hinge propositions, which – according to Wittgenstein – function as expressions of objective certainty. This gives rise to a paradox. On the one hand, delusions are compatible to Wittgensteinian certainties in some respects; on the other hand, they contradict beliefs shared by other members of the community, which makes them different from ‘normal’ certainties. In order to address this issue, I use Moyal-Sharrock’s taxonomy of hinge propositions. This taxonomy allows one to distinguish between different types of hinge propositions; all types share the same features, but these features are manifested in a variety of ways. Thus, delusional beliefs might also be regarded as constituting a specific type of hinge propositions. This move makes it possible to resolve the paradox and to identify the special epistemic features of delusional beliefs.     

The unity of consciousness in pre-psychotic states. A phenomenological analysis / La unidad de la conciencia en estados pre-psicóticos. Un análisis fenomenológico

This paper explores the way in which the phenomenon called delusional moods — an alteration of consciousness that characterizes the moment that precedes the adoption of delusional beliefs — would challenge the claim that consciousness is necessarily deployed as an experiential unity. After exploring three basic characterizations of the unity of consciousness, it is concluded that during delusional moods only some of them are completely altered. Finally, after complementing the analysis with the examination of some psychotic states, it is concluded that, from the three dimensions of the unity of consciousness that are explored, only one seems to be fundamental.     

Delusions as harmful malfunctioning beliefs

Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced by an imposter or another patient with schizophrenia believes that “The Organization” painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield’s harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions according to teleosemantics, a popular naturalist account of mental content, but harmful false beliefs do not have to be pathological. I examine those objections in detail and show that they should be rejected after all.     

INCREASING REQUESTS BY ADULTS WITH DEVELOPMENTAL DISABILITIES USING INCIDENTAL TEACHING BY PEERS

A peer-delivered incidental-teaching procedure was used to instruct appropriate requesting in adults with moderate to severe mental retardation or autism. Three pairs of group-home residents participated in an incidental-teaching procedure to increase appropriate requesting, prompting, and responding of residents during lunch-preparation sessions. An increase in the number of incidental-teaching episodes during dinner was obtained, and remained high when lunch-making training sessions were withdrawn. In addition, during the incidental-teaching phase, an increase in appropriate requests and overall verbalizations occurred for the peer learners. Changes in appropriate requesting and overall verbalizations also remained higher than baseline when training was withdrawn.     

The intricacies of verbalizations,gestures, and game outcome using sequential analysis

ObjectivesThe purpose of the present study was to identify the intricacies of verbalizations, gestures, and game outcome during competition.DesignThe behavioral research software Observer XT^® using sequential analysis was used to analyze our data.MethodParticipants were 34 junior tennis players with a mean age of 13.68 (SD = 1.8). Youth players were observed during 17 matches using the Self-Talk and Gestures Rating Scale and were examined by a built-in application (Observer XT^®) of mapping of verbalizations, gestures, and performance.ResultsSequences indicated negative verbalizations were the most frequently exhibited form of overt verbalizations, followed by positive and instructional verbalizations. Furthermore negative verbalizations for either the server or the receiver decreased the probability of winning a game and showed verbalizations from the server related to the receiver's verbalizations and game outcome, and vice versa.ConclusionsThe results shed light on how verbalizations and gestures interact differently according to the context, which may have important implications for research that has focused on verbalizations and has neglected gestures and contextualized performance in sport.     

Delusions,Acceptances, and Cognitive Feelings

Psychopathological delusions have a number of features that are curiously difficult to explain. Delusions are resistant to counterevidence and impervious to counterargument. Delusions are theoretically, affectively, and behaviorally circumscribed: delusional individuals often do not act on their delusions and often do not update beliefs on the basis of their delusions. Delusional individuals are occasionally able to distinguish their delusions from other beliefs, sometimes speaking of their “delusional reality.” To explain these features, I offer a model according to which, contrary to appearances, delusions are not beliefs at all. Delusions are acceptances that are generated by pathologically powerful cognitive feelings. This model has implications for the way that we should think about non‐pathological doxastic states and emotions.     

Preschoolers' use of eye contact while speaking: The influence of sex,age, and conversational partner

The influences of sex, age, and conversational, partner (mother vs. stranger) on eye contact during verbalizations were examined in a longitudinal study of 33 children at 2 and 4 years of age. A free-play sample was obtained of each child interacting with mother and with a male or female experimenter. The amount of eye contact in conjunction with verbalization was analyzed. Significant main effects were found for sex (females engaged in a higher percent of eye contact than males) and conversational partner (more eye contact while speaking exhibited to experimenter than to mother). There was an interaction between age and conversational partner, in that mother received more and experimenter relatively less percent of eye contact during verbalizations as children got older. Notably, there was no main effect for age. These results revealed sex differences at an age (2–2 1/2 years) and in a context (free-play setting) not previously studied, demonstrating the robustness of the effect. Further, age findings seem indicative of unique developmental trends for eye contact during verbalizations for the ages between 2 and 4 years.Mount Saint Vicent University     

Perceptual biases and metacognition and their association with anomalous self experiences in first episode psychosis

Anomalous self-experiences have been described as a prerequisite for anomalous perceptual experiences. Later, these anomalous perceptual experiences may then be metacognitively appraised as distressing, maintaining these experiences and later leading to anomalous (delusional) beliefs. This model of anomalous events may potentially be driven by perceptual biases and metacognitive deficits. This cross-sectional study explored the association between perceptual biases, metacognition and anomalous self- and perceptual experiences and delusional beliefs in First Episode Psychosis (FEP) and a matched healthy control sample. Fifty-eight individuals with FEP and seventy-two healthy controls were included in the main analysis. Increased auditory perceptual biases were significantly associated with increased state and trait anomalous self-experiences, in particular alienation from surroundings and emotional numbing. No significant associations were found between metacognitive efficiency and anomalous experiences. These findings may be consistent with the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly with the hyperreflexivity concept.     

Identity with Jesus Christ: The Case of Leon Gabor

From July 1, 1959 to August 15, 1961, Milton Rokeach studied three male patients at Ypsilanti State Hospital who believed that they were Jesus Christ. They met regularly together with Rokeach and his research staff, a procedure designed to challenge their delusional systems. He believed that Leon Gabor, the youngest of the three, would be the most likely to abandon his delusional beliefs. Instead, Leon met the challenges that the procedure posed by creative elaborations of his delusional system, especially through the adoption of a new name that gave the initial appearance of the abandonment of his Christ identity but in fact drew on aspects of the real Jesus Christ’s identity that were missing from his earlier self-representation.     

Transmitting delusional beliefs in a hypnotic model of folie à deux

Folie à deux is the transference of delusional ideas from one ‘primary’ individual to one or more ‘secondary’ individuals (Lasègue & Falret, 1877). However, it is difficult to investigate experimentally because often only one patient is identified as delusional. We investigated whether hypnosis could model the experiences of the secondary in this delusion. Our primary was a confederate, who displayed two delusional beliefs and attempted to transmit them to hypnotised subjects. We manipulated the status of the confederate so that they were portrayed as either “credible” or merely “interesting”. Many high hypnotisable individuals adopted the confederate’s beliefs and confabulated evidence in support of them. Also, subjects who interacted with a credible confederate extended their delusions beyond those displayed by the confederate. We discuss the strengths and limitations of this approach and suggest ways to improve the validity of this model.     

Addressing Challenges in Individual Psychotherapy with Delusional Patients: A Case Study

Although cognitive-behavioral treatments for schizophrenia and other psychotic disorders demonstrate strong results in clinical trials, not all patients respond to these treatments. Common challenges in psychotherapy with delusional patients include a mismatch between the therapist’s and the patient’s expectations about the purpose of therapy, the patient’s lack of motivation to reduce delusional beliefs in service of other goals, and the patient’s dependence on the delusions in order to preserve an intact sense of self. This case highlights the value of integrating a psychodynamic perspective with cognitive-behavioral interventions to address challenges in psychotherapy with chronically delusional patients.     

Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing

Group Cognitive Behavior Therapy (CBT) was used to treat residual delusions in patients with schizophrenia. Initially all patients (N = 6) reported delusions of various types, such as persecution, body/mind control, grandiosity, and religious themes. The group format allowed patients to share their experiences and beliefs, thereby eliminating shame and providing support and coping strategies; as well as allowing for peer–peer discussion of irrationalities and inconsistencies in each other's beliefs. After 13 sessions there was a statistically significant reduction in delusional conviction, unhappiness associated with thinking about a delusion, intensity of distress associated with delusion, and an increased ability to dismiss a delusional thought.     

Deconstructing delusions: A qualitative study examining the relationship between religious beliefs and religious delusions

Delusions have been conceptualized as forming in response to experience, yet the relationship between religious belief, and beliefs regarded as delusional, has received little research attention. This is despite the high prevalence of delusions featuring religious content. Semi-structured interviews were conducted with seven participants who had been diagnosed as experiencing delusions. Participants from a range of religious backgrounds were asked about their religious experiences and beliefs, family background and experiences of psychosis. These interviews were analysed qualitatively. Whilst religious background affected the content of delusions, the nature of delusions appeared to be influenced by other factors, such as early family experiences, particularly an absent parent and conflict within the family. Individuals often used a religious framework to understand unusual experiences, and there seemed to be a role for the process of identification and wish fulfilment in influencing delusional content. Whilst this research is clearly limited by its exploratory nature, it offers a possible framework of understanding which helps make sense of religious delusions, and suggests approaches which may be helpful in recovery.     

Children's verbalizations and cheating behavior during game playing: the role of sociometric status,aggression, and gender

The first goal of this study was to investigate sociometric status, aggression, and gender differences in children's verbalizations and cheating behavior during game playing using a fine-grained observational coding system. The second goal was to control for the effects of differential peer treatment and bias on children's behavior by observing children in a standardized procedure with unfamiliar peer confederates. Participants were 111 second-grade African American children, half average and half rejected sociometric status, half aggressive and half nonaggressive based on peer nominations, and half boys and half girls. Rejected children engaged in more cheating behavior and made more negative and argumentative verbalizations than average status children. Boys made more negative and argumentative verbalizations than girls. Aggressive children did not differ from nonaggressive children, in terms of either verbalizations or cheating behavior.     

Paranoid disorders : the interpersonal perspective

The material included in this article is part of a clinical study reporting the life-course and therapy of a group of thirty-four families in which at least one member of the family developed a delusional system.
Specifically, this paper discusses the rôle played by particular interpersonal transactions in the maintenance and amplification of paranoid beliefs. It is pointed out that the paranoid delusional system never remains a pure intrapsychic issue. In all our case studies, we have been able to show the presence and influence of an interactional feedback system.     

Effects of alcohol intoxication and aggressivity on aggressive verbalizations during anger arousal

We examined the moderating effect of dispositional aggressivity on the relationship between alcohol intoxication and aggressive verbalizations. Using a laboratory anger-induction task that simulated an interpersonal conflict as a method to assess aggressive verbalizations (the articulated thoughts in simulated situations paradigm), 70 participants (33 women, 37 men) consumed either an alcoholic or a placebo beverage, and then imagined a series of audiorecorded interpersonal scenarios. Two blind-to-condition raters assessed the frequency of participants' aggressive verbalizations (insults, aggressive threats, belligerent provocations) articulated during anger arousal. Aggressivity was assessed using a standard measure of dispositional aggression. Results supported the aggressivity moderation hypothesis: intoxicated participants high in aggressivity responded with significantly more aggressive verbalizations relative to low-aggressivity participants regardless of beverage condition, and three times more aggressive verbalizations relative to the high-aggressivity/placebo group. There were no gender effects. These data support the hypothesis that alcohol potentiates aggression primarily among individuals at dispositional risk for engaging in such a behavior. Aggr. Behav. 34:428-436, 2008. (c) 2008 Wiley-Liss, Inc.     

PREPARATION FOR EFFECTIVE SELF-REGULATION: THE DEVELOPMENT OF GENERALIZED VERBAL CONTROL

A correspondence training procedure was used to develop consistency between children's verbalizations and their subsequent behavior across increasingly remote settings and time. The interval of time between the verbalizations and the opportunity to engage in several target behaviors was systematically increased across four preschool settings. Probes of generalized verbal control of home behaviors were conducted throughout training and showed that generalization was obtained in the absence of any salient externally imposed contingencies after the children had reliably come under the control of verbalizations about preschool behaviors.