Running head: SCHIZOPHRENIA AND BEHAVIOR MODIFICATION

Behavior Modification’s Efficacy in Treating Schizophrenia

Melanie Hall

Kansas State University

Running head: SCHIZOPHRENIA AND BEHAVIOR MODIFICATION

Schizophrenia and Behavior Modification

Schizophrenia’s complexities have afforded it much attention from various

fields of psychology. The underlying interest seems to be discovering more about it

in order to improve the lives of those diagnosed with it. There are numerous

treatments available, one subset being behavior modification. A great amount of

information about the link between behavior and learning has been discovered.

Even more there is much information about the functionality and efficacy of utilizing

this knowledge for schizophrenia treatments. Out of the various behavior

modification programs used two examples are shaping and token economies. These

two methods will be explored in more detail to be followed by examining behavior

modification’s role in treating schizophrenia.

Shaping speech in schizophrenia patients. Speech issues are a common

challenge associated with schizophrenia. Shaping can be utilized to develop speech

that is conducive to successful communication and has been shown to work even in

cases as severe as reinstating speech in mute subjects. Operant shaping can

“mold” speech through positive reinforcement, rewarding subjects’ attempts to

imitate desired, sometimes prompted vocal behavior. In one study rewarding

successive approximations led to the reacquisition of speech in 6 of 13 subjects. Of

those 6 subjects 5 maintained their reacquired speech when checked a year later

(Cliffe, 1974). Being able to teach speech reacquisition in patients with

impairments should not be undermined but this therapy is not one that could be

used alone. This is especially true if a hope for patients is to receive care that will

treat their diagnosis in its entirety.

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Token economies and schizophrenia. Employing token economies is

another use of the paradigm of operant learning for the sake of modifying behavior

in patients with schizophrenia. As opposed to patients being punished when they

engage in undesirable behavior token economies can be used to take advantage of

positive reinforcement’s affect on increasing wanted behaviors. To accomplish this

staff must first pair a neutral stimulus with a primary reinforcer to create a token

and then use that token to positively reinforcement target behavior. Acquiring

tokens should be completely contingent upon the presence of target behavior in

patients and time wise should be given in close proximity to the occurrence of the

behavior. Successful studies have shown behavior changes such as an increase in

hygiene and social interaction and a reduction in apathy (Dickerson, Tanhula, and

Green-Paden, 2005). Token economies were used in hospital settings which leaves

many of the implications derived from their results unexplored in regards to the

population of those diagnosed with schizophrenia that are actively functioning in

societies.

Behavior Modification’s Efficacy in Treating Schizophrenia

Metaphorically speaking, questioning behavior modification’s efficacy in

treating schizophrenia as a sole means of therapy opens up a can of worms. The

easy answer is no. Not only is behavior modification not successful in and of itself

but according to The Schizophrenia patient Outcomes Research Team (PORT) in

their 2009 summary of current evidence-based psychosocial treatment

interventions attempts to treat schizophrenia more holistically by using different

therapies in conjunction with one another is not proving to be significantly effective

either. There is not sufficient evidence to merit specific recommendation for

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schizophrenia treatment (Dixon, Dickerson, Bellack, Bennet, and Dickenson, 2009).

This is unfortunate given the amount of treatments being recommended to people

in desperate need of being able to benefit from them. Beyond the lack of

treatments with promising outcomes is something that merits greater concern;

there are not many other conditions that have been researched as much as

schizophrenia with such a low rate of substantial returns (Jablensky, 1987).

Concerns emerge that lead to questions whose answers cannot be obtained

by merely studying subjects diagnosed with schizophrenia. Foremost, the tendency

to use the disease model as a sole perspective when researching the condition

generates an unease given the lack of variability in approaches and perspectives.

Acknowledging this concern can lead to a greater capacity to develop new areas of

interest in regards to schizophrenia research. Two such areas are going to be

discussed and these are undiscovered strengths associated with schizophrenia and

the importance of environmental effects on symptoms.

The disease model and schizophrenia research. Like most studies

conducted since WWII schizophrenia has been analyzed through the lenses of the

disease model psychology is all too familiar with. After WWII two of three goals of

psychology: making the lives of all people more productive and identifying and

nurturing and fulfilling high talent were unfortunately weeded out. What was left

was focus on individual suffering (Seligman, and Csikszentmihalyi, 2000). In science

it should be clear that overuse of one model is systematically going to create bias in

research. Given what is known about concepts such as learned helplessness and

self fulfilling prophecy it does not seem like such an oddity that the prevalence of

what seems to be an increase in diagnosis of psychosis such as schizophrenia is

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resulting. One begins to wonder if this has become a witch hunt of sorts. These

last statements do sound extreme but this should not immediately discredit the

questions.

Invariability in research. In Jablensky’s work there was the introduction of

the idea that schizophrenia could be theorized under a “non-disease” model. Just as

quickly there is a follow-up statement expressing the implausibility of this idea. This

is precisely the lack of variability that is going to result when the disease model

reigns. Quickly writing off the option of moving away from using only the disease

model shows a lack of curiosity and creativity that should be innate in research and

science. To fully approach such an idea is exactly the outlet needed for new

questions to make strides towards the overarching goals of schizophrenia research.

The successes of studies that find medications or behavioral therapies that

generate individualized improvements for those with schizophrenia should not be

undermined. Equally necessary though is not giving so much attention to short term

goals such as strengthening speech that the approach of research becomes

stagnate in a sense. Even more, advances in technology do not translate and should

not be mistaken for advances in research. If the technology that comes along, for

example with neuroscience, is used only as tools serving the disease model then

outcomes could be quite the opposite of advancement. This biased approach could

lead to more information to load the stigma that those living with schizophrenia

already face. Societal stigmas lead to self stigma’s which have been shown to

reduce desired behaviors in schizophrenia patients such as pursuing work (Corrigan,

2007; Lamb, 2009). A magnanimous amount of effort has been put into changing

people perceived to be suffering from schizophrenia. Given the comments from

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PORT about the inefficacy of these efforts in lieu of diagnosis and treatment means

it is time to stop reinforcing the behavior of these efforts. This does not mean stop

typical research entirely but to at the very least start reinforcing those who change

their approach and perspectives when studying schizophrenia.

In Genes for Psychosis and Creativity, the investigator explores the possibility

of a relationship between psychosis genes and something other than psychosis. Keri

predicts that the neuregulin 1 gene, whose T/T expression has so far only been

associated with psychosis, may have a beneficial expression, creativity. Keri did

indeed find a correlation between increased creativity scores and the T/T genotype

(Keri, 2009). This approach is a prime example of the kind of perspective change

that may need to occur to assist with a genuine advance in schizophrenia research.

As uncomfortable as people may be with accepting it there may be benefits that

come from psychosis including schizophrenia. This one study’s exploration of

possible benefits of psychosis should not seem insignificant.

Environment and schizophrenia. If research and treatment move forward

under the sole auspice of the disease model there is at least the responsibility to

acknowledge this as an intellectual decision. Such a decision though would appear

to be made out of the sake of traditionalism. Considering Keri’s findings ignites

curiosities about the impact of the disease model on frames of thought and the

environment of those living with schizophrenia. If schizophrenia is always

communicated as a “state of suffering” do those diagnosed with it really have a

chance of a significant increase in well-being? What is known about self fulfilling

prophecy and learned helplessness would imply no, they don’t have a chance. If

there are strengths that can be associated to schizophrenia it is the responsibility of

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those doing research to find those strengths, validate and nourish them. This could

result in much greater progress in individuals and ultimately society. A question for

future behavioral research could examine the likelihood that certain behavioral

modification’s expectations increase internal conflict in schizophrenia patients due

to their going against possible unique behavior systems. If such a thing is true this

could help generate information to de-stigmatize schizophrenia and change one of

the most important stimuli that shape the behavior of people with schizophrenia

have, other people.

Running head: SCHIZOPHRENIA AND BEHAVIOR MODIFICATION