Running head: SCHIZOPHRENIA AND BEHAVIOR MODIFICATION 1

Behavior Modification’s Efficacy in Treating Schizophrenia

Melanie Hall

Kansas State University

Running head: SCHIZOPHRENIA AND BEHAVIOR MODIFICATION 2

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.

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

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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 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

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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

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.

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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 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.

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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 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.

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