Re-establishing conversational skills in overtly psychotic, chronic schizophrenic patients. Discrete trials training on the psychiatric ward

Validation of the Use of a Nonparametric Smoother for the Examination of Data from a Single-Subject Design

The statistical analysis of data from a single-subject design remains somewhat an issue of debate. The frequently employed procedure for examining data from a single-subject design involves visually inspecting the graphed outcome variable over the observation time. Potential difficulties of this procedure have been shown. The application of traditional statistical tests has also been questioned. The nonparametric smoother has been presented as a possibly appropriate and useful technique for the examination of data from a single-subject research paradigm. This article attempts to validate the use of a nonparametric smoother for the examination of data from a single-subject design. A recommendation is given regarding the use of this technique.

A review of training intraverbal repertoires: can precision teaching help

Intraverbal behavior is common in conversation and academic and professional settings. Many individuals with disabilities fail to acquire intraverbal repertoires. Some individuals who do acquire intraverbal behavior fail to acquire responses that are functional and complete. Research has examined procedures to establish or increase intraverbal repertoires of individuals with impaired verbal repertoires. Several of these studies integrate a precision teaching methodology with Skinner's (1957) conceptual framework. This paper reviews the literature on the most commonly examined methods of establishing or increasing intraverbal repertoires. Articles that incorporate precision teaching are emphasized. The review highlights the strengths (including the effectiveness) and limitations of each procedure. The review concludes with a discussion of the implications of using precision teaching to establish or increase an intraverbal repertoire and with suggestions for future research.

Towards an integrated, structural model of psychiatric rehabilitation

In the past two decades, the number of principles and approaches that have been touted as psychiatric rehabilitation have overwhelmed the service provider. As a result, the field seems to be bombarded by contradictory ideas. In this paper, I seek to resolve this problem by providing an overview of psychiatric rehabilitation in terms of four key structures: goals (the reasons why people with psychiatric disabilities seek rehabilitation), strategies (the tools which service providers might use to help consumers reach their goals), settings (the places in which providers and consumers use these tools), and roles (the variety of professional and personal backgrounds which influence providers in carrying out their duties). In this paper, I review the research literature that has identified relevant examples of each of these structural dimensions. This description of psychiatric rehabilitation is based on a two-factor model of the life challenges that arise from mental illness: the disabilities produced by the disease and the loss of opportunity that result from stigma and discrimination. The paper also includes a brief discussion of the two-factor model.

Cognitive-behavioral therapy in schizophrenia

The authors review the literature on cognitive-behavioral approaches to the treatment of schizophrenia. They begin by providing a historical context to explain the recent resurgence of interest in this area. Next, they provide an overview of studies of cognitive-behavioral interventions that target poor insight, medication nonadherence, and refractory symptoms. Insight and nonadherence are emphasized because these are particularly common and problematic areas that present major stumbling blocks in the treatment of patients suffering from schizophrenia that are not yet sufficiently addressed by the interventions clinicians currently have in their treatment arsenal. The authors conclude that support exists for the efficacy of interventions derived from cognitive-behavioral approaches in improving some aspects of insight into illness, increasing adherence to medication, ameliorating the severity of symptoms, and mitigating other negative consequences of schizophrenia. Finally, the authors offer guidelines for future work in this area and emphasize the importance of identifying patients who are most likely to benefit from the use of cognitive-behavioral approaches.

Cognitive therapy with schizophrenic patients: conceptual basis, present state, future directions

Schizophrenia may nowadays be most readily understood as a systemic disorder in which changes in the brain structure underlie individual cognitive abnormalities which for their part interact with environmental factors at the onset of the illness and during its course. From this, one may deduce the rationale for cognitive therapy for schizophrenic patients. Existing approaches may be systemised as direct, indirect and combined procedures. The latter are based on the assumption of the pervasive effects of elementary and complex cognitive dysfunctions at the levels of open behaviour. However, in a mirror-design study with 21 schizophrenic patients according to DSM-III-R in which the effects of various intervention sequences were examined, it was not possible to find confirmation for this. This and other open questions have led to doubts expressed in current literature concerning the utility of cognitive therapy, especially with respect to the locus, nature and malleability of cognitive disorders, as well as the possibility of generalizing cognitive improvements. The latter are discussed in detail and possible future directions in cognitive therapy for schizophrenic patients are shown.

Cognitive correlates to social cue perception in schizophrenia

Previous research has examined social skill learning in schizophrenic patients in relation to information-processing deficits and psychiatric symptoms. Relationships were examined in the current report between social cue perception, thought to be an early and necessary component of skill learning, and various information-processing deficits and psychiatric symptoms. Twenty-six inpatients with DSM-III-R diagnoses of schizophrenia completed measures of social cue perception, cognitive functioning, and psychiatric symptoms. Results showed that cue perception was significantly related to measures of early visual processing, recognition memory, and psychiatric symptoms of withdrawal/retardation. Implications of these findings for future research into the social-perceptual deficits of schizophrenic patients are discussed.

Conversation skills training of thought-disordered schizophrenic patients through attention focusing

An attention-focusing procedure was designed as discrete trials and multiple prompts with contingent social reinforcement to facilitate the acquisition of conversational skills in thought-disordered schizophrenia patients. Three patients with DSM-III-R diagnoses of schizophrenia completed a standard social skills training program and the attention-focusing procedure in multiple baseline experimental designs. While social skills training had little effect on the acquisition of skills, patients who completed the attention-focusing procedure significantly increased performance of conversational skills and showed some generalization of trained behaviors.

Teaching conflict resolution skills to the chronically mentally Ill. Social skills training groups for briefly hospitalized patients

Previous research on social skills training has demonstrated its usefulness as an adjunct treatment for a variety of psychiatric disorders. At the Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, an acute-care psychiatric hospital, a social skills training group has been in operation for over 3 years. The group is unique in its format in several ways that are described in this article. Data collected over the 3-year period are also presented. The major findings indicate that even over a very brief period of time during an acute hospitalization, patients can learn basic conflict resolution skills. Some predictors of skill acquisition were also identified.