Shaping Attention Span in Treatment-Refractory Schizophrenia

Principle Investigator:

Steven M. Silverstein, University of Illinois at Chicago

Co-Investigators:

William D. Spaulding, University of Nebraska-Lincoln

Tony Menditto, Fulton State Hospital and University of Missouri

One of the major reasons for poor outcomes in schizophrenia is that patients often have severe cognitive deficits that preclude their ability to fully engage in, and benefit from available psychological treatments. In particular, treatment refractory persons with schizophrenia often display severe attentional impairments that interfere with the encoding of material presented to them. This study aims to standardize a method to increase the attention spans of treatment refractory patients in order to prepare such patients for constructive engagement in skills training.

Shaping is the application of several fundamental techniques of learning to bring about new behavior or to modify a certain aspect of existing behavior. As such, shaping can be viewed as a method to achieve operant conditioning, with, for the purposes of this project, attention or attentiveness being the response that is targeted. The primary technique involved is differential reinforcement of incremental changes that represent successive approximations toward the desired target behavior. That is, rather than waiting for the complete behavior (e.g., a 20 minute attention span) to occur before offering reinforcement, reinforcement is provided for successive approximations or steps toward the final behavior. When the initial step toward a behavior (e.g., four minutes of continuous attention) has been reinforced and occurs fairly regularly, the criterion for reinforcement is advanced to the next step (e.g., five minutes of continuous attention). This sequence of reinforcing, changing the criterion for reinforcement, fading reinforcers for previous versions of the behavior and limiting reinforcers to behavior meeting the new criterion, is then repeated until the behavior resembles the final desired response. A strength of shaping is therefore that it allows for specific learning techniques to be used to develop and strengthen behavior that does not normally occur, or else occurs at a very low frequency. It is this feature that makes it suitable for treatment of patients whose severely impaired attention spans preclude them from active participation in other forms of treatment, including many forms of cognitive remediation.

For this study, Basic Conversation Skills groups are currently run at the Community Transition Program (CTP) at the Lincoln Regional Center (LRC).