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.     

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.     

Comparison of three abbreviated MMPIs for psychiatric patients and normals.

Two studies, one using 242 psychiatric patients and the other 120 normal college students, were conducted to evaluate the predictive potential of three abbreviated MMPIs namely the Midi-Mult, Hugo abbreviated MMPI and Faschingbauer abbreviated MMPI. With regard to psychiatric inpatients, the Faschingbauer abbreviated MMPI-scale group means were markedly similar, highly correlated, and seemed to be a fairly accurate substitute for the MMPI in predicting clinical types. Numerous deficiencies were evident when using the Midi-Mult or Hugo abbreviated MMPI, especially with regard to classification analysis concerning validity, mean raw score scale differences and high point codes. In contrast, results from a normal college sample showed close statistical correspondence, high comparability in identifying valid and invalid profiles as well as high correspondence with respect to high point codes and general profile elevations regardless of which abbreviated form was used.     

Comparison of schizophrenics and normals on a visual search task.

The response times of 16 paranoids, 16 nonparanoids and 16 normals were compared on a search task which required subjects to identify target letters embedded in displays of varying numbers of non-targets. The rate on increase in response times with increased numbers of letters displayed was not markedly different for the various groups, although a derived measure of decision and response-selection time indicated that normals selected responses more rapidly. When compared with normals, schizophrenics seemed to experience more difficulty in response selection and decision than in processing visual stimulus information.     

Blinking and thinking.

Blinking is related to certain cognitive processes. For example, individuals "punctuate" their speech by blinking between phrases and at the end of sentences. Daydreaming is associated with low rates of blinking. Blinking occurs between fixations and may be timed so as not to interfere with significant visual input. Apparently, blinking occurs at transitions between internal events and is inhibited at other times. In the experiment reported here, blinking was measured while the activity of operational memory was manipulated with mental load kept constant. The rate of blinking was significantly reduced when the cognitive operation of internal counting was being performed. It is inferred that the blink rate is low when information in memory is being operated on. To suspend blinking during certain cognitive activities would be adaptive if blinking disrupts them. Since the blackout period of the blink produces a rapid change in visual level, blinking disrupts those cognitive processes utilizing display areas accessible to visual input. Operational memory and the visual imagination may share components with the visual perceptual system. To protect these vulnerable processes from interference, blinking may be inhibited when they are active.     

Visual backward masking in retardates and normals

Educable adolescent male retardates were compared with normal males of equal CA and equal MA on a visual backward masking task. Significantly shorter interstimulus intervals were required to induce a masking effect in the equal-CA group than in the retarded and equal-MA groups, who did not differ from each other. Speed of visual processing is a function of MA. It is related to CA in normals. and to IQ when retardates are compared with equal-CA normals.     

Reducing delusional speech in chronic, paranoid schizophrenics

Four schizophrenic patients with paranoid and grandiose delusions who had been hospitalized for an average of 17 yr were exposed to social reinforcement contingencies in a multiple baseline design. During the baseline period, each patient was interviewed for four 10-min sessions each day. The elapsed time from onset of conversation to onset of delusional talk was recorded. At the end of each day, the patients engaged in a 30-min informal chat with a nurse-therapist while relaxing with coffee, snacks, and cigarettes. The intervention introduced two contingencies: (1) The 10-min interviews were terminated as soon as the patient began talking delusionally; (2) The patients earned time for their evening chat by talking rationally during their daytime interviews. Increases of from 200 to 600% in the amount of rational talk exhibited during the interviews occurred as the contingencies were introduced for each patient sequentially over time. These increases were maintained in three patients when the amount of reinforcement was halved, but declined when the patients were confronted directly with their delusional ideas. A modest amount of generalization occurred from the day-time interviews to the evening chats but did not extend to the behavior of the patients on the ward.     

Schizophrenic tendencies and memory deficits in normals

The report tests the hypothesis that normals who exhibit schizophrenic tendencies are likely to show verbal-memory deficits of the types observed in schizophrenics. Thirty-four middle-aged men were tested using the MMPI 2–7–8 schizophrenic-tendency scales, the Sorting Consistency Task and the Physical Anhedonia Scale. The dependent variables were four memory tests selected on the basis of their known discriminating power and their relevance. The results showed the Schizophrenia (8) and Psychasthenia (7) scales of MMPI, and the Sorting Consistency Task effectively detected memory deficits in normals. When partialling out intelligence, as a measure of general current cognitive functioning, it appeared that one of the deficits reflecting encoding difficulty disappeared. This suggests that normal ‘high-risk’ subjects for schizophrenia show a ‘generalized deficit’, which affects memory in addition to a ‘differential deficit’ in retention. Though tentative, the results can be taken as an indication that ‘high-risk’ subjects indeed show memory deficits and that detecting these deficits requires relatively sensitive tools.     

Approaches and thinking styles in teaching.

In this study, the author examined the relationship between teaching approaches and thinking styles in teaching. The study parallels previous investigations (Zhang, 2000a, 2000b; Zhang & Sternberg, 2000) of students' learning approaches and thinking styles in learning. Seventy-six in-service teachers from Hong Kong responded to the Approaches to Teaching Inventory (K. Trigwell & M. Prosser, 1996) and the Thinking Styles Inventory in Teaching (E. L. Grigorenko & R. J. Sternberg, 1993) as well as to a range of questions designed to assess the participants' perceptions about their work environment. It was concluded that approach and style are two overlapping constructs with different labels. The differences between approach and style are in degree, but not in kind.     

Reasoning, emotions, and delusional conviction in psychosis

The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction.