The Effects of Instructions and Reinforcement Versus a Multifaceted Self Control Procedure on the Modification and Generalization of Behavior in Schizophrenics

The Effects of Instructions and Reinforcement Versus a Multifaceted Self Control Procedure on the Modification and Generalization of Behavior in Schizophrenics

THE EFFECTS OF INSTRUCTIONS AND REINFORCEMENT VERSUS A MULTIFACETED SELF CONTROL PROCEDURE ON THE MODIFICATION AND GENERALIZATION OF BEHAVIOR IN SCHIZOPHRENICS Robert C. Gresen A Dissertation Submitted to the Graduate School of Bowling Green State University in partial fulfillment of the requirements far the degree of DOCTOR OF PHILOSOPHY March 1975 ii ABSTRACT The present investigation examined the treatment efficacy of a multifaceted self control procedure relative to behavior modification and yoked control procedures with chronic, nonparanoid schizophrenics. Further, the potential differential effectiveness of the same proce­ dures, depending upon the experimenter (E) who administered them, was examined. Forty-two subjects were pretested on five dependent measures. Subsequently, each subject was randomly assigned to one of two training Es and to one of the three experimental procedures. Regardless of B and treatment assignment, each subject received four hours of training on two of the five dependent variables- digit symbol and proverb inter­ pretation. After training, the subjeots were posttested using parallel forms of the five dependent measures. Four weeks later, a follow-up assessment was conducted, using a third set of parallel forms. Analysis of the pretest measures and five individual difference variables suggested that the groups were comparable prior to training. Individual analyses of the posttest and follow-up data, however, failed to reveal significant effects due to the E or methods or £ by method interaction. Separate multivariate trend analyses were conducted on each of the five dependent variables. Except for the digit symbol analysis, which may have reflected a rather transitory difference in treatment effectiveness, significant differential trends were not found among the three training methods, between the two training Es, or on the E by method interaction. Significant trends over time for the 42 subjects combined were found on both training variables but only on one of the three variables employed to assess generalization across responses the Holtzman inkblot test (HIT). For digit symbol, the trend reflected an increasing performance from pretest through the follow-up session. For proverb Interpretation, subjects significantly improved on the post- test relative to pretest levels. In addition, posttest performance was maintained on the four week follow-up. On the HIT, subjects improved significantly from pre- to posttest{ follow-up performance was sig­ nificantly lower than either pre- or posttest levels. The remaining measures of generalization across responses did not reveal significant change over time relative to pretest levels. It was concluded that for chronic, nonparanoid schizophrenics, the training procedures employed and/or the E administering the procedures were not differentially effective. This conclusion was equally applica­ ble to generalization across situations and responses. The research further demonstrated the complexity of the area and the necessity far conducting a series of experimental studies to isolate important in­ dependent variables. iii ACKNOWLEDGEMENT I wish to express ray appreciation to Donald Leventhal, Ph.D., Pietro Badia, Ph.D., Robert Warehirae, Ph.D., and Peter Facione, Ph.D. far their valuable contributions to the current research endeavor as well as their support and guidance throughout irçy career at Bowling Green State University. In addition, I wish to acknowledge the Psychology Department and the Research Services Office at Bowling Green State University, and the Research Service at the Veterans Administration Center, Wood, Wisconsin, for the funding made available to the present investigation. I also want to thank Mr. Paul DeLisle and Stan Simon, Ph.D., whose active assistance was indispensible to the implementation and completion of this study. iv TABLE OF CONTENTS Page INTRODUCTION...................................................................................................... 1 METHOD................................................................................................................19 Subjects........................................................................................ 19 Apparatus and procedure .........................................................................19 Digit symbol test....................................................................................20 Auditory distraction test.................. 21 Proverbs test......................... 22 Word Association test................................................... 22 Holtzman inkblot test............................................................................ 23 SI training group ................................................................................. 25 Operant training group ...................................................................... 29 Practice control group.................................................................. 31 RESULTS........................................ 33 Interrater reliability ...................................................................... 33 Pre-, post-, and follow-up test analyses ..... ................... 3^ Trend analyses......................................................................................... 36 Digit symbol test............................................................................ 36 Proverbs test....................................................................................38 Holtzman inkblot test .... ...................................................... ^3 Auditory distraction test ...................... .............................. 46 Word association test ................................................ .... 46 DISCUSSION....................................................................................................51 REFERENCES....................................................................................................60 V APPENDIX I. DEPENDENT MEASURES AND TRAINING TASKS ........................... 66 APPENDIX II. BECKER’S SCORING SYSTEMS ............................................... 87 APPENDIX HI. E GUIDE FOR PROVERB INTERPRETATION INSTRUCTIONS . 106 APPENDIX IV. DATA................................................................................109 APPENDIX V.S UBJECT ASSIGNMENT SCHEDULES................................................. 122 vi LIST OF TABLES Table Page 1. Multivariate trend analysis far digit symbol .......................... 37 2. Tukey’s HSD post hoc test results for digit symbol. All pairwise comparisons of means within each treatment group ................................................................................................ 40 3. Multivariate trend analysis for proverb interpretation . 42 4. Tukey’s HSD post hoc test results for proverb interpreta­ tion. All pairwise comparisons of means for all subjects combined............... ... ..................................................................... ... 43 5. Multivariate trend analysis for the HIT..................................44 6. Tukey’s HSD post hoc test results for the HIT. All pairwise comparisons of means for all subjects combined ....................... 46 7. Multivariate trend analysis for the auditory distraction task....................................................................................................47 8. Multivariate trend analysis for the word association task . 48 9. Tukey’s HSD post hoc test results far the ward association task. All pairwise comparisons of means for all subjects combined ................................................ ............................................50 1- A. Univariate analyses of variance. Pretest data.................. 110 2- A. Univariate analyses of variance. Posttest data ...... 112 3- A. Univariate analyses of variance. Follow-up data ..... 113 4- A. Correlation matrix for the 10 pretest variables ...... 114 5- A. Means and standard deviations for each group. Pretest data.115 vii LEST OF FIGURES Figure Page 1. Pretest, posttest, and follow-up mean performance for the SI, operant, and control groups on digit symbol.......................39 2. Pretest, posttest, and follow-up mean performance for all subjects combined on digit symbol ................................................ 41 3. Pretest, posttest, and follow-up mean performance for all subjects combined on proverb interpretation .............................. 41 4. Pretest, posttest, and follow-up mean performance for all subjects combined on the HIT............................................ 45 5. Pretest, posttest, and follow-up mean performance for all subjects combined on the word association task ....................... 49 1- A. Mean performance for each group on digit symbol............... 117 2- A. Mean performance for each group on proverb interpretation . 118 3- A. Mean performance for each group on the HIT........................... 119 4- A, Mean performance for each group on the auditory distraction task.......................... ... ..................... ............................................... 120 5- A, Mean performance for each group on the word association task 121 I Behavior modification, defined by Liberman (1972) as the applica­ tion of operant conditioning principles to abnormal behavior, is currently among the most widely used treatments with schizophrenics. This approach has provided the clinician with a variety of intervention techniques and, even more importantly, has attempted to substantiate the effectiveness

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