Abstract
A variety of cognitive mechanisms have been proposed to apprehend the maintenance of delusional beliefs, a typical feature of schizophrenia. However, none of these mechanisms takes into account the verbal properties of delusions. An alternative behavioral approach is proposed, which considers delusional beliefs as verbal rules and maintenance of delusions as a form of rule-based insensitivity to changing environmental contingencies. A pilot study is described in which patients formerly presenting with delusional ideas and control participants were exposed in a repeated measures design to three different instructional conditions, instructions, no instructions, and self-instructions, in the context of a non-signaled changing multiple reinforcement schedule. Results suggest that, in the presence of instructions, patients formerly presenting with delusional ideas demonstrate greater insensitivity to changes in schedule contingencies than control participants. While these findings are preliminary, they suggest that rule-based insensitivity to changing environmental contingencies constitutes a new promising way to approach maintenance of delusional beliefs.
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Notes
Accepted by CCPPRB of Picardie under reference 03H19.
Fixed reinforcement schedules have been preferred to variable ones so that adjusted patterns of response are distinguished clearly across the two keys of responses, and lack of adjustment is easily observed during the reversed part of the experiment.
Keeping the data from the first presentation of each schedule in the data set revealed that patients in SI groups did not adjust to contingencies changes in regular phase, as controls WI and patients NI groups did not. In sum, the changes comparing the results without the first presentation of the results are from adjustment to non-adjustment to the programmed contingencies. Presentation of each schedule engenders too eratic behaviors since participants spend this first presentation exploring the contingencies.
Interestingly, the difference of adjustment between Patients and Controls WI groups in the reversed phase of the experiment while keeping the first presentation data shows that controls tend to be maladjusted during first presentation, then to adapt to contingencies (they carry on following the instruction at first presentation, then adjusted their behaviors), while patients fail to do so.
As it turned out, the instructions formulated by control participants and patients corresponded closely in all but one case to those actually given to the participants in the with-instruction groups. Only one patient formulated slightly different instructions and, even in this case, these instructions, when followed, engendered similar patterns of response This participant thought that in the ratio program, he had to press strongly among a sequence of light presses, while in the interval program, three presses followed by a pause were needed to earn a point. Following these instructions, he would have emitted more responses on the ratio program, exactly as with a more accurate instruction.
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Monestès, J.L., Villatte, M., Stewart, I. et al. Rule-Based Insensitivity and Delusion Maintenance in Schizophrenia. Psychol Rec 64, 329–338 (2014). https://doi.org/10.1007/s40732-014-0029-8
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DOI: https://doi.org/10.1007/s40732-014-0029-8