A behaviour modification project with chronic schizophrenics in the community

A major shortcoming of token economies is their failure to ensure carry over of behavioural gains into the community; hence it is logical to investigate the feasibility of behavioural programmes for schizophrenics in their own homes. The token economy literature and the literature on behavioural interventions in the natural environment provide guidelines but also indicate possible difficulties arising from the nature of the illness and the use of the family setting.

Despite numerous accounts of effective behavioural treatment of schizophrenics (Ullman and Krasner, 1965; Ayllon and Azrin, 1968; Atthowe and Krasner, 1968; Stoffelmayr et al., 1973) here and there in the literature a note of caution is sounded. Meyer and Chesser(1970) and Yates (1970) suggest that there is undue optimism. Kazdin (1973) notes that reports of non-response in psychotics range from 10 per cent (Atthowe and Krasner. 1968) to 52 per cent (Panek 1969). Non-response is sometimes attributed to practical or administrative obstacles (Ayllon and Azrin, 1968; Hall and Baker, 1973) or shortcomings in the application or Operant principles (Ayllon and Azrin, 1965; Atthowe and Krasner, 1968; Kazdin and Bootzin, 1972). but more serious objections stem from the view that Operant principles may be applicable only to certain aspects of the behaviour of psychotics, such as apathy and withdrawal fostered by institutional environments. Operant technology may fail to take into account the antecedents of behaviour, including anxiety, delusions and hallucinations or covert consequences such as relief of anxiety (Davison, 1969). ‘Non-functioning’ behaviour, particularly deficit in social interaction, and paranoid behaviour, have been found especially resistant, the former because of initial low levels of the desired behaviour, the latter because of covert self-reinforcement (Libermann, 1968). Kazdin (1973) suggests that there is support from laboratory studies for the view that response patterns in psychotics may be atypical. A further qualification is that one cannot readily generalise from the American ‘chronic schizophrenic’ to his British counterpart (Cooper et al., 1972) nor from the long-stay patient to the chronic schizophrenic in the community.

The literature on behavioural intervention in the family setting gives further cause for caution. Thomas and Walter (1973) report a 27 per cent dropout, and suggest this was due to client inaccessibility, “countervailing environmental influences”, non-compliance, crises and unstable domestic situations. Patterson (1972) and Sajwaj (1973) cite parents' personal problems. Tharp and Wetzel (1969) rejection of Operant methods, and Salzinger et al. (1972) parents' poor verbal ability and low educational achievement as factors related to unsuccessful outcome. In the Project described below, it was hoped that problems would be more clearly identified and that a beginning might be made in selecting suitable cases for behaviour modification in the family setting.     

Modification of preschool isolate behavior: a case study

A 5-yr-old preschool boy with a low rate of interaction with his nursery school classmates was induced to pass out candy as a tactic to increase his rate of interaction with them. Interaction with classmates increased markedly during the periods he passed out choices of candy. These changes may have been due to increases in both his rate of initiating activities with his classmates and to increases in his classmates' rate of initiating activities with him. A total time of less than 1 hr was required of the teacher during the experiment.     

An operant treatment procedure for alcoholics

For many years total abstinence was regarded as the appropriate criterion for the successful treatment of alcoholism. It is suggested that given societal norms for social consumption of alcohol, plus the social reinforcers which maintain beverage alcohol ingestion, social drinking may serve as a realistic treatment goal. The efficacy of a social drinking criterion was clearly demonstrated by Bigelow et al. (1972). Chronic alcoholic in-patients were placed in a choice situation in which they earned the opportunity to participate in an ‘enriched’ environment contingent upon either moderate drinking or abstinence. Subjects overwhelmingly chose the moderate drinking alternative. Results also suggested that moderate drinking is more reinforcing than abstinence for alcoholics. Further support for the moderate drinking concept was rendered by Mills, Sobel and Schaeffer (1971) in a study which made electric shock contingent on gulping drinks, ordering straight alcoholic drinks and ordering and consuming more than three drinks. Time-out (Cohen et al., 1971), positive reinforcement (Cohen et al., 1971) and social contracting procedures (Miller, 1972) have been effectively employed to reduce drinking behavior from maladaptive to adaptive frequencies.

The present study attempts to extend treatment with a controlled drinking outcome to out-patient alcoholics     

Effects of relaxation instructions on the electromyographic responses of abstinent alcoholics to drinking-related stimuli

Viewed from a behavioral perspective alcoholism is a behavioral disorder which should be influenced by the same range of environmental and historical variables which affect other operant behaviors. Therefore, environmental stimulus circumstances should play a significant role in influencing alcoholics' disposition to drink. In particular, stimuli which have previously been associated with drinking behavior should come to exert some controlling influence over subsequent disposition to drink. Relapse to substance abuse is often believed to be precipitated by exposure to stimulus circumstances previously associated with the drug or its use. This hypothesis has received its greatest emphasis in the area of narcotics abuse (Wikler, 1965). but presumably it is relevant also to the case of alcohol abuse. Research concerning abusers' reactions to alcohol-related or drinking-related stimuli has been minimal. Ludwig et al. (1974) have presented data suggesting that alcohol-related stimuli interact with priming doses of ethanol to increase alcoholics' disposition to drink. Miller et al. (1974), however, failed to observe a significant effect of drinking-related stimuli upon alcoholics' disposition to drink.

In the field of behavior therapy, relaxation and stimulus-exposure techniques (e.g. systematic desensitization) are often recommended as techniques for reducing the effect of environmental stimuli upon an individual's behavior. However, data are lacking concerning the effect of relaxation training upon alcoholics. The present study uses psychophysiological procedures to investigate three issues concerning the effect of drinking-related stimuli and relaxation instructions upon alcoholics: (1) the effect of a single session of systematic relaxation instructions upon the electromyographic tension levels of abstinent alcoholics; (2) the effect of drinking-related auditory stimuli upon the electromyographic tension levels of abstinent alcoholics; and (3) the influence of prior relaxation instructions upon the EMG responses of abstinent alcoholics exposed to drinking-related stimuli.     

Sex differences in the reading process revealed by a letter-detection task

Four experiments used a task in which males and females had to work through a passage and circle instances of a target letter. Coltheart, Hull and Slater (1975) have previously used this task to show that females have greater difficulty than males in detecting target letters, especially letters in the and other silent letters. The four experiments failed to replicate Coltheart et al.'s findings and, in fact, frequently found significant sex differences in the opposite direction. This discrepancy in results could not be accounted for in terms of procedural differences between the two studies. It was concluded that Coltheart et al.'s (1975) results with the letter detection task may not be reliable.     

A behaviour modification technique for the hyperactive child

This paper describes a procedure for the conditioning of attending behaviour in a brain-injured hyperactive boy.

Observations of the behaviour of two hyperactive children were made in the classroom setting. These observations were made from an observation bootn adjoining the classroom and provided data on the frequency of occurrence of the following high rate responses: walking, talking, distraction, “wiggling”. Each child was observed for a minimum of ten minutes a day, four days a week. Following several weeks of baseline observation, the conditioning procedure was begun with the expel imental subject. The conditioning trials took place in the classroom setting. During each time interval in which one of the high rate responses did not occur, S received an auditory stimulus (secondary reinforcer). This auditory stimulus had previously been paired with the delivery of candy and pennies. The stimulus was dispensed by a radio device which activated an earphone worn by the subject. At the end of each conditioning trial, S received whatever candy or pennies he had “earned”.

The data show that the control subject showed no significant change in the frequency of occurrence of the high rate responses during the three month period. The experimental subject showed a significant decrease in non-attending behaviour. This reduction in rate was maintained over a four week extinction period.     

Differences in baseline drinking behavior between New Zealand alcoholics and normal drinkers

Details of alcohol drinking by 12 New Zealand hospitalized alcoholics and 12 normal drinkers from the local community were compared in an experimental bar-and-lounge environment. Differences between the drinking behavior of the two groups were found to be statistically significant on measures of total alcohol consumed, sip size and rate of alcohol ingestion (speed of drinking). The drinking pattern exhibited was similar to that reported in baseline studies of North American drinkers, as reported by Schaefer et al. (1971). This similarity was discussed in terms of a behavioral profile of alcoholics as compared with normal drinkers for the diagnosis of problem drinking.     

Problems involved in toilet-training profoundly mentally handicapped adults

Toileting difficulties constitute a severe problem in institutions for the mentally handicapped. The present study, in a British institution, is a cross-validation of the approach to toilet training outlined by Azrin et al. in the U.S.A. Although Azrin's approach was basically successful, a number of differences were found in running the programme. These differences, together with practical difficulties encountered, are discussed.     

Palatability of food as a factor influencing obese and normal-weight children''s eating habits

The type and amount of food leftover from school lunches by normal-weight and obese elementary school children was examined for its similarity to the pattern reported by Krassner et al. (1979) in a study of normal-weight and obese college students. In this study 102 observations of children between the ages of 9–11, were taken over eight lunch periods in their school cafeteria. Overall, the normal-weight children left only slightly more food uneaten than did the obese children. However, when food palatability was examined, it was found that normal-weight children left over twice as much palatable food as did obese children. Children did not differ on the amount of unpalatable food left uneaten.

These results suggest that Krassner et al.'s observation that obese adults leave less food on their plates may be extended to children and, further, that like obese adults, obese children may be more influenced by the palatability of food than their normal-weight peers.     

Treatment of stammering by reinforcement of fluent speech

A series of small experimental studies was conducted with three stammerers. The studies show that stammering may be controlled by positive reinforcement of fluent speech in a machine reading task. This new procedure for the treatment of stammering is convenient and effective in producing fluent speech in the laboratory. Evidence suggests some generalization of a stable kind to outside settings.

Stammering interrupts speech and disturbs communication. It has been treated by a variety of methods, ranging from physical assault on the speech organs, through procedures designed to establish new speech patterns, training in deliberate speech control, and masking of auditory feedback, to psychotherapy and behaviour therapy.

Negative practice has brought about improvement in up to a third of cases (Dunlap, 1932; Fishman. 333 1937; Sheehan, 1953; Lehner, 1954; Jones, 1955; Case, 1960). The other common form of behaviour therapy has usually involved negative reinforcement or punishment. Flanagan, Goldiamond and Azrin (1958) used a loud blast of noise every time subjects stammered. Stammering rate was markedly depressed during the aversive conditioning, but when the aversive conditions were discontinued, stammering rate showed a pronounced increase. More recently, Goldiamond (1965) used fluency to terminate a noxious stimulus and reported a reduction in stammering.     

The use of restricted environmental stimulation therapy (REST) in the treatment of essential hypertension: Two case studies

The previous paper (Suedfeld et al., 1982, pp. 553–559) reported the use of Restricted Environmental Stimulation Therapy (REST) in treating hypertension. This paper reports the response of two patients to 24 hr of a similar treatment offered as an adjunct to a weight-control program. In both patients blood pressure dropped immediately following the REST session and remained lower for up to 9 months. The initial drop in blood pressure was independent of weight loss. These results are interpreted in terms of a psychobiological model of self-regulation.     

Inappropriate speech in a severely retarded child: a case study in language conditioning and generalization

The modification of inappropriate speech, a class of behaviors rather than a limited number of specific examples, is little known in the severely retarded. In this study, operant techniques were used to modify the strikingly bizarre and inappropriate speech of a severely retarded boy. The boy's appropriate verbal responses to questions about magazine pictures were reinforced with candy. When he responded inappropriately, the magazine was withdrawn, and social interaction was discontinued for a 10-sec timeout period. Negative responses were ignored, the next picture displayed, and the next question asked immediately. In 10 sessions, appropriate responses increased from 26% to 86% of all responses. A reversal of reinforcement was then introduced, in which inappropriate responses were reinforced, appropriate responses resulted in timeout, and negative responses were treated as before. This reduced the percentage of appropriate responses to 24%. Subsequent sessions of reinforcement for appropriate responses increased appropriate responses to 96% of all responses. At significant stages in the experiment, a measure of possible generalization was attempted. Although some generalization was recorded, it was minimal: some explanations are discussed.     

The speech and vocalization patterns of boys with ADHD compared with boys with dyslexia and boys without learning disabilities

This research study dealt with an inquiry into the speech and vocalization patterns of boys with Attention Deficit Hyperactivity Disorder (ADHD) who were not under the influence of stimulating medication, compared with the speech and vocalization patterns of boys with reading disabilities and a control group of learners without learning disabilities. The voices of 105 participants were recorded during interviews and analyzed in the laboratory using equipment that examined the temporal speech patterns and physical features of vocalization. The speech patterns were examined with a frequency examination, speech unit length duration, and correlation between the vocalization and pauses in the speech unit. The physical features of vocalization were examined with volume and frequency scales. The research results indicated that the speech and vocalization patterns of boys with ADHD were significantly different from those of boys with reading disabilities and from the boys in the control group. The results support the assumption that speech and vocalization indicators can be used as objective indicators for the diagnosis of hyperactivity syndrome with attention and concentration difficulties.     

Effects of candy and social reinforcement, instructions, and reinforcement schedule leaning on the modification and maintenance of smiling

Two retarded boys exhibited abnormally low rates of smiling. In Exp. I, the frequency of a boy's smiling was first increased with candy reinforcement, but the frequency of the response did not decrease when candy reinforcement was terminated. When the subject wore a sign designed to make social interactions contingent on not-smiling, the frequency of smiling decreased. The sign was then changed to make social interactions contingent on smiling and the rate of smiling increased. In Exp. II, a second boy initially never smiled. Establishment of a contingency for candy reinforcement did not increase this zero response rate. Instructing the child to smile initially increased smiling, but the instructions then became progressively more ineffective. Candy reinforcement increased the rate of smiling to a normal range, but the rate of the response promptly decreased when this reinforcement was discontinued. Continuous candy reinforcement was again employed to increase the response rate and then progressively leaner schedules of variable-ratio candy reinforcement were employed. Consequently, the rate of smiling did not decrease when candy reinforcement was again eliminated. Subsequently, signs were employed to regulate social interactions and the rate of smiling was shown to be controlled by these interactions serving as reinforcers.     

Timing and co-ordination of repetitive bimanual movements

Similar timing of movements of the two hands has been observed when they are moved to separate targets (Kelso et al., 1979). This was taken as evidence for a low-level, co-ordinative structure that constrains the muscles of the arms to function as a single unit.

An experiment to investigate the relation between voluntary timing control and timing in bimanual movement is described. The task required subjects to make repetitive movements of unequal difficulty for the two hands with the hands arriving synchronously at their respective targets. Estimates of the covariance of successive intervals defined by pairs of left-right responses (arrivals at the targets) were not negative. It is shown that this indicates that the motor delay between the timer regulating repetition rate and the overt responses has no component common to left- and right-responses. Although the co-ordinative structure is described as low-level, in terms of the time sequence of operations associated with each response pair, the data indicate its place is before, not after, the timer.     

Backward recognition failure: A case of retrieval success

Tulving and Wiseman (1975) have demonstrated that a systematic relationship exists between the recognition probability of recallable words and the overall level of recognition. However, this relationship has only been shown in the paradigms examining “forward” recognition failure, as defined by Rabinowitz, Mandler and Barsalou (1977). A reanalysis of their data shows that just such a systematic relationship exists in “backward” recognition failure experiments, and a model developed from the tenets of Fragmentation Theory is shown to predict this. A critical experiment which falsifies the dual-coding, dual-access model used by Rabinowitz et al. (1977) is also reported, thereby extending the generality of the Fragmentation Model.     

Cognitions related to anxiety: a pilot study of treatment

In general, where anxiety appears to have a specific external focus, such as the situations which are avoided by phobic patients, treatment involving systematic exposure to those situations seems to be effective. This is less appropriate, or even impossible, where anxiety is not dependent on any external circumstance, but is described by the patient as occurring at any time or place, either chronically over long periods, or acutely in the form of ‘panic attacks’. These patients with ‘generalised’ anxiety often describe internal cues for anxiety either in the form of thoughts (e.g. worry over a current problem) or somatic (e.g. chest sensations interpreted as possible heart disease). Beck et al. (1974) has suggested that on interview, all patients diagnosed as suffering from diffuse or generalised anxiety can report specific ideas or other cognitive cues which are associated with anxiety. These usually concern possible traumatic events, such as illness and death, or social rejection. Clearly Beck has in mind the possibility that these cognitions have the effect of inducing anxiety, although even if the validity of the subjective reports were to be accepted, the problem remains of whether the relationship between mood state and cognitions is causal and if so, in which direction it operates. Obviously a causal relationship may also operate in both directions simultaneously, to form a ‘vicious circle’ in which each exacerbates the other. To establish whether there is a sense in which particular cognitions contribute causally to anxious mood, it would be necessary to find a method of manipulating the type or frequency of cognitions thought to be operating in this way.

One obvious possibility is that of ‘thought-stopping’: that is, patients could be taught to identify thoughts which are associated with anxiety and stop them in the usual way (Wolpe, 1973, p. 211) e.g. by' shouting stop, and substituting an alternative thought. The present study was planned as a pilot experiment to determine (i) if appropriate anxiety related cognitions could be elicited from a series of patients with generalised anxiety, (ii) if the reported frequency of such thoughts could be modified by a thought-stopping technique, and (iii) if any changes in thought frequency were associated with improvements in mood.

Clearly there are many ‘non-specific’ features involved in thought-stopping which could also have therapeutic effects on mood. For this reason it was necessary to include an alternative procedure, not directed at reducing thought frequency, but having the same degree of plausibility to patients, and preferably to therapists. The control procedure chosen for this purpose was modelled on desensitisation, in which patients were encouraged to allow the supposedly anxiety-provoking thoughts into their mind and tolerate them, rather than attempt to stop them. In summary, the study employed a relaxation training phase as a base-line, followed by a cross-over design in which the two treatment phases of thought-stopping and ‘cognitive desensitisation’ were given to each patient, in balanced order.     

The effect on the test behavior of children, as reflected in the I.Q. scores, when reinforced after each correct response

This experiment studied the effect on intelligence test scores of a probable reinforcer given for correct responses. Eleven pairs of 5- to 7-yr-old children were matched on the basis of a strong liking of candy, no physical problems associated with eating it, parent permission to receive and eat the candy, age, sex, and a revised Stanford-Binet Scale Form L IQ score. The control group was given the revised Stanford-Binet Scale Form M, as prescribed in the test manual. The experimental group was also given Form M according to the manual, except M&M candy was given for each plus or correct response. There was an appreciable, statistically significant difference between the resulting IQ test scores of the two groups.     

Infant-adult vocal interaction dynamics depend on infant vocal type,child-directedness of adult speech,and timeframe

This study explored the temporal contingencies between infant and adult vocalizations as a function of the type of infant vocalization, whether adult caregivers’ vocalizations were infant-directed or other-directed, and the timescale of analysis. We analyzed excerpts taken from day-long home audio recordings that were collected from nineteen 12- to 13-month-old American infants and their caregivers using the LENA system. Three 5-minute sections having high child vocalization rates were identified within each recording and coded by trained researchers. Infant and adult vocalizations were sequenced and defined as contingent if they occurred within 1 s, 2 s, or 5 s of each other. When using 1 s or 2 s definitions of temporal adjacency, infant vocalizations generally predicted subsequent infant-directed adult vocalizations. A reflexive vocalization (i.e. a cry or a laugh) was the strongest predictor. Likewise, within 1–2 s timeframes, infant-directed adult speech generally predicted infant vocalizations with reflexive vocalizations being particularly predictive. Infant vocalizations predicted fewer subsequent other-directed adult vocalizations and were less likely following other-directed adult vocalizations when considering up to 5 s lags. This suggests an understudied communicative role for infants of non-infant-directed adult speech. These results demonstrate the importance of timescale in studying infant-adult interactions, support the communicative significance of reflexive infant vocalizations and other-directed adult speech in addition to more commonly studied vocalization types, and highlight the challenges of determining direction(s) of influence when using only two-event sequences.