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Use Of College Students In A Social Therapy Program With Chronic Schizophrenics To Produce Changes In Mood And Social Responsiveness
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Use Of College Students In A Social Therapy Program With Chronic Schizophrenics To Produce Changes In Mood And Social Responsiveness
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Content
This dissertation h as been
m icrofilm ed exactly as received
KONRAD, W illiam Edward, 1930-
USE OF COLLEGE STUDENTS IN A SOCIAL
THERAPY PROGRAM WITH CHRONIC
SCHIZOPHRENICS TO PRODUCE CHANGES
IN MOOD AND SOCIAL RESPONSIVENESS.
U niversity of Southern California, Ph.D ., 1968
Psychology, clinical
U niversity M icrofilms, Inc., Ann Arbor, M ichigan
USE OF COLLEGE STUDENTS IN A SOCIAL THERAPY
PROGRAM WITH CHRONIC SCHIZOPHRENICS
TO PRODUCE CHANGES IN MOOD AND
SOCIAL RESPONSIVENESS
by
William Edward Konrad
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirement for the Degree
DOCTOR OF PHILOSOPHY
(Psychology)
January 1968
UNIVERSITY O F S O U T H E R N C A L IF O R N IA
T H E GRADUATE S C H O O L
UNIVERSITY PARK
LOS AN G ELE S, C A LIF OR N IA 9 0 0 0 7
This dissertation, written by
...........Wniiam..Edwar.d. K .Q JW .ad..........................
under the direction of his.....Dissertation C o m
mittee, and approved by all its members, has
been presented to and accepted by the Graduate
School, in partial fulfillment of requirements
for the degree of
D O C T O R O F P H I L O S O P H Y
i Z f t e S K ' C - .
Date. .. J a n u a r y . , ..1 .9 .6 8
D1SSERTATION COM M ITTEE
.......
' ) / 1 -7 Chairman
...
^ 'i § C
TABLE OF CONTENTS
Page
LIST OF TABLES ........................................
y
LIST OF FIGURES..................................... .
Chapter
I. THE PROBLEM................................... 1
Introduction
Description of the Problem
Theoretical Considerations
Hypotheses
II. HISTORY OF THE PROBLEM...................... 14
Theoretical Background
Background of Rehabilitation Treatment
Studies
Summary
III. M E T H O D ........................................ 55
Subjects
General Procedure
Treatment Sessions Procedure
Selection of Role Play Materials
Preparation of the Subjects
Preparation and Training of Students
Contingency Schedule
Test Instruments
Statistical Considerations
IV. RESULTS........................................ 88
ii
Chapter Page
V. DISCUSSION................................... 119
Theoretical Implications
Treatment Implications
VI. SUMMARY........................................ 134
BIBLIOGRAPHY.......................................... 140
APPENDIXES............................................ 150
APPENDIX A: Questions for Control Group After
Exposure to Role Play Materials . . 151
APPENDIX B: Total Score and Rankings of Role
Play Materials According to the
Preference Indicated by Six Subjects
Who Participated in the Role Suit
ability Procedure................. 155
APPENDIX C: Role Play Materials Used During
Third Week........................... 15 7
APPENDIX D: Role Play Materials Used During
Fourth W e e k ........................ 160
APPENDIX E: Role Play Materials Used During
Fifth Week........................... 163
APPENDIX F: Role Play Materials Used During
Sixth Week........................... 166
APPENDIX G: Role Play Materials Used During
Seventh Week........................ 169
APPENDIX H: Scales for Use by Students in Rating
the Subjects 1 Social Responsiveness 172
APPENDIX I: Scales Used by Students to Rate the
Subjects' Affect and Role Involve
ment ................................. 174
Chapter
APPENDIX J
APPENDIX K
APPENDIX L
APPENDIX M
APPENDIX N
APPENDIX O
APPENDIX P
Adjective Checklist ...............
Total Score Obtained On Individual
Factors of the ACL After Each Ses
sion by Each of the Three Groups
in the Program ......................
Summary of Values for All
Analyses of Difference Scores on
ACL Factors of Fear, Anger, Depres
sion, and Weakness as Assessed by
Friedman Two Way Analysis of
Variance.......................... .
Summary of Results for All
Analyses of Positive Word Differ
ence Scores on ACL Factors of
Energy and Happy ....................
Summary of Results of Evaluation of
Positive Word Scores from ACL for
Factors of Energy and Happy as
Assessed by Use of a Two Factor Re
peated Measurement Analysis of
Covariance ..........................
Summary of Chi Square Analysis of
the Change in Ratings of Affect
from the First to the Last Session .
Summary of Chi Square Analyses
of the Change in Ratings of Social
Responsiveness from the First to
the Last Rating Session ...........
Page
176
178
180
182
184
186
188
iv
LIST OF TABLES
Table Page
1. Means and Standard Deviations of Character
istics of Subjects........................... 58
2. Means and Standard Deviations from Prestudy
Data from Adjective Checklist................ 59
3. Number of Subjects in Each Group Who Show an
Increase, Decrease, or No Change in ACL
■ Scores for Each of the Last Seven Sessions
of the Program Compared to the First
Session......................................... 90
4. Summary of Xr Values for All Between Group
Analyses of Difference Scores on the ACL as
Assessed by the Friedman Two Way Analysis
of Variance.................................... 92
5. Number of Subjects Who Increase, Decrease, or
Show No Change in Positive and Negative Word
Scores on the ACL from the Sixth to the
Seventh Session ................................ 94
6. Summary of Results of All Analyses of Variance
that Evaluate Positive Word Difference
Scores........................................... 100
7. Summary of Results of Evaluation of Total
Positive Word Score from ACL as Assessed by
a Two Factor Repeated Measurement Analysis
of Covariance.................................. 103
v
Table
8.
9.
10 .
11.
12 .
13 .
Page
Summary of Xr Values for Between Group Analyses
of Difference Scores from the Rating Scales
of Affect as Assessed by the Friedman Two Way
Analysis of Variance by Ranks ................ 107
Spearman Correlations (rs) Between the Students'
Ratings of Affect and the Subjects' Self-
Reported Affect Scores from the A C L ........ 109
Summary of Xr Values for Between Group Analysis
of Difference Scores from the Ratings of
Social Responsiveness as Assessed by the
Friedman Two Way Analysis of Variance by
Ranks........................................... 113
Spearman Intercorrelational Matrix (rs) on the
Four Scales of Social Responsiveness .... 115
Summary of Analyses of Variance Using Dif
ference Scores Between Initial and Final
Markings of OMI Questionnaire by Treaters
and R a t e r s .................................... Il7
Spear*man Correlations (rs) on Subjects' Social
History Scores; Ratings by Students on Sub
jects' Role Involvement; and Ratings by In
vestigator on Students' Role Involvement;
All Compared to the Main Dependent Variables
in the S t u d y .................................. 118
vi
LIST OF FIGURES
Figure Page
1. Means for Positive and Negative Word Scores
from the ACL that was Administered to Both
Treatment Groups and the Control Group
During Each of the Eight Weeks of the
Social Therapy Program ...................... 89
vii
CHAPTER I
THE PROBLEM
Introduction
There are theoretical views that traditional
hospital care tends to increase and perpetuate the social
withdrawal and apathy that characterize the chronically
institutionalized schizophrenic by stabilizing the patient
in custodial routines (Barton, 1959).
The impoverished social life available to patients
(Williams, 1960) contributes to social withdrawal, and
studies have shown that social therapy programs counteract
the lack of social stimulation (Smith, et al. , 1965;
Sanders, et al., 1962). A major drawback in making avail
able such social stimulation to large groups of the chroni
cally hospitalized has been the lack of available manpower.
However, recent evidence (Holzberg, Whiting, and Lowy, 1964)
suggests that student volunteers can be used effectively as
companions to chronic schizophrenics, although effectiveness
of student companion programs has not been investigated
1
within a formal research design. Also, the attitudes of
the students toward the mentally ill change as the result
of such a program (Holzberg and Gewirtz, 1963; Holzberg,
Gewirtz, and Ebner, 1964).
Not only may unstructured social relationships be
effective in counteracting the withdrawal and apathy of
chronic schizophrenics, but it also may be possible to
structure relationships to elicit social responsiveness and
desired moods. Role playing and role taking procedures
provide such a vehicle that may be used both to encourage
social interaction as well as to elicit different moods.
Although theoretical formulations and evidence suggest basic
deficits in the role playing and role taking skills of
schizophrenics there is also speculation that schizophrenics
have ordinarily been well trained to play roles prescribed
by the institutional setting and are perhaps unusually
adaptive in certain role playing and role taking activities.
Description of the Problem
The above formulations are the context in which
the present research project has been conceived. Three
major research questions are being investigated:
1. Will a social therapy program that brings
3
together untrained college students and chronic institu
tionalized schizophrenics in unstructured social interaction
he effective in improving the mood and social responsiveness
of the schizophrenics?
2. Will a social therapy program that brings
together untrained college students and chronic institu
tionalized schizophrenics in structured role playing ses
sions be more effective in improving the mood and social
responsiveness than a program that uses unstructured
sessions?
3. Will a social therapy program that utilizes
untrained college students and chronic institutionalized
schizophrenics result in beneficial changes in the attitudes
of the students toward mental illness?
In the present study measurements were obtained
from a group of 57 male members of the Los Angeles Veterans
Administration Domiciliary who carried a prime diagnosis of
schizophrenia on their medical records. All of the schizo
phrenics had been institutionalized for a minimum of two
continuous years prior to the start of the study. The
subjects were all born and reared in the United States and
had no additional diagnosis of organic brain pathology or
physical condition which would interfere with their speech
or hearing.
Measurements were also obtained on 98 students.
They were all members of an undergraduate class in Abnormal
Psychology at the University of Southern California.
In order to assess the mood of the schizophrenic
subjects, a previously developed adjective check list (ACL)
(Jacobs, unpublished paper) was used to obtain self-reports
of mood state. The 90-word ACL had been previously factor
analyzed into six dimensions: Fear, Anger, Depression,
Weakness, Energy, and Happy. In this study, the factors
Energy and Happy were grouped to constitute "positive words"
and the remaining four factors were grouped to constitute
"negative words." Also, six 8-point rating scales of
affect, corresponding to the six factors of the ACL were
constructed in order to obtain ratings of the subjects'
mood as seen by the students.
For the measurement of social responsiveness, four
8-point rating scales were designed to deal with different
aspects of interpersonal interaction. The focus of these
scales was aimed at assessing the adequacy of the subjects'
interpersonal performance when interacting with the stu
dents .
5
The instrument used to measure the students'
attitudes toward the mentally ill was the Opinions about
Mental Illness (OMI) questionnaire (Cohen and Struening,
1963). The OMI is a factor analytically derived set of
scales made up of 51 items which yield factorially stable
scores on five dimensions of attitudes toward the mentally
ill: Authoritatianism, Benevolence, Mental Hygiene
Ideology, Social Restrictiveness, and Interpersonal
Ideology.
Measures of social responsiveness and mood ratings
were obtained at the beginning and at the end of the study.
Mood measures from the ACL were obtained after each of the
eight weekly sessions of the program. The first and the
last sessions were for the purpose of obtaining the before-
after ratings of social responsiveness and mood on all
subjects. These two "rating" sessions consisted of 20 to
30 minutes of unstructured social interaction between a
subject and a pair of students (who were called Raters).
In the middle six "treatment" sessions, pairs of
students (called Treaters) who had not participated in the
rating sessions, interacted with the two experimental groups
of subjects. One experimental group of subjects (Companion
Group) was seen once weekly for 20 to 3 0 minutes by the same
Treaters whose only task was to develop a friendship with
the subject. Another experimental group of subjects (Role
Play Group) was also seen weekly in 20 to 30 minute sessions
by Treaters who interacted within a prearranged structure
that utilized preselected role play materials.
The remaining subjects (Control Group) received
no social interactive experience with students during these
six treatment weeks; but in all other pertinent aspects,
were treated similarly to the experimental groups. This
group was used as a control for the possible contaminating
effects of changes in medication, effects of the repetitive
procedure connected with completion of the ACL, effects of
simple exposure to role play materials and effects of gen
eral environmental factors at the institution that could
result in changes in mood.
The measurement of the students attitudes toward
mental illness was obtained a week prior to the beginning
of the study by having all of them complete the OMI
attitude questionnaire. The Treaters completed the form
again after the last treatment session. The Raters com
pleted the questionnaire a second time before their second
session with the subjects. Therefore, the Treaters had a,
total of six experiences with the subjects between
measurements while the Raters saw subjects only once between
measurements. The Raters were used as controls for changes
in attitude due to classroom experiences during the time
of the program.
If social interaction with college students is
effective in counteracting the symptoms of institutional
ization, then it should be possible to demonstrate a
significantly greater improvement in mood and social re
sponsiveness for both treatment groups when compared to the
Control Group. Also, if role playing techniques can be
devised in a specific attempt to elicit positive mood then
it should be possible to demonstrate a significantly greater
improvement in mood for the Role Play Group when compared
to the Companion Group.
If social therapy programs with chronic schizo
phrenics and college students are effective experiences
for altering attitudes toward mental illness, then the
students who have six experiences with the subjects should
show significantly greater changes in attitudes than the
students who only have one session with the subjects.
Consequently, a comparison of change between
groups of subjects was made on: (1) the before-after
ratings of social responsiveness, (2) the before-after
8
ratings of mood, (3) the before-after scores on the OMI
questionnaire, and (4) the ACL data from the six treatment
sessions.
Theoretical Considerations
♦
It has only been in recent years that investiga
tors of schizophrenic behavior have taken into account the
distinctions between schizophrenic symptomatology within
an institutional setting and inappropriate or schizophrenic
behavior outside of that context. Williams (1960) pointed
out that "much of the symptomatology traditionally asso
ciated with chronic schizophrenia and other disorders is
brought about by prolonged incarceration in an impoverished
and unnatural social situation" (p. 9).
In institutions which have been used primarily
as a custodial and protective resource, most schizophrenics
have been cut off from the ordinary social world, resulting
often in a lessening of social responsiveness and an apa
thetic demeanor. However, to consider schizophrenic
behavior as purely idiosyncratic and a matter only of
personality is to ignore the fact that this behavior is
often patterned and regulated by norms (Thrasher and Smith,
1964). The institutionalized schizophrenic does, in
actuality, respond to the actions and expectations of others
and often appropriately to the context of the hospital
setting. It is suggested that not only is much of the
institutionalized schizophrenic's social behavior based on
his role within the hospital, but that he may be very skill
ful in perpetuating this role.
This contradiction to the assumption of role
theory which states that schizophrenics are deficient in
the ability to take roles in a socially appropriate way,
suggests that it may be the particular social situation
that renders the schizophrenic inappropriate rather than
an over-all general defective ability. Therefore, if the
social situation at the institution were altered by in
creasing the amount of social stimulation, the schizophrenic
should respond by becoming a more socially responsive
person.
Traditional efforts to help the patient improve
his social effectiveness have concentrated on overt social
behavior with little or any emphasis given to covert states
such as mood. Nowlis and Nowlis (1956) have conceptualized
mood as an organismic state that is a predisposing condition
that makes behaviors more likely to occur. Under this
conception mood changes would lead to changes in the
10
probability of occurrence of large repertoires of behavior.
Consequently, the concept of mood is definable in terms
of the antecedent inducing operations and the correlated
behavioral consequences. Among the antecedent conditions
inducing mood or mood change are withholding reinforcement,
environmental deprivation, emotional stimulation, and
intraorganic events such as illness. Among the behavioral
correlates of mood shifts are changes in frequency and
intensity of many acts and verbal responses. It is these
verbal responses which are measured through marking of an
ACL.
Hypotheses
The questions raised in the preceding sections have
been reduced to the following general hypotheses and spe
cific predictions.
Hypothesis A
The mood of chronic institutionalized schizo
phrenics can be improved through a social therapy program
that uses college students.
Prediction 1
Subjects participating in the Companion Group when
marking the adjective checklist will show a greater
decrease in negative word score and a greater
increase in positive word score after the last
treatment session compared to the first session
than subjects participating in the Control Group.
Prediction 2
Subjects participating in the Role Play Group
when marking the adjective checklist will show a
greater decrease in negative word score and a
greater increase in positive word score after the
last treatment session compared to the first ses
sion than subjects participating in the Control
Group.
Prediction 3
Subjects participating in the Role Play Group
when marking the adjective checklist will show a
greater decrease in negative word score and a
greater increase in positive word score after the
last treatment session compared to the first ses
sion than subjects participating in the Companion
Group.
Prediction 4
Subjects participating in the Companion Group
will show a greater increase in rating on each of
12
two scales of positive affect and a greater\dg-
crease in rating on each of four scales of
negative affect after the last session compared
to the first session than subjects in the Control
Group who do not participate in the social therapy
program.
Prediction 5
Subjects participating in the Role Play Group
will show a greater increase in rating on each of
two scales of positive affect and a greater de
crease in rating on each of four scales of negative
affect after the last session compared to the first
session than subjects in the Control Group who do
not participate in the social therapy program.
Hypothesis B
The social responsiveness of chronic institution
alized schizophrenics can be improved through a social
therapy program that uses college students.
Prediction 1
Subjects participating in the Companion Group
will show a greater increase in rating on each of
four scales of social responsiveness after the last
13
session compared to the first session than subjects
in the Control Group who do not participate in the
social therapy program.
Prediction 2
Subjects participating in the Role Play Group will
show a greater increase in rating on each of four scales
of social responsiveness after the last session compared
to the first session than subjects in the Control Group
who do not participate in the social therapy program.
Hypothesis C
The attitudes of college students toward mental
illness will be more accepting after they participate in a
program of social therapy with chronic institutionalized
schizophrenics.
Prediction 1
The scores on two factors (Benevolence and Mental
Health Ideology) from a scale of attitudes toward mental
illness will show a greater increase and the score on
one factor (Social Restrictiveness) will show a greater
decrease for students participating in six weekly ses
sions of social therapy with chronic schizophrenics
than for a Control Group of students who participate
in only one such session.
CHAPTER II
HISTORY OF THE PROBLEM
Theoretical Background
Theorists vary widely in their opinions regarding
the etiological factors in schizophrenia from those who see
it as a strictly organic disease to those who are convinced
that social or interpersonal factors are responsible for the
affliction. However, the majority of investigators agree
that social factors play some part in the symptomatic be
havior that characterizes the schizophrenic (Beliak. 1958).
Meyer (1906, 1910) was one of the first writers
to describe schizophrenia as a disorder characterized by a
lifelong pattern of faulty social adjustment to the demands
of reality. The symptoms of the schizophrenic are seen as
growing out of "faulty habits of living." When such people
are subjected to emotional stress they become increasingly
isolated^ and since they cannot satisfy their interpersonal
needs they tend to rely increasingly on their "faulty
habits."
14
15
Sullivan (1953, 1956) also regarded schizophrenia
as primarily a disorder of living, with particular emphasis
being placed upon the developmental aspects of the inter
personal relationships. Especially important are those
relationships which occur early in life between the child
and the adults significant to his physical and emotional
well-being. It is these early interpersonal encounters
that tend to set the pattern for all later social inter
actions.
Out of such interpersonal exchanges develop the
"self dynamism" or self system. The self dynamism is a
construct, "made up of reflected appraisals, " that "come
into being as a dynamism to preserve the feeling of secur
ity. " As such, "it is built largely of personal symbolic
elements learned in contact with other significant people.
. . ." (1947). It is an emergent system that never fully
encompasses the personality; but, "only represents those en
during patterns of social interaction which eliminate anx
iety, " i.e., maintain one's self esteem (1953).
In the schizophrenic the self dynamism is poorly
developed, and under stress it ceases to maintain a func
tional unity with the personality and becomes dissociated
from consciousness. Unable to relate with other persons
without experiencing intense anxiety, the schizophrenic
represses that aspect of his personality necessary for
meaningful human interchange,, i.e., the self dynamism. Such
repression makes meaningful human interaction difficult if
not impossible.
Cameron (1944) was the first to use role theory
as an explanation of the relationship between interpersonal
factors and schizophrenic behavior. He described the psy
chological disturbance which is basic to schizophrenia as
a social disarticulation "resulting from the cumulative
replacement of communication by private fantasy in persons
who have been unable to establish themselves firmly in
their cultural pattern because of failure to develop ade
quate role-taking skills" (p. 891).
Cameron's thinking also shows the influence of the
sociological theoretician, G. H. Mead. Mead (1934) intro
duced the concept "taking the role of the other" as the
necessary factor in adaptation or adjustment. He saw the
individual's adjustment as a function of his ability to be
flexible and alter his behavior in terms of the demands of
the social situation in which he is engaged. The ability
to be flexible is one factor which Cameron suggested is
related to behavior pathology (1950, 1951). If a person
can easily shift perspectives through different social
roles, he can more easily anticipate and interpret others'
reactions. Cameron also suggested as a second factor
related to behavior pathology the variety of roles an in
dividual has in his repertory. He maintained that an in
dividual who has a number of well-practiced, well-grounded
social roles is better equipped to meet new situations than
one who does not. Cameron described a third factor as
"socialized self reactions." Adaptive behavior is more
possible if an individual is able to recognize and appraise
his own reactions and hence relate to himself as a social
object.
Desocialization, on the other hand, takes place as
a result of partial or complete detachment from social
participation (Cameron, 1951). Cameron believed that the
schizophrenic has entered adolescence inadequately social
ized. Since he has not mastered the techniques of social
validation, his attitudes tend to block further social
help; and he becomes increasingly isolated and disorganized,
relying more and more on withdrawal, preoccupation, fantasy,
and delusion.
Sarbin (1943, 1954, 1955) has further developed
role theory also emphasizing the effect of the environment
18
upon the individual's habitual ways of behaving. Sarbin
outlined the series of events which constitute the develop
ment of a role. A role was defined by him as a "patterned
sequence of learned actions or deeds performed in an inter
action situation."
The organizing of the individual actions is a
product of the perceptual and cognitive behavior of person
A upon observing person B. B behaves in a way which allows
A to organize B's behavior into a concept, a role. On the
basis of this conceptualization, A then expects certain
further actions from B. This expectation is covert and
enables A to, as Sarbin stated, "locate the position of the
other." Once having located the position of the other, A
can perform certain acts which he has learned belong to
the reciprocal position and are conceptualized by A as his
role in relation to B.
Role expectations for oneself and others are de
veloped through experience. The experience comes from
intentional instruction and incidental learning which allows
the person to adopt the ways of others through play, fan
tasy, and imitation. This learning experience enables the
individual to engage in the "as if" process, that is, to
adopt the perspective and attitude of the other person. At
19
the developmental stage, where concept formation becomes
possible, the individual develops the "I-concept" and the
ability to group people into social roles. When the in
dividual gains the "ability to bind time and tension," that
is, delays gratification of his impulses, he can begin to
observe the actions of others; and the social self emerges.
This ability makes it possible for him to maintain a set
or assumption in spite of its fictional character and
consequently take-the-role-of-the-other. The ability to
bind tension also makes it possible to inhibit inappropriate
role behaviors.
According to Sarbin (1954), the schizophrenic lacks
the ability to bind time and tension and has never reached
the level of the development of a social self. The schiz
ophrenic, however, will maintain the constancy of his own
particular self-structure (at an earlier level of fixation)
at any cost and consequently eventually will resort to
"autistic, invalid, and de-socialized role enactments"
(p. 252).
Sarbin carefully distinguished between role
enactment and role taking, a distinction that few subsequent
investigators have made. Role enactment, or role playing,
is the overt performance of the individual. The ability
20
to observe one's own role enactments makes it possible to
check one's effectiveness as a social object. Role taking,
on the other hand, means taking the role of the other in
terms of adopting the perspective or attitude of the other,
a concept similar to Mead's and also to terms such as
empathy and identification, all of which are covert. Both
the actions or potential actions of the individual and the
qualities of the person which make the actions possible
are necessary in order to understand his role behavior.
There is another group of theorists who have
highlighted the effects of institutionalization upon the
chronic schizophrenic. They also emphasized social psy
chological factors, but were more concerned with the effect
of these factors on the schizophrenic's behavior after the
psychopathology had already been established.
Williams (1962), in his analysis of the rehabili
tation potential of the chronic schizophrenic, found the
socially deprived atmosphere typical of many state institu
tions, a specific cause of "much of the symptomatology
traditionally associated with chronic schizophrenia." The
debilitating effects of such a socially impoverished atmo
sphere upon mental patients, have been described by numerous
persons (Wing, 1960; Cameron, 1951; and Goffman, 1961).
21
Barton (1959), however, is the first to give a
detailed description of a disease syndrome which he states
is produced by such social impoverishment. Thus he contends
that the apathy, lack of initiative, loss of interest,
especially in things of an interpersonal nature, submissive
ness, apparent inability to make plans for the future, lack
of individuality, and sometimes characteristic posture and
gait all of which are characteristic of the long-stay
schizophrenic are not the result of schizophrenia. Rather,
these symptoms comprise a separate disease, which he calls
institutional neurosis. Barton lists the following as the
probable causes of this disease in hospitalized mental
patients:
1. Loss of contact with the outside world.
2. Enforced idleness and loss of responsibility.
3. Bossiness of medical and nursing staff.
4. Loss of personal friends, possessions, and
personal events.
5. Drugs .
6. Ward atmosphere.
7. Loss of prospects outside the institution.
Increasing physical activity, re-establishing con
tacts with family, providing for personal possessions,
reducing drugs and distranquilizing, and directing the
22
patient's attention towards prospects of accommodation,
work, and friends outside the hospital are all means where
by the institutional neurosis may be alleviated. With the
alleviation of these symptoms, it is implied that a reduc
tion in the psychological deficits of the schizophrenic will
take place.
Greenblatt and Lidz (1957) saw the hospitalized
schizophrenic as a "normal deviant," where apart from the
characteristics of his illness he is affected by his posi
tion as a deviant member of his culture and the stigma which
is attached to this position.
Thrasher and Smith (1964) suggested that the
hospitalized schizophrenic patient has the opportunity to
function in three major interactional settings, and that
within these settings he can handle the relevant social
roles with varying degrees of adequacy. In the ward, 'where
the patient is directly involved as a participant, he may
be one who conforms to the staff's expectations, one who
rejects the role of the patient as defined by the hospital,
or one who rejects the fact of his illness. In the patient
society, there is usually a modal role or central tendency
which is the public face which the patients as a group
present. However, within this setting some patients clearly
23
take on such roles as the leader, follower, or deviant.
In the third setting, the cliques, the investigators sug
gested that the role of patient is less relevant and more
individual role taking becomes apparent. They stressed
that the difficulty is assessing the appropriateness of a
patient's role behavior in that what may be appropriate in
one of these three contexts may not be so in the others,
and the possibility exists that all three contexts are
taking place at the same time.
Background of Rehabilitation Treatment
The acceptance of a social psychological model of
mental illness has led to social therapy programs for the
chronic schizophrenic whose purpose is to provide the
social stimulation necessary to counteract the withdrawal
and apathy common among institutionalized patients. These
social therapy programs had their antecedents in the "total
push" treatment introduced by Myerson (1939), the "thera
peutic social club" and "situational treatment" of Bierer
(1942) and the "therapeutic community" as conceived by
Jones (1953).
Myerson (1939) claimed that hospitalization of a
patient, under the circumstances of the care usually given,
24
produces a "prison stupor" or a prison psychosis which
interacts with the social retreat of the original schizo
phrenia. In order to counteract this "prison stupor" he
advocated a "total push" therapy whose primary purpose was
an attempt to arouse the patient from his "motivational
vacuum." In order to accomplish this, extensive use was
made of physiotherapy, exercise and games, diet and
vitamins, attention to clothing, and attention to and
liberal use of praise.
Bierer (1942) developed the term "situational
treatment" to describe changes in attitudes of the patient
as a result of direct experience in a situation that was
created specifically for the patient's needs. Therefore,
the treatment had to be tailored on an individual basis.
This treatment was in contrast to "institutional treatment"
where measures were taken in an attempt to achieve changes
in attitudes in patients without knowledge of the individ
ual background that would be necessary for situational
treatment. An important factor in this situational treat
ment was social treatment, and especially the self-governing
social club. The idea of the social club was that no
entertainments would be arranged for the patients, but
everything would be arranged and governed h£ them.
25
Jones (1953) applied principles of sociology in an
attempt to favorably alter the existing social structure
of hospital communities for the benefit of the patient. He
felt that established practices in most hospital communities
had no relation to treatment, but in many instances appeared
to be elaborate defenses protecting the staff against the
treatment needs of the patient. In his therapeutic com
munity he thought of the whole of the patients' time spent
in the hospital as treatment. Not only must the individ
ual's emotional problems be considered, but also there
must be an awareness of the fresh problems which the fact
of being in a mental hospital creates for the patient.
The patient, the social milieu in which he lives and works,
and the hospital community of which he becomes temporarily
a member, are all important and interact on each other.
More recently there has been a gradual returning
to the principles of what was termed, over a century ago,
moral treatment. Adams (1964), referring to a number of
studies that have been published in recent years on the
"moral therapy" of the early nineteenth century (Bockoven,
1956, 1957; Brown, I960; Ewalt, 1961; Rees, 1957), con
cludes that the results of moral therapy compare favorably
with the best hospital programs of today. Moral therapy
26
was essentially a program of planned psychological retrain
ing within a positive, sympathetic social milieu. The word
moral was used in a sense comparable to contemporary usage
of the words "psychological" or "interpersonal"--". . .
moral treatment aimed at relieving the patient by friendly
association, discussion of his difficulties, and the daily
pursuit of purposeful activity" (Rees, 1957, 306-307).
The ability to provide such beneficial social
stimulation rests primarily with the availability of ade
quate manpower. The Joint Commission on Mental Illness
(Ewalt, 1961) in addressing itself to the manpower shortage
recommended the use of an increasing number of individuals
from the community to cooperate with the mental health
profession. One response to the above recommendation has
been in the use of college students to act as companions
to chronic schizophrenics (Greenblatt and Kantor, 1962).
Holzberg (1963) sees the benefits of a program
that utilizes students to interact with chronic mental
patients as a result of the patient's receiving a vivid
experience in human devotion; an experience that permits
them to relearn that there are people who "do indeed care."
Secondly, he believes that such a program has a significant
impact on the students themselves. The students are given
27
a very immediate experience in learning that patients are
not strange and disturbing and that one need not be made
anxious by the patient and his behavior.
Studies
Studies relevant to this research can be divided
into two broad areas. The first area deals with those
studies which investigate the effect of interpersonal
factors on the symptomatic and social behavior of the
schizophrenic. The second area deals with the approaches
to social therapy that have been used in an attempt to
combat the symptoms of institutionalization and the schiz
ophrenic process itself.
Kantcr, Waller, and Winder (1953) began research
of the first kind by proposing a new typology for schizo
phrenics based upon the pre-morbid level of social, inter
personal adjustment. Two types of schizophrenics, called
"process" and "reactive," are described. Process schizo
phrenics are those with a chronically unsatisfactory
adjustment to the world, involving all spheres of social,
economic, and interpersonal relationships. The disorder
is of gradual development with signs of the illness present
early in life. Usually precipitating factors are absent
28
and a relative failure in peer interactions, excessive
fantasy in childhood, and rigid inappropriate affect early
in life are present. Reactive schizophrenics on the other
hand, are persons who, prior to hospitalization, lack the
signs noted above and have had little apparent difficulty
in social, economic, and interpersonal relationships.
A similar differentiation of types was made by
Phillips (1953) who developed a scale separating schizo
phrenics who are characterized by a poor premorbid
adjustment from those characterized by good premorbid
adjustment. Poor preraorbids have a poorer prognostic
potential with the most discriminating determinant being
the level of their social-sexual maturity prior to break
down. This dichotomy is defined similarly to the process-
reactive dimension; and consequently investigators have
found many overlapping characteristics in these dimensions
and in the acute-chronic dichotomy which is also commonly
utilized (Johannsen, Friedman, Leitshuk, and Ammons, 1963).
The attempt to differentiate schizophrenics on
the basis of interpersonal factors was carried further by
Zigler and Phillips (1960), who investigated the relation
ship between social effectiveness and different symptomatic
behaviors. In an earlier study (Phillips and Rabinovitch,
29
1958) the investigators proposed a developmental hierarchy
of symptoms, distinguishing between symptoms indicative of
"turning against the self," "avoidance of others," and
"turning against others." In the Zigler and Phillips study,
the authors used case history data such as age, intelli
gence, occupation, education, and marital status as vari
ables of social effectiveness. The authors found a
systematic relationship between these measures of social
effectiveness and particular groups of symptoms, a finding
which the authors felt may reflect two possibilities:
that both "social effectiveness and pattern of symptomatic
behavior represent the degree to which an individual tends
to resist or to conform to the mores of society" (p. 185),
or that a symptom cluster may be indicative of an individ
ual ' s role orientation in society.
Rodnick and Garmezy (1957) conducted a whole
series of studies addressed to the hypothesis that there
is in schizophrenics "a functional and behavior deficit
(on the response side)." The results of their studies, as
well as the work of others, have substantially supported
this hypothesis.
Dunn (1954) studied the effect of increasing the
level of social interaction portrayed in a set of pictures
30
upon a visual discrimination task. Schizophrenics showed
definite impairment in discrimination when dealing with
pictures showing scolding and whipping. No such impairment
was noted, however, when the scenes portrayed were emotion
ally neutral. Phillips (1953), in a subsequent analysis
of Dunn's study, further demonstrated that the impairment
found was largely restricted to those patients within the
sample who had poor premorbid adjustments, i.e., process
schizophrenics.
Harris (1957) investigated the relationship in
schizophrenia between type of affective relationship and
amount of impaired performance. He showed that schizo
phrenic patients had difficulty in making size discrimin
ations between sets of pictures when the pictures depicted
problems of mother-child relationships involving domination,
rejection, and overprotection. Dividing his sample into
good and poor premorbid groups, he reported that the poor
premorbid patients tended to attribute a greater amount
of rejection to their mothers than the good premorbids.
They also tended to overreact to the pictures portraying
ignoring and overprotection.
Schwartz (1959) studied in one patient the
relationship of her participation in interactions with
31
others and varying degrees of disorganization in her
behavior. He found consistently more integrative behavior
and reduction of symptomatology when there was participa
tion in a shared act toward which both the patient and the
significant other person had a positive motivation.
In the specific area of role theory there have
been a fair number of studies that investigated the schizo
phrenic's performances and abilities. Senf, Huston, and
Cohen (1956) studied role perception in chronic and acute
schizophrenic, neurotic, and normal groups by using
cartoons which depicted familiar social interaction situa
tions. Subjects were required to identify the social roles
involved, the social situations, the speakers and listeners,
the type of action portrayed, the motivation of the char
acters, and the humor element involved. The results
showed that chronic schizophrenics were severely deficient
in the ability to identify social roles or relations of
the cartoon characters, but acute schizophrenics differed
little from normals. The investigators suggested that the
chronic schizophrenics withdrawal involved the misidentifi-
cation of social roles.
Helfland (1956) also tested the hypothesis that
schizophrenics were deficient in role taking ability in a
32
study comparing chronic schizophrenics, schizophrenics in
remission, normals, and tubercular patients. Role taking
ability was measured by means of an 80-item Q sort which
had been constructed from a schizophrenic patient's auto
biography. The patient was asked to distribute the items
of the Q sort so that they reflected his attitudes and
feelings. Each subject in the study read the autobiography
and then sorted the items in accordance with his perception
of the attitudes and feelings of the patient. When Helfland
compared the Q sorts, using the patient's own Q sort as the
standard, he found that chronic schizophrenics showed the
greatest impairment in role taking skills. Normals tended
to rely on a conventional frame of reference (the cultural
stereotype) and schizophrenic patients in remission showed
strong empathy but nevertheless tended to respond in an
idiosyncratic way.
Whiteman (1954) using a similar approach, hypothe
sized that schizophrenics' defective role taking occurred
primarily in interpersonal conceptual problems. He admin
istered three concept formation tests to a group of schizo
phrenics and to a normal control group. Two of the tasks
were relatively free of interpersonal content, while the
third was a social concept test devised by Whiteman. His
33
results indicated that schizophrenics demonstrated a sig
nificantly greater deficit on the socially toned test than
on the neutrally toned tests.
Affleck (1954) extended Whiteman's work in a study
in which he varied the intensity of interpersonal inter
action portrayed. The schizophrenic group again showed a
differential deficit on the tests which involved inter
personal content. As the degree of interpersonality
increased, the schizophrenic group took progressively more
time to complete the task. Further, a significant correla
tion was found between a rating of behavioral withdrawal
and the length of time needed by the schizophrenic group
to complete the interpersonal tests. This relationship
existed independently of IQ, educational level, age,
chronicity, and schizophrenic sub-type.
Bloom and Arkoff (1961) compared acutely ill
schizophrenics with a group of chronic schizophrenics with
respect to role playing ability. They found that acutely
ill patients were better at playing the "normal role" than
were those schizophrenics who were chronic and had been
hospitalized for some time. Also, "patients who subse
quently improved were better at playing the normal role
than those patients who became chronic."
34
That there is a generalized deficit in self-other
conceptualization in schizophrenia would seem to be further
borne out by the work of Dinitz, Mangus, and Pasamanick
(1959). In their study of 140 institutionalized mental
patients, they found that schizophrenics are defective in
their ability to perceive others realistically and in their
capacity to play roles in such a way as to alter their self
concept and/or the way other persons view them.
In recent years there has been an increasingly
large amount of activity in the use of social therapy pro
grams to improve treatment at mental hospitals. Mendel and
Rapport (1963) report that 70 per cent of 166 severely
chronically ill female schizophrenic patients were main
tained outside of the hospital at an adequate level of
functioning during a 51-month period of observation, by a
20 to 30 minute monthly transaction of individual psycho
therapy. The results of treatment by non-professional
personnel used in this study compared favorably with those
of the psychiatrists who also performed the treatment.
Smith et al. (1965) studied the effects of three
socio-environmental treatment programs on "awareness of
others" within the context of a rehabilitation program for
chronic psychotic patients. The criterion of awareness
35
was the ability to identify fellow patients from recent
photographs. Awareness was conceptualized as an early
stage in the process of resocialization. Best results were
obtained when patients were required to participate in an
intensified group interaction program. Changes in the
treatment milieu which were not accompanied by direct
pressure to interact were relatively ineffectual.
Sanders et al. (1962) established three experi
mental treatment programs and a control condition to test
the relative effectiveness of social therapy. These con
ditions included an interaction treatment program, an
intensified interaction treatment program with a greater
quantity of interaction, a therapeutic community, and the
control condition (regular ward life). The two interaction
programs were more successful than was the therapeutic
community in raising the level of social participation.
The greatest degree of social participation was found in
the intensified interaction program. The authors suggest
that the IIP seems to be the most effective type of social
treatment for patients whose initial psychiatric status
is poor.
At Houston VA Hospital Rothaus, Morton, and
Johnson (1963) adapted the Human Relations Training
36
Laboratory to open ward psychiatric patients with the goal
of motivating the patients to experiment with their be
havior and to develop awareness of intergroup, intragroup,
and interpersonal dynamics. Results thus far suggest that
the laboratory's problem centered orientation reduces the
degree to which patients are illness centered, dependent,
and preoccupied with themselves. The authors believe that
the focus of the laboratory on social and interpersonal
dynamics may interfere with the involvement by the patients
in highly self-centered and despondent ruminations. The
latter results however, were not definitive. The labora
tory attempts to place participants in the role of "learner
in a learning situation" rather than "sick person in a
healing situation."
Spohn and Wolk (1963) hypothesized that a group of
chronic schizophrenics who were exposed to a group problem
solving experience would tend to improve their level of
social participation. Participation was determined by
measures on tasks which were socially more challenging and
complex, and tasks which required interaction with total
strangers. The hypothesis was confirmed in the study and
led the authors to suggest that experiences which permit
social participation allow factors to become operative
37
"which reduce the anxiety associated with socially more
challenging situations" (p. 190) and thereby facilitate
participation in such situations.
Freudenberg and Wing (1961) investigated the
effects of varying degrees of social stimulation on such
aspects of the schizophrenic's functioning as changes in
output, ward behavior, and workshop behavior. They found
that when supervisors in the workshops offered increases
in social incentives, the patients showed a decrease of
symptoms such as immobility, mannerisms, and restlessness
and an increase in output in their workshop behavior.
Output decreased whenever passive conditions were resumed;
although ward behavior remained unaffected throughout.
The technique of remotivation has also been used
as a tool in rehabilitation programs. Remotivation is a
method of group interaction that has been developed to
increase contact between a psychiatric nursing assistant
and his patients. Remotivation is believed to help patients
turn toward "reality." By "reality" is meant that the
patients become more aware of others and outside events,
interacting on a level that the staff considers appropriate.
Examples of behavior at this level of awareness are knowing
the names of the aides, responding when addressed, respond-
38
ing to direct questions, and participating in simple con
versations. Results of studies on the procedure are as
follows: Long (1961) reports an elaborate experiment
involving motivation and control groups in a state hospital,
concluding that "remotivation technique is instrumental in
modifying the behavior of patients. . . . making them more
communicative and increasing their participation in the
other activities." The aides in Long's study were college
students who volunteered for summer work in mental hospit
als. Hill, Howill, Liebroder, Long, and Morill (1959)
found no difference between chronic psychiatric patients
exposed to remotivation and control patients. Another
study by Eliseo (1964) showed there were no differences
between experimental and control groups on socialization,
self-maintenance, and work potential before remotivation
started and after six months. Psychiatric aides were used.
In a study at a State Hospital (Sines, Silver, and
Lucero, 1961), in which selected aides were assigned to
chronic psychiatric patients with twice weekly individual
"therapeutic" sessions for 12 months, no significant dif
ferences were found between the experimental and control
groups or between pre and post treatment level for ward
behavior of the groups.
39
Spohn (1963) found in a long term, well controlled,
intensive socio-environmental treatment program with chronic
schizophrenics, in which aides acted as group leaders for
discussion and other activities, that the experimental
patients showed significantly more tension and psychopathy
and less socialization than controls after two years.
One might conclude from the above "remotivation"
studies that the possibility that "therapy," either indiv
idual or group, by psychiatric aides can influence the
behavior of chronic patients seems remote. College students
rather than permanent aides served as "therapists" in the
only study showing significant improvement.
There have been other programs that depended upon
the availability of college students. Holzberg and Knapp
(1965) outlined the history and purposes of the Companion
Program. The program provides for weekly visits by a
number of volunteer college students to selected patients.
Each student is matched with a single patient whom he
visits weekly throughout the academic year. From the be
ginning there were three major goals:
1. It was intended to provide a rewarding educa
tional experience for the student both emotionally and
intellectually.
40
2. The program was designed as part of a re
habilitation program for patients who had significantly
withdrawn from social intercourse and social relationships.
3. It was hoped that the program would positively
affect the morale of the institution by bringing in young
people.
One study by Knapp and Holzberg (1964) showed that
the volunteer students taking part in the Companion Program
were not significantly differentiated from a non-volunteer
control group on certain personality variables. There
was evidence that the Companions were: slightly more
religiously oriented, more morally concerned, more com
passionate, and more introverted than the control subjects.
Also Holzberg and Gewirtz (1963), using a control
group, showed that the Companions had grown more knowledge
able concerning the problem of mental illness and had more
enlightened and informed opinions concerning it.
The results of a study by Holzberg, Gewirtz, and
Ebner (1964) indicated that the students participating
in the Companion Program became more tolerant in their
judgmental evaluations of sexual and aggressive behaviors
than a control group. The Companion Group also shifted
toward greater self-acceptance, and the non-companion group
41
showed a trend toward less self-acceptance at the end of
the year.
The impact of the Companion Program on patients
has been evaluated only by non-controlled investigations
and by the observations of the professional leaders. How
ever, a questionnaire study (Holzberg, Whiting, and Lowy,
1964) suggests that the Companion Program may be a fruit
ful approach to modifying patient behavior. Below is
listed a summary of responses by students on this ques
tionnaire:
. . . 84 per cent reported that their patients
desired the companionship relationship and sought
to maintain it;
. . . 71 per cent reported that students and the
patients conversed more freely;
. . . 65 per cent reported greater interest on the
part of the patient in his surroundings;
. . . 55 per cent reported positive changes in the
patient's personal appearance;
. . . 48 per cent reported that the patient's
social behavior had improved;
. . . 46 per cent reported improvement in the pa
tient's mood state reflected in reduction of de
pressive indications.
Greenblatt and Kantor (1962) state that since 1953
undergraduates of Harvard and Radcliffe have been carrying
42
on therapeutic activities with chronic patients at a State
Mental Hospital. Two major forms of activities are used:
ward work and case aid. The former concerns a variety of
services to patients on the ward essentially in groups in
which volunteers act as quasi-recreational and occupational
therapists. The latter concerns one-to-one relationships
between volunteer and patient in which the volunteer
functioning as quasi-social worker attempts to aid patients
in transition from hospital to community. No experimental
investigations were reported.
A study by Beck^ Kantor, and Gelineau (1962) in
vestigated the therapeutic results of the Harvard program.
A follow-up interview was obtained by telephone with a
relative of every patient who had left the hospital. The
most important result is that 31 per cent of patients who
worked with students left the hospital after an average
hospitalization of 4.7 years. Brown (1960) has reported
that after four years of hospitalization only three per
cent of patients will ever be discharged.
Lawton and Lipton (1963) report that in the summer
of 1962 Morristown State Hospital initiated a trial program
which utilized college students as non-professional Mental
Health workers. This experiment differed from similar
43
programs in that the students were employed full time, and
devoted all of their efforts to creating highly personal
relationships with individual patients. The contacts of
the students with the patients were extremely varied, but
for the most part consisted of from three to five contacts
per week, on the wards, and on the grounds. At the start,
the goal of discharge was stressed more than that of
providing patients with the immediate pleasure of spending
time in social activity. However, eventually teleologic
and immediate goals were equally stressed. No definitive
evaluation of the program was carried out.
Scheibe (1965) reported on the Connecticut Service
Corps Program that was inaugurated in 1963 by the Con
necticut Department of Mental Health. Hospitals provided
room and board and $200 to each student for a two-month
project. Students were assigned to wards for a continuous
eight-week period and were not assigned to a specific
patient, but came to know all the patients on the ward.
This study only assessed changes in the students and did
not employ controls.
Other than the type of personnel who are available
to participate in social therapy programs the techniques
used to structure the interactions have been varied. The
44
general technique of role playing has proven to be useful
for such programs and can be tailored to suit the specific
purposes of the research design. Rothaus, Johnson, and
Lyle (1964) compared two role playing techniques for
changing typical behavior patterns. Active and passive
patients were assigned group discussion roles either simi
lar to their usual behavior (role repetition) or opposite
their usual behavior (role reversal). Following group
discussions, patients filled out rating and reaction scales.
The following statistically significant results were ob
tained: (1) during role repetition group discussions,
patients exaggerate their typical behavior; (2) passive
patients have difficulty with role reversal, and active
patients feel highly frustrated, yet role reversal is the
most satisfying technique; (3) passive patients can achieve
high feelings of responsibility by asserting themselves
only moderately.
Research by Moreno (1946) in psychodrama suggests
that such procedures lead to changes in schizophrenics'
social behavior with observable decreases in delusions and
other symptomatic manifestations. However, Moreno's
studies have few controls and his results are based mainly
on clinical observations.
45
Schneidmuhl (1951), in a more systematic study in
a state hospital, set up group meetings of psychodrama
which were held twice a week for 18 months. At the end of
this period observations of the groups suggested that the
content of group sessions consisted essentially of material
at the level dealing with problems centered around the
hospital setting, and only patients with affective dis
orders engaged in role playing behavior. The author
stated, however, that the method may be helpful in dealing
with realistic situations and enabling patients to stabilize
themselves as social beings.
Parrish and Mitchell (1951) also used psychodrama
as a treatment technique with hospitalized schizophrenic
patients. Evaluations and analyses were made by the staff
at the end of each meeting after the patients had returned
to the wards. The conclusions drawn from the evaluations
were that the sessions were helpful with regard to hos
pital adjustment, but only a few patients developed insight
or personality change.
Parrish (1959) employed psychodrama with 37 women
diagnosed as chronic schizophrenics. Psychologically-
oriented movies helped establish group feeling and served
as a stimulation for dramatization. The scenes dramatized
46
by patients included enactments of such interactions as
husband-wife relationships as well as portrayals of feel
ings about the hospital or about leaving the hospital.
Parrish had no non-psychodrama control group to evaluate
the effects of variables other than the psychodrama train
ing. He concluded that a majority of patients improved in
amount and type of social interaction. Parrish comments
that psychodrama is useful with chronic schizophrenics
because role playing facilitates verbalization, and inhibits
unrealistic thinking.
Rothaus (1964) described instrumental role playing
(IRP) as consisting of the following: (1) role playing
exercises are formulated as experiments in which the intro
duction of role variations of the participants (patients)
constitute the experimental variable. The participants are
instructed to consider themselves scientists experimenting
with the consequences of their own behavior through role
playing; (2) tasks are selected in which role playing
interaction can take place; (3) practice training in the
roles is given and all participants learn to play all role
variations; (4) naive subjects, who are not aware that their
task partners are role playing, are needed to react to the
role players; (5) the naive subjects rate their task
47
partners behavior on various scales, and such ratings
constitute the response variable in the role playing ex
periment; (6) feedback of the reactions of the naive
subjects is given to the participants; (7) all participants
are to discuss and formulate a conceptual theory explaining
the data. Rothaus believes the IRP technique overcomes
a great deal of the resistance of patients to engage in
role playing, because, for example, IRP makes the patient
feel as though he is a scientist or learner rather than a
sick person demonstrating his ability to change sick be
havior .
Harrow (1952) studied the effect of engaging in
role playing on 20 schizophrenics organized into two groups
that met 25 times over a two-month period. A third group
of schizophrenics was designated as a control. The
Rorschach, MAPS and a special role test was administered
to each patient before and after the role playing series.
A group of judges concluded that the experimental subjects
increased more than the controls in realistic perceptions
of and interest in the outside world as well as increasing
in ability to handle personal problems, although statisti
cally significant results were not obtained.
Riessman (1964) lists four reasons explaining the
48
value of role playing techniques to modify the behavior
of low-income groups: (1) role playing is congenial with
the low-income person's style, physical (do versus talk);
(2) the professional worker reduces role distance between
himself and the disadvantaged person; (3) role playing
changes the setting and tone of what often appears to the
low-income person as an office-ridden, impersonal, foreign
procedure; (4) role playing facilitates verbalization in
the educationally deprived person. Riessman believes that
many are often unwilling to employ role playing techniques
because of its supposed or reputed sensationalistic,
charlatan-like overtones.
A review of the literature has not revealed any
studies that investigated the mood of schizophrenics. Sim
ilarly, there have been no investigations of social therapy
that used mood as a dependent variable. Much of the work
with the concept of mood is in its beginning phases and
little has been done so far in the area of pathology.
McNair and Lorr (1964) tested the existence of a set of
mood factors, replicating the factors, and determined their
sensitivity to brief chemotherapy and psychotherapy. Evi
dence is presented for the factorial and concurrent
validity of the mood factors and for their sensitivity to
49
various treatment effects. The mood scales are thus shown
to provide a useful method for assessing mood profiles in
psychiatric outpatients.
Damaser, Shor, and Orne (1964) demonstrated that
consistent psychological changes occur in response to
hypnotically requested emotions, but that similar changes
occur just as readily during waking control conditions,
and can be produced just as clearly by subjects simulating
hypnosis.
Izard (1964) in a study using normals, hypothesized
that one member of a two-person group behaving as an highly
emotional individual would influence the affective and
cognitive behavior of the other member. More specifically,
roles displaying positive emotion (enthusiasm, affection)
would result in higher scores on intellectual tasks, more
favorable evaluations of the role player, and more positive
self-reported feelings during the experiment than will
roles displaying negative emotion (anger, fear). Signifi
cant differences were obtained on ratings of the actress
and positiveness of self-reported feelings during the ex
periment. The difference in intellectual functioning was
significant on one task and approached significance (approx
imately .07) when the three intellectual tasks were
50
considered simultaneously. These results present further
evidence that the view of affect as internal process is
unnecessarily restricted. Affect or emotion expressed as
a role or personality characteristic constitutes a potent
social cure. The perception of different affects or
emotions portrayed by another person can function as a
cue-producing response generating significantly different
internal and external response sequences.
Wehmer and Izard (1962) tested the general
hypothesis that induced positive and negative affect would
have differential effects on interpersonal perception,
opinion change, and intellective functioning. It was also
hypothesized that there would be interaction between induced
affect and self-esteem.
The experimenter used a role playing technique
to treat half the subjects positively and half negatively.
Results showed that self-esteem was not related to the
subjects' intellective functioning but was related to per
ception of the experimenter, and willingness to change
opinion. There were interaction effects on the intellective
tasks, but not on the measures of interpersonal perception
or opinion change. Role playing intended to induce posi
tive affect resulted in more favorable perceptions of the
51
experimenter, greater attitude change, and higher scores on
intellective tasks.
Summary
Methods of treatment to counteract the withdrawal
and apathy of institutionalized schizophrenics are not yet
available for the multitudes of patients. However, a great
deal of knowledge is available that indicates such treat
ment programs may be feasible. There is a substantial
amount of evidence that clearly substantiates the importance
of social and interpersonal factors in relation to the
schizophrenic's symptomatic and maladaptive behavior. Such
factors appear to affect the schizophrenic's behavior on
two different levels. First, there is the role of social
and interpersonal factors in development of psychopath
ology per se. Studies suggest that interpersonal experi
ences early in life either are beneficial or detrimental
in terms of the development of adequate social skills. If
such skills are not adequately learned the individual tends
to depend to an inordinate degree on intra-personal
approaches for need gratification. Therefore, in times of
stress, the poorly developed social self easily gives way
to preoccupation, fantasy, and delusion. As this situation
52
becomes more chronic the individual becomes increasing
isolated and disorganized.
r"-
Other than affecting the individual in terms of
the development of psychopathology, social factors play an
important role in determining his behavior during hospit
alization. Many writers have commented on the debilitating
effects of long term institutionalization. Living in a
socially impoverished environment without the necessary
social shills to initiate interpersonal interaction, only
accentuates the basic inadequacy and leads to a "sympto
matic overlay" that has been called the institutional
neurosis. Since the results of institutionalization appear
to be basically the result of the lack of social stimula
tion in a highly organized impersonal living situation,
such a condition should be correctable if proper social
stimulation could be made available.
A large number of studies have indicated that such
social therapy programs are effective in counteracting the
withdrawal of chronic mental patients. However, a review
of the studies using the remotivation technique indicates
that "therapy," either individual or group, by psychiatric
aides has been of little use. College students rather
than permanent aides served as "therapists" in the only
53
study showing significant results. Since the administrative
responsibility of the psychiatric aides put them into an
authoritarian role in the eyes of the patients, these
results suggest that who supplies the social stimulation
is an important factor to consider. Traditional social
therapy techniques that have been successful are able to
reach only a small number of the multitudes who need help.
However, other studies have indicated that this problem may
be alleviated through the use of large numbers of non
professional individuals from the community. Such an
approach also solves the problem of using personnel who
function in an authoritarian role at the institution. Col
lege students were the first to be used in this manner and
initial observations appear to be favorable although none
of the studies have been designed in an experimentally
controlled manner.
Other than the problem of who participates in the
social therapy programs, there is also the problem of what
techniques should be used in the programs to make them
most effective. Several studies have indicated that a role
playing procedure can be shaped to produce beneficial re
sults. Even though there are theoretical formulations and
evidence that indicate that shcizophrenics have some basic
deficit in role playing and role taking skills., there is
also evidence that they have been trained to play roles
prescribed by the institutional setting and in fact do
possess some capability in role playing and role taking.
Investigations based on clinical observations indicate that
psychodramatic techniques substantially reduce symptomatic
behavior. Other studies indicate that a very important
factor in social therapy programs is that techniques should
be used that require the subject to participate. Role
playing aptly meets this need.
CHAPTER III
METHOD
Subjects
The 98 students in the study were members of an
undergraduate class in Abnormal Psychology at the University
of Southern California. All of the students in the class
were utilized except for eight who either lacked trans
portation or whose schedule was not open at convenient
times. They were divided randomly, within the limits of
their schedules, into two groups: the Raters and the
Treaters. The Raters participated only in the first and
last sessions of the program and were responsible for
rating the subjects on the scales of social responsiveness
and affect. There were 48 students in this group. The
Treaters participated in the middle six treatment sessions
of the program and 50 students were assigned to this group.
The 57 subjects in this study (19 in the Companion
Group, 19 in the Role Play Group, and 19 in the Control
Group) were selected from the male member population of the
55
Los Angeles Veterans Administration Domiciliary according
to the following criteria:
1. Diagnosis of schizophrenic reaction, regardles
of subtype; the official diagnosis as noted in the subject
medical record was used;
2. A resident of the Los Angeles Veterans Admin
istration Domiciliary, a mental hospital, or comparable
institutions for a continuous period of no less than two
years prior to the start of the study;
3. Born, reared, and educated in the United
States;
4. No neurological or physical diagnoses where
such faculties as speech and hearing might be impaired;
5. At least a verbal age of 13.0 on the Shipley-
Hartford Intelligence Test;
6. At least six years of formal education
completed;
7. Not older than 65 at the start of the program;
8. Willingness to voluntarily participate in the
program for the total eight sessions.
The selection procedure for subjects was initiated
by a search of the Central Index files for all residents
57
of the Domiciliary who met the criterion of schizophrenic
diagnosis. This group was then further selected according
to the remaining criteria of the study. In order to assess
their willingness to voluntarily participate in the pro-
gram, potential subjects were individually interviewed by
the investigator. During this interview the requirements
and purposes of the program were discussed with the sub
jects .
The 57 subjects comprising the total sample had
a mean age of 41.20 years; had been continuously institu
tionalized for 5.44 years; had completed 10.32 years of
school; and had an average verbal age on the Shipley-
Hartford Intelligence Test of 15.39 years. These subjects
were matched in groups of three in accordance with the
total number of words marked on the Fear, Anger, Depression,
and Weakness factors of the ACL that was administered be
fore the study began. This matching was effected because
preliminary evidence from a pilot study suggested that
patients differed markedly in their base rate of words
marked on the ACL. The matched groups of three were then
randomly assigned to the two treatment groups and the
Control Group. A comparative analysis of the characteris
tics of the three groups is provided in Tables 1 and 2.
TABLE 1
MEANS AND STANDARD DEVIATIONS OF CHARACTERISTICS
OF SUBJECTS*
Source
Control
Group
Companion
Group
Role Play
Group
Age Mean: 42.3 7 40.98 41.45
S.D. : 10.45 8.32 8.95
Verbal age Mean: 15.21 16.04 14.94
S.D. : 1.89 2.40 2.10
Years of current Mean: 5.32 6.10 4.90
institutionalization S.D. : 3.02 4.09 2.75
Education level Mean: 10.43 9.12 11.40
S.D. : 2.45 2.10 2.65
*All t tests between groups were non-significant
TABLE 2
MEANS AND STANDARD DEVIATIONS FROM PRESTUDY DATA
FROM ADJECTIVE CHECKLIST*
Source
Control
Group
Companion
Group
Role Play
Group
Number of negative Mean: 19.8 20.2 20.1
words marked S.D. : 17.2 17.4 16.7
Number of positive Mean: 18.6 18.6 22.9
words marked S.D.: 7.89 6 .68 6.92
Score from Mean: 28.0 26.1 24.1
negative words S.D. : 20.1 20.5 21.9
Score from Mean: 26.5 23.6 30.1
positive words S.D. : 13.6 10.8 12.3
*A11 t tests between groups were non-significant
General Procedure
The study ran for a total of eight weeks. Each sub
ject in the two treatment groups met with a pair of students
once per week for all eight weeks of the study. The sub
jects in the Control Group met only twice with a pair of
students. These two sessions occurred during the first and
the last weeks of the program and were for the purpose of
obtaining ratings of affect and social responsiveness. Also,
during these "rating weeks" each subject from both treatment
groups met with a pair of the "rating" students (whom were
called Raters). Pairs of Raters were randomly assigned to
individual subjects within the limits of available sched
ules. Each pair of Raters was assigned to at least one sub
ject and to as many as three depending upon scheduling con
venience. In no case were the Raters aware of the group to
which the subject had been assigned.
The two rating sessions were conducted in an identi
cal manner for the Control Group as well as for the two
treatment groups. This was necessary in order that the
Raters could rate all the subjects under comparable condi
tions. The meetings consisted of 20 to 30 minutes of un
structured social interaction during which time the Raters
were free to relate to their subjects in any way they felt
was most conducive for establishing a friendly relationship.
After each of the rating sessions the Raters independently
completed the rating scales of social responsiveness and af
fect according to the subject's behavior and demeanor during
the session. The subject was taken to a separate area where
he completed the ACL. Each subject was seen by the same
Raters in both rating sessions. Such a procedure allowed
for control of error due to differences between students in
rating behavior. However, it did not control for the effect
of the first rating session's experience upon the students.
The error due to this factor did not systematically affect
any one group since Raters were randomly assigned to their
subjects. Also, it was felt that the error due to this
experience would be less than the error that would be intro
duced if pairs of Raters participated in only one rating
session with different Raters interacting with the same
subject during the first and last rating session.
The treatment sessions were conducted during the
middle six weeks of the program. Each subject in the two
treatment groups met with a pair of the "treatment" students
(whom were called Treaters). Treaters were randomly
assigned to individual subjects within the limits of avail
able schedules. Each pair of Treaters met with each of
their assigned subjects individually for 20 to 30 minutes
once per week for each of the six treatment weeks. Each
pair of Treaters saw either one or two individual subjects
each week depending upon scheduling convenience. Also,
individual pairs of Treaters in many cases met with sub
jects that had been assigned to different treatment groups.
Consequently, these Treaters conducted both Companion ses
sions and Role Play sessions depending upon the assignment
of the particular subject involved.
During these six treatment weeks the Control Group
met with no students. However, each week they reported to
the investigator and completed the ACL. Before completing
the ACL they were given a copy of the role play script that
was used in the Role Play treatment sessions for that
particular week. They were told to read this script twice
since the Role Play Group read it twice during their ses
sions. The purpose of this procedure was to control for
the effect of merely being exposed to the content of the
role play materials without actually role playing. In
order to assure that the control subjects actually read and
understood the materials, they were asked to answer three
simple multiple choice questions relating to the content
of the script. Copies of these questions are presented in
63
Appendix A. Correct responses on two of the three questions
were required before the subject was allowed to complete
the ACL. If a subject failed to answer correctly two of
three questions, he was asked to read the script again and
to reanswer the questions. In the first week two of the
subjects repeated the reading one time. During the remain
ing weeks there was only one other instance where such a
repetition was necessary.
Treatment Sessions Procedure
If a subject was assigned to the Companion Group,
then the pair of Treaters conducted the session in an un
structured way. Essentially the students were free to
interact in any way that they felt was best to promote the
establishment of a friendly relationship. They could stay
in a private room and talk, take a walk around the grounds,
go to the canteen for coffee, visit the subject's work
assignment area, etc. The main idea was to convince the
subject that the students were there because they wanted
to be friends and wanted to help ease the monotony of the
day-to-day routine. After completion of the sessions the
subject was brought to a separate area where he completed
the ACL after being exposed to the role play materials and
64
answering the related questions.
If a subject was assigned to the Role Play Group,
only the first of the six treatment sessions was conducted
in an unstructured manner. Since this first session was
the initial meeting between the Treaters and the subject,
it was felt that the time should be used only for the
establishment of rapport. The next five sessions, however,
were highly structured. The first five minutes were used
for unstructured social interaction, but after this pre
liminary phase a role playing script was introduced. A
different script was used in each of the five remaining
treatment weeks and all role playing sessions used the same
script during any one week.
In the second treatment week the scripts were
introduced with a detailed explanation of their use. The
subjects were told that similar role plays would be used
in each of the following four sessions and that the exer
cise would be conducted in exactly the same manner as in
this first session. Therefore, in following sessions it
was not necessary to spend much time in elaborating on the
procedure to be used, but simply certain key points were
re-emphasized.
The subject was told that the role play materials
65
were exerpts from popular pl|^j3 and that he was to read one
of the parts in the script^was toid that the main idea
of the exercise was for both participants in the two-part
play to practice "putting themselves into the shoes" of
the character whose role they had been assigned. As each
role player reads his part he is to act "as if" he were the
person in the play. The subject was told that this is
sometimes difficult to do, but that it can be a very en
joyable experience if it can be achieved. The best way for
a person to achieve this goal is to try to imagine how the
character feels and to try to see if he can actually ex
perience these feelings as he enters into the role.
Following this explanation, the subject was
assigned his role and one of the students played the other
role. (Students alternated weeks in role playing.) Each
participant read his part as the role was enacted. After
completion of this reading the subject was asked if he
was successful in experiencing any of the pertinent feel
ings. If the subject answered that he had some success,
he was praised and encouraged to improve his performance
next time. If the subject indicated that he was completely
unsuccessful, he was told that it often takes practice be
fore success is achieved. Next, the script was read a
66
second time by the same role players, and it was again
emphasized that each participant should try to enter into
the role to the extent of experiencing the emotions that
are appropriate to the role.
After completion of the second reading, the subject
was asked if the situation in the role reminded him of any
event in his past life. Particularly he was asked if it
brought to mind any past experiences where he had similar
feelings. As many memories as possible were elicited and
the subject was encouraged to elaborate on each of them.
The purpose of this memory recall exercise was an attempt
to further elicit positive feelings through connection with
some appropriate experience in the subject's past. Pre
vious research had indicated that memory recall procedures
were effective in eliciting affects (Glick, J., unpublished
paper).
After the completion of the role play session the
subject was brought to a separate area where he completed
the ACL. Before completing the ACL the subject also
answered the questions pertaining to the applicable role
play materials. The students returned to the role playing
room and independently rated the subject on his role in
volvement .
67
Selection of Role Play Materials
1
The role play materials were selected from published
plays. Scenes or portions of scenes were selected that were
charged with positive emotion, and where this positive
emotion was expressed by at least one of the players. The
subject was assigned to the role which required the great
est amount of expression of positive feeling. Positive
feeling was simply defined as joy, elation, enthusiasm,
security, love, and happiness.
After a search for applicable materials, eight
potential scripts were selected. In order to assure that
the roles were suitable for our subject population, a
preliminary investigation was conducted. Six subjects were
selected at random from the pool of available subjects.
These were subjects who met all the criteria for the study,
and who were subsequently eliminated from participation
in the study because of their use in this preliminary role
suitability investigation. Each of these six subjects met
individually with the investigator and the role playing
procedure was enacted for each of the eight selected
scripts. Each script was enacted only once and the recall
of personal memories procedure was eliminated. After all
eight scripts were used, the subject was asked to rank them
68
beginning with the most preferred. It was hoped that such
a ranking would eliminate all scripts that would create
undue resistance. It could be expected that such resistance
would be encountered if the vocabulary was unnatural, un
familiar, or too difficult; or if the content of the situa
tions themselves was completely foreign to the subjects.
The ranks of each script were then summed to obtain a score
of suitability. The scripts with the five lowest total
scores were selected for use in the program. Scores for all
potential scripts are listed in Appendix B.
Preparation of the Subjects
The subjects were individually interviewed two
weeks prior to the beginning of the program in order to
eliminate all subjects who were not willing to voluntarily
participate. During this interview the subjects were in
formed of the following facts concerning the nature of the
program:
1. A group of undergraduate students from the
University of Southern California had contacted the Domi
ciliary and expressed an interest in visiting with residents
of the Domiciliary.
2. The students' purpose in making this offer
69
was their hope that such visits could make the days a
little more pleasant for the Domiciliary members whom they
realized often had little contact with people in the com
munity.
3. The students would come for a total of eight
weeks, and would visit with each participant for about
20 to 30 minutes each week. They would come in pairs so
each Domiciliary resident would be visiting with two stud
ents during each session.
4. The Psychology Section thought the student's
idea was a good one and they had decided to organize the
program. At the same time it was hoped that the program
could be organized in a way that would also produce re
search information. It was carefully explained that the
research information to be gathered was focused on Domi
ciliary members as a group and there would be no information
gathered that would affect any individual member in any way
whatsoever. No information as a result of the program
would be added to the participant's files nor would any
reports be written that referred to individual subjects.
5. In order to gather research information the
participants would be asked to complete a certain form after
each session. The ACL was shown to the potential subject
70
at this time, and explained to him.
6. The program was voluntary, but it was important
that all beginning subjects complete the full eight weeks.
For completing necessary forms for the full eight weeks,
subjects would be paid $5 at the end of the program.
If the prospective subject agreed to participate
after listening to all of the above information, his daily
schedule was explored, and suitable free times were ascer
tained for later scheduling. He then completed an ACL,
Social History Questionnaire, and verbal portion of the
Shipley-Hartford, if necessary. The subject was then told
he would be contacted in advance of his first appointment
which should take place in about two weeks.
Preparation and Training of Students
Because of the inexperience of the students, con
siderable time and effort was allocated for their prepara
tion prior to the start of the program. This preparation
took place in two general meetings during their normal
class time. The first meeting ran for about two hours and
the final meeting for about one hour.
During the initial meeting the following general
information and specific points were presented to the
students:
1. Participation in the program was not mandatory,
but in the case of nonparticipation a term paper would be
assigned 'as a substitute.
2. During the eight weeks of the program, one of
the regularly scheduled weekly class meetings would not be
held.
3. The Domiciliary was discussed in some detail
in order to familiarize the students with its physical
aspects as well as its purposes and functions. Also, the
general background of the problem was explained which in
cluded the broader aspects of the socio-psychological
model of mental illness, institutionalization theory, the
manpower problem, and history of nonprofessional programs.
4. The students were told that the subject
population would be former mental patients, but they were
not told that the subjects carried the label of schizo
phrenia. It was felt that this information would only
serve to bias the students' expectations of the subjects.
However, the students were told that the diagnosis and
other background information on the subjects would be avail
able at the end of the study.
5. The more formal details of the program were
72
outlined, but the details of the role play procedure were
deferred until the final session at which time the students
would know who had been assigned as Raters and Treaters.
6. It was explained that the subjects were par
ticipating on a voluntary basis and the students were made
aware of what information had been given to the subjects
regarding the study.
After all of this preliminary discussion, interested
students were asked to sign up in pairs and to select five
preferred meeting times from a list of 23 possibilities.
The final meeting with the students was held in
the week prior to the start of the study. This meeting was
largely devoted to a thorough explanation of the role play
procedure and to training on the use of the rating scales.
The OMI was also completed by the students at this time
and a Program Manual containing the following items was
distributed to each participant:
1. Opinions about Mental Illness Questionnaire.
2. Master Schedule of Individual Assignments.
3. Road Map to Domiciliary.
4. General Outline of the Program.
5. Instructions for Companion Sessions.
73
6. Instructions for Role Playing Sessions.
7. Role Play Materials.
a. Tom Sawyer (Appendix C).
b. Wednesday's Child (Appendix D).
c. Abie's Irish Rose (Appendix E).
d. Robinson Crusoe (Appendix F).
e. The Male Animal (Appendix G).
8. Social Responsiveness Rating Scales (Appendix
H) .
9. Affect Rating Scales (Appendix I).
10. Role Involvement Rating Scales (Appendix I).
After distribution of the Program Manual, the role
playing instructions were read and discussed. It was
emphasized that it was very important that these instruc
tions be carried out as indicated on the instruction sheet.
It was also emphasized that the students' most important
task during the role play sessions was to motivate the sub
jects to fully participate in the exercise. It was ex
plained that the subjects would be' influenced by the
students 1 enthusiasm or lack of enthusiasm, and that they
should try to create a playful atmosphere rather than allow
too serious of a tone to develop.
74
The remaining portion of this meeting was used for
training in the use of the social responsiveness scales.
This training was an effort to reduce the differences be
tween individual raters, and to be sure that all raters
understood what behaviors were to be rated. The training
began with a thorough discussion of the rating scales with
emphasis on examples of the specific behaviors referred to.
At this point a two-person social interaction was staged
at the front of the room that simulated what might be
expected during the sessions with the schizophrenics.* At
the end of this five-minute interaction the students were
asked to complete the four scales of social responsiveness
on the person who took the role of the schizophrenic. The
ratings were collected and distributions were quickly
compiled on the blackboard so that individual Raters might
have feedback on how their ratings compared to the ratings
of the group as a whole. An attempt was made to stimulate
a discussion with deviant Raters in hopes of adjusting
their perspective on the rating task. After this practice,
two more interactions were staged using the same procedures.
During the first treatment week further role
playing training was given to all Treaters who had been
assigned to role playing sessions. The investigator met
75
with these Treaters and simulated a role play session as
it was to be conducted with a subject. The investigator
assumed the role of the subject with the student playing
his appropriate role. Two separate role plays were con
ducted , with each student participating in one of them.
After each practice the investigator suggested changes that
should be made in cases of wrong procedure. The students
were also encouraged to be enthusiastic and to become
involved in the exercise. After this meeting the inves
tigator rated each student on a scale of role playing
involvement. This rating was primarily based on the en
thusiasm that each student showed in the exercise.
Other than the formal training procedures, the
students also met with the investigator on each of their
visits. These meetings were cast in the form of informal
discussion groups and included all pairs of students who
were scheduled at any one time. The meeting took place
after their sessions with the subjects, and lasted from 10
to 30 minutes depending upon the needs of the students and
the schedule of the investigator. Topics of discussion
were at the option of the students and usually included
such areas as: techniques of approach to the subjects,
anxieties generated by the meetings, and a general exchange
76
of experiences between the different pairs of students.
Contingency Schedule
Because this study depended very heavily on many
people conforming to a fixed schedule, it was necessary to
have a procedure to follow in cases of deviance from this
schedule. Following is a list of the procedures that were
used in such cases:
1. If one student of a pair failed to show for a
session, the session was held as scheduled and data result
ing from the session were treated in the standard manner.
2. If both students in a pair failed to show for
a session, the subject was excused and told that he would
be contacted when the students were available. The students
were then contacted and an effort was made to reschedule
the missed session before the next regularly scheduled
session. If this was possible, the data from the session
were handled in the standard manner. If it was not pos
sible, that particular session was eliminated from the
program. This situation occurred in only two instances
during the study. In order that the two subjects might not
be lost from the study, they were given a score for the
missed session that was an average of the scores from the
77
sessions just before and just after the missed one.
3. If a subject missed a session, no attempt was
made to reschedule the session and the same procedure for
handling the missing data was used as for (2) above. This
situation occurred in only three instances for subjects
who were included in the final analysis.
4. If a subject left the Domiciliary, or dropped
out of the program, he was lost for purposes of the study.
Test Instruments
The scales of social responsiveness were con
structed specifically for this study. Since they were
used by relatively inexperienced college students, the be
haviors to be rated were made very gross and of a nature
that could be easily assessed after social interaction.
Emphasis was placed on assessing the social adequacy of
the subject's performance, and whether he did his "share"
in exercising initiative to maintain the interaction. The
criterion of social adequacy seemed to be most pertinent
to the study since chronic schizophrenics are usually
described as socially inadequate.
These scales were not anchored by fixed numbers
of social behaviors, since an excess of certain behaviors
78
is just as inadequate and inappropriate as a lack of the
same behaviors. Instead, the scales were anchored with
such labels as: 100 per cent socially adequate performance,
75 per cent socially adequate performance, etc. The
ratings, therefore, depended upon the subject's performance
within the context of each individual interaction. Natur
ally each interaction depended also on the personalities
and needs of the particular students involved. However,
since each subject was rated by the same pair of students
in both rating sessions, the individual Raters' needs were
held constant so that the difference between pre and post
ratings would not be a function of these factors. Each
scale ranged from 0 to 7 and, since there were two Raters
for each subject, the total of the two ratings comprised
the score for any one subject.
The primary instrument used to assess mood change
was a previously developed adjective check list (Jacobs,
unpublished paper). An ACL is an instrument that endeavors
to assess certain verbal responses of a subject. As dis
cussed earlier, verbal responses are behavioral consequences
of mood change which offer readily abailable indices of
mood variation; and adjectives, in particular, are the most
frequent verbal responses to mood. Therefore when given
79
the instructions to mark adjectives according to the extent
to which each adjective describes his mood;, a subject's
responses offer a measure of mood.
While we considered mood to be a major source of
variation affecting responses to the adjective list, it
was recognized that verbal responses have multiple deter
minants and that other factors undoubtedly influence
reports of mood. For example, social acceptability of
certain words and feelings, social desirability, acquies
cence, and other response sets are such factors. An
advantage of ACLs is that such factors are far less rele
vant if the instructions request the subject to mark each
word as it applies to his feelings and mood at the moment
he reads the word. With such instructions, the marking
of each word is only a commitment of the moment not a
lifetime.
The specific ACL that was utilized in this study
(Appendix J) contained 90 adjectives that had been pre-
viously factor analyzed into six dimensions of 15 adjectives
each (Fear, Anger, Depression, Weakness, Energy, and Happy).
The instructions called for the subject to mark an X
through either a 0, 1, or 2 according to how a particular
word applied to the subject's feelings at the moment. The
80
digits were coded as follows:
0 = not at all
1 = a little
2 = a lot
Therefore, the scores used for the basic data in the study
were simply the sum of individual word scores for all of
the words in the factor being analyzed.
The six affect rating scales were designed in an
attempt to assess the mood of the subjects as interpreted
by the students. The affects to be measured were chosen
to be identical with the six factors from the ACL: Fear,
Anger, Depression, Weakness, Energy, and Happy. The
anchors on the eight point scales were given such labels
as Not at All and Very which referred to the student's
impression of the intensity of the subject's mood. The two
ratings on each subject were summed to obtain the final
score.
The questionnaire that was used to test the student
attitudes toward mental illness was the previously developed
OMI (Cohen and Struening, 1962). The OMI is a factor ana
lytically derived set of scales made up of 51 Likert-type
items which yield factorially stable scores on five
81
dimensions of attitude toward the mentally ill:
A— Authoritarianism, with its characteristic sub
mission, anti-intraception, and view of patients
as an inferior, threatening outgroup;
B— Benevolence, based on humanistic or religious
grounds;
C--Mental Hygiene Ideology, the tenets of mental
health professionals;
D— Social Restrictiveness of patients and ex
patients, who are viewed as a threat to family
and society;
E— Interpersonal Etiology of mental illness, par
ticularly parental love deprivation in child
hood .
There is some tendency for A and D to form one cluster, B
and C to form another, and for the two clusters to be neg
atively related. E is negatively related to the other
scales (Cohen and Struening, 1963).
Statistical Considerations
Hypothesis A pertaining to a change of mood in
chronic schizophrenics through a social therapy program
with college students was evaluated by several different
82
statistical methods. Initial evaluations using data from
the ACL were made with nonparametric techniques. The
Friedman two-way analysis of variance (Siegel, 1956) was
selected for this purpose and evaluations were computed on
the difference scores from the first to the seventh session
for both positive and negative words. Separate evaluations
were computed for the three basic comparisons in the study:
Companion Group versus Control Group; Role Play Group
versus Control Group; and Role Play Group versus Companion
Group.
The above series of evaluations was as called for
in the basic predictions of the study. However, two other
series of evaluations were computed using slightly differ
ent sets of data. In one series, difference scores from
the last session to the first session were used. In these
evaluations the longer term effects of treatment, if any,
could be assessed. In another series, difference scores
from the sixth session to the first session were used.
This series of evaluations was computed because of evidence
that came to light that indicated the seventh session had
largely a detrimental effect on treatment results in com
parison to the sixth session.
In addition to the nonparametric analyses discussed
83
to this point, several parametric analyses were computed
on the ACL data. Observations of the distributions of the
sample ACL scores indicated that scores from positive words
were sufficiently normal in form to warrant such analyses.
The distributions from the negative word scores were
extremely skewed and parametric analyses were not possible.
Therefore, the three series of positive word difference
scores were analyzed a second time by means of a simple
one way analysis of variance. The same comparisons were
made as in the nonparametric evaluations.
So far we have discussed only analyses of dif
ference score data. Such analyses make use of data from
two sessions while ACL data were available from each session
in the program. In order to take advantage of this large
amount of data an additional statistical technique was
employed. A Two Factor Repeated Measurement Analysis of
Covariance (Winer, 1962) was used on positive word scores
for both five and six session analyses. This technique
also made possible the evaluation of the factor of Time as
well as Treatments. An analysis of covariance was used
in order to adjust for any differences between groups on
the base rate of marking behavior for positive words.
Other techniques automatically corrected for this factor
84
through the use of difference scores.
To summarize, three methods were used in evalua
tions of the ACL data:
1. Nonparametric Friedman two-way analysis of
variance on difference scores for both negative and posi
tive words from the first to the sixth, seventh, and
eighth sessions respectively.
2. Parametric one-way analysis of variance on
difference scores for positive words from the first to the
sixth, seventh, and eighth sessions respectively.
3. Parametric Two _Factor Repeated Measurement
Analysis of Covariance for positive word scores for total
of five and six treatment sessions.
In order to further gather information that might help ex
plain the results of the present study these same analyses
were computed on the six separate factors from the ACL.
Each factor was evaluated in the same manner as for the
conglomerate positive and negative word scores.
Other than the evaluations that used data from
the ACL, further evaluations of mood were computed using
data from the rating scales of affect. The Friedman Two
Way Analysis of Variance by ranks was again used to evaluate
85
the rating scores from the six separate scales of affect.
Separate evaluations were computed for the Companion Group
compared to the Control Group; for the Role Play Group
compared to the Control Group; and for the Role Play Group
compared to the Companion Group. The data were in the form
of difference scores from the first to the last session.
Hypothesis B which pertained to changes in social
responsiveness of chronic schizophrenics as a result of
social therapy with college students was evaluated also by
the Friedman procedure. The data used were from the four
scales of social responsiveness and were in the form of
difference scores from the first to the last rating ses
sion. This assessment was computed for each of the four
separate scales as well as for the sum total ratings of
the four scales for the Companion Group compared to the
Control Group; for the Role Play Group compared to the Con
trol Group; and for the Role Play Group compared to the
Companion Group.
Hypothesis C which pertained to changes of atti
tudes toward mental illness of the students who participate
in a social therapy program with chronic schizophrenics
was evaluated by a simple randomized One Way Analysis of
Variance. All five factors were evaluated separately even
86
though only three of the factors carried formal predictions.
In the evaluation of hypothesis A both ACL self-
marking data and ratings from the scales of affect were
utilized. A Spearman correlation was computed on each of
the six factors of the ACL compared to the like-named
rating scale, to assess if the students were rating the
same entity as the subjects were reporting.
Also, to assess if the four scales of social
responsiveness were measuring unique behaviors, an inter-
correlational matrix was computed on these scales. Because
the data were considered to be nonparametric a Spearman
analysis was used.
Finally, as noted earlier, three additional groups
of data were gathered during the process of the experiment.
It was hoped that these data would correlate with one or
more of the major dependent variables. If significant
correlations were obtained, then the pertinent data could
be used as an additional control in further analyses of
the main results. The three groups of data were: Social
History scores on all subjects; Role Involvement scores
on subjects in the Role Play Group as rated by the inter
acting students; and Role Play Involvement ratings on the
students as assessed by the investigator in a prestudy
87
training session. The data from these three factors were
correlated with data from the ACL and scales of social
responsiveness. The form of the data from the ACL that
was used for these correlations was the total score from
all six treatment sessions for both negative and positive
words. Also, for social responsiveness correlations, the
total score obtained on all four scales at the last rating
session was the pertinent data used. In correlations
involving Social History scores, subjects from both treat
ment groups were used while in correlations involving the
two Role Involvement ratings only the Role Play Group
could be used.
CHAPTER IV
RESULTS
Hypothesis A
It was hypothesized that the mood of chronic
institutionalized schizophrenics could be improved through
a social therapy program that utilized college students.
This hypothesis was tested with both self-report data from
the adjective checklist and data from ratings of affect as
assessed by the student Raters. The basic data from the
ACL are summarized in Figure 1 and Table 3. These two pre
sentations summarize the ACL data in two basically differ
ent ways. Figure 1 is based on the means for both positive
and negative word scores for all eight sessions and for
each of the three groups in the program. Table 3 shows
the number of subjects in each group who increase, decrease,
or show no change in both positive and negative word score
at each of the last seven sessions in the program relative
to session number one. Perusal of these presentations
gives an over-all picture of the changes and trends that
88
MEAN NEGATIVE WORD SCORE
i f iflOtEietAYrGftOUP-
• COMPANION GROUP-
--CONTROL- GROUP-
24
->
- SESSIONS- ? -— -— l- fh S U R r f
MEANS FOR POSITIVE AND NEGATIVE WORD SCORES FROM THE ADJECTIVE
SESSIONS
CHECKLIST
o o
&
90
TABLE 3
NUMBER OF SUBJECTS IN EACH GROUP W HO SHOW AN INCREASE,
DECREASE, OR NO CHANGE IN ACL SCORES FOR EACH OF
THE LAST SEVEN SE SSIO N S OF THE PROGRAM
COMPARED TO THE F IR ST SE SSIO N
N e g a t i v e W ord S c o r e
C o m p a n io n G ro u p R o le P l a y G ro u p C o n t r o l G r o u p
p
c u
■i
G
2
G
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- P
co
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Is P
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7 4 12 0
8 3 12 1
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3 12 1
3 12 1
3 12 1
3 13 0
3 1 0 3
4 9 3
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P o s i t i v e W ord S c o r e
10
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12
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12
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12
12 10
91
occurred during the program.
In testing the basic hypothesis, the positive and
negative word difference scores at the last treatment
session (seventh session) compared to the first session
were assessed according to the specific predictions of the
study. These data were tested by use of the nonparametric
Friedman two way analysis of variance and the results are
summarized in Table 4. Of the three basic predictions con
cerning the change in negative word score, one proved to
be statistically significant. More subjects in the Com
panion Group showed a greater decrease in negative word
score from the first to the seventh session than the sub
jects in the Control Group. A x| = 6.25 with ldf resulted
in a significance level of .02. Results of the evaluations
of the same prediction for the Role Play Group compared
to the Control Group and the Role Play Group compared to
the Companion Group were both nonsignificant.
Of the three basic predictions concerning the
change in positive word score, one of the three also proved
to be statistically significant. More subjects in the
Role Play Group showed a greater increase in positive word
score from the first to the seventh session than the
subjects in the Companion Group. A Xr = 6.25 with ldf
TABLE 4
SUMMARY OF X* VALUES FOR A L L BETWEEN GROUP A N A L Y SE S ON D IF F E R E N C E
SC O R ES ON THE A CL A S A S S E S S E D BY THE FRIEDM AN TWO WAY
A N A L Y S IS OF V AR IA N C E
N e g a t i v e W o r d S c o r e P o s i t i v e W o r d S c o r e
D a t a U s e d f o r D i f f e r e n c e D i f f e r e n c e D i f f e r e n c e D i f f e r e n c e D i f f e r e n c e D i f f e r e n c e
A n a l y s i s i n S c o r e i n S c o r e i n S c o r e i n S c o r e i n S c o r e i n S c o r e
f r o m t h e 1 s t f r o m t h e 1 s t f r o m t h e 1 s t f r o m t h e 1 s t f r o m t h e 1 s t f r o m t h e 1 s t
t o t h e 6 t h t o t h e 7 t h t o t h e l a s t t o t h e 6 t h t o t h e 7 t h t o t h e l a s t
S e s s i o n S e s s i o n S e s s i o n S e s s i o n S e s s i o n S e s s i o n
C o m p a n i o n G r o u p
b b
c o m p a r e d t o 5 . 6 0 6 . 2 5 1 . 0 0 2 . 2 5 0 . 6 0 0 . 0 0
C o n t r o l G r o u p
R o l e P l a y G r o u p
b
c o m p a r e d t o 4 . 0 0 3 1 . 6 0 0 . 0 0 4 . 0 0 a 1 . 6 0 6 . 2 5
C o n t r o l G r o u p
R o l e P l a y G r o u p
b b b
c o m p a r e d t o 3 . 1 0 0 . 6 0 1 . 6 0 6 . 2 5 6 . 2 5 5 . 6 0
C o m p a n i o n G r o u p
a = s i g n i f i c a n t a t t h e . 0 5 l e v e l ( o n e - t a i l e d t e s t ) .
b = s i g n i f i c a n t a t t h e . 0 2 l e v e l ( o n e - t a i l e d t e s t ) .
N o t e : X j v a l u e s a r e u n d e r l i n e d i f t h e d i r e c t i o n o f c h a n g e f a v o r s t h e s e c o n d g r o u p i n
t h e c o m p a r i s o n .
93
yielded a significance level of .02 on this evaluation.
Results of the evaluation of the same prediction for the
Companion Group compared to the Control Group and the Role
Play Group compared to the Control Group were both non
significant.
Therefore, two of the six basic predictions that
were based on ACL data were supported. However, information
that came to light during the actual running of the program
led to a testing of a slightly different set of predictions.
This new series of evaluations was a result of the obser
vation by the investigator that the last treatment session
caused some disappointment on the part of many of the
subjects due to the fact that this was the last time that
the Treaters would come to visit them. Since this disap
pointment seemed to be a factor that could adversely affect
the results of the program, a perusal of the ACL data was
made to assess the changes from the sixth to the seventh
session. These data are summarized in Table 5. As can be
seen from these data, there is clear evidence that the
last treatment session (seventh session) resulted in
diminished treatment effects compared to what had been
achieved up to the sixth session. While the Control Group
remained essentially unchanged, the majority of subjects
TABLE 5
NUMBER OF SUBJECTS WHO INCREASE, DECREASE, OR SHOW NO CHANGE IN POSITIVE
AND NEGATIVE WORD SCORES ON THE ACL FROM THE SIXTH TO
THE SEVENTH SESSION
Negative Word
Score
Positive Word
Score
Companion
Group
Role Play
Group
Control
Group
Companion
Group
Role Play
Group
Control
Group
Number of subjects who scored
higher after the seventh session
than after the sixth session
8 10 7 6 4 6
Number of subjects who scored
lower after the seventh session
than after the sixth session
3 3 6 8 10 7
Number of subjects who showed
no change in score after the
seventh session in comparison
to the sixth session
5 3 3 2 2 3
95
in both the Role Play Group and the Companion Group gener
ally produced a lower positive word score and a higher
negative word score at the seventh session compared to the
sixth session. Therefore, since the last treatment session
had a generally adverse effect on the results of the pro
gram (as measure by ACL data), the previous analyses were
repeated, but with data from the sixth session substituted
for that from the seventh session. Such a procedure
eliminated any effects of the last treatment session.
The summary of results from this new series of
analyses, as assessed by the Friedman technique, is also
presented in Table 4. While two of the six basic predic
tions were supported when using data from the seventh
session, the evaluations of change in ACL scores from the
first to the sixth session yielded significant results for
four of the six predictions. With regard to negative word
score, more subjects in the Companion Group continued to
show a greater decrease than subjects in the Control Group.
A X^. = 5.60 with ldf yielded a significance level of .02
which was also the same as obtained on the previous analy
sis. In addition, more subjects in the Role Play Group
showed a greater decrease in negative word score than sub
jects in the Control Group. In this case, a Xr = 4.00
96
with ldf yielded a significance level of .05. The evalua
tion of change of negative word score for the Role Play
Group compared to the Companion Group continued to produce
nonsignificant results.
With regard to the new series of analysis on
positive word scores, more subjects in the Role Play Group
continued to show a greater increase than subjects in the
Companion Group. The X® = 6.2 5 with a significance level
of .02 was the same as for the previous analysis. Likewise,
more subjects in the Role Play Group showed a greater in
crease in positive word score from the first to the sixth
session than the subjects in the Control Group. This was
a significant result that was not obtained previously.
A Xr = 4.00 with ldf yielded a significance level of .05.
Results of the comparison of the Companion Group to the
Control Group continued to be nonsignificant.
In all of the preceding analyses data were used that
had been collected immediately following the sessions. Since
there was a specific attempt in the Role Play treatment pro
cedure to elicit positive mood, the ACL data that were gath
ered immediately after such sessions should have been partly
determined by the degree to which the procedure was success
ful. Such data helped to assess the immediate effects of
97
the procedure, but did not assess if the procedure had any
long term effects. In order to do this, a series of analy
ses was computed using data from the last session. Since
the last session was not a treatment session, but was used
primarily for rating, all three groups were treated in ex
actly the same manner and there was no specific attempt to
elicit positive mood. Therefore, an analysis of the change
in ACL data from the first to the last session eliminated
any short term effects of the role play procedure.
The results of this series of analyses, as assessed
by the Friedman technique, is also presented in Table 4.
With regard to negative word scores, no significant results
were produced for any of the three basic evaluations: Com
panion Group compared to the Control Group, Role Play Group
compared to the Control Group, and Role Play Group compared
to the Companion Group. However, two of the three evalua
tions of positive word scores were significant and were
identical to the results of the evaluations which used data
from the sixth session; e.g., more subjects in the Role Play
Group showed a greater increase in positive word scores from
the first to the last session than either subjects in the
Control Group or subjects in the Companion Group. Both re
sults were significant at the .02 level. The comparison of
98
the Companion Group to the Control Group was again nonsig
nificant as it was when data from both the sixth and the
seventh sessions were used.
In relation to the predictions of this study, the
results of all the foregoing nonparametric evaluations can
be summarized as follows:
1. Subjects in the Companion Group showed a sig
nificantly greater decrease in negative word scores, but
they did not show a greater increase in positive word scores
than the Control Group.
2. Subjects in the Role Play Group did not show a
greater decrease in negative word scores or a greater in
crease in positive word scores than the Control Group when
comparing the seventh to the first sessions. However, these
same predictions were significant when evaluated at the
sixth session instead of the seventh.
3. Subjects in the Role Play Group showed a signif
icantly greater increase in positive word scores, but they
did not show a greater decrease in negative word scores than
the Companion Group.
Therefore, of the six basic predictions, two were
clearly supported, two were partially supported, and two
were clearly not supported.
All of the preceding evaluations were determined
99
by use of the nonparametric Friedman two way analysis of
variance. This technique was selected partially because the
data from the negative word scores formed a distribution
that was highly shewed. However, the sample distribution of
positive word scores appeared to be essentially normal in
form and a parametric analysis was possible on this segment
of the ACL data. Therefore, in order to further evaluate
positive word scores, a one way analysis of variance was
computed on each of the three sets of data that had been
previously used for the nonparametric analyses, e.g.:
1. Difference scores from the first session to the
sixth session;
2. Difference scores from the first session to the
seventh session;
3. Difference scores from the first session to the
last session.
Results of these analyses, as summarized in Table 6,
were essentially the same as the results of the non-paramet-
ric evaluations of positive word scores. Therefore, these
results add further support to the results of the nonpara
metric evaluations of positive word scores.
In addition to the preceding parametric and nonpar
ametric analyses one final evaluation of ACL data remains to
be reported. In all of the analyses up to this point, a
TABLE 6
SUMMARY OF RESULTS OF ALL ANALYSES OF VARIANCE THAT EVALUATE
POSITIVE WORD DIFFERENCE SCORES
Data Used
For the
Analysis
Positive Word Differ
ence Scores Between
1st and 6th Session
Positive Word Differ
ence Scores Between
1st and 7th Session
Positive Word Differ
ence Scores Between
1st and Last Session
SS
Treat
ments
SS
Within
Groups
F
Score
(1,30)
SS
Treat
ments
SS
Within
Groups
F
Score
(1,30)
SS
Treat
ments
SS
Within
Groups
F
Score
(1,30)
Companion Group
compared to
Control Group
32 630 1.52 47 812 1.37 22 1832 0.36
Role Play Group
compared to
Control Group
73 516 4.22a 77 703 3.29 300 1636 5.50a
Role Play Group
compared to
Companion Group
195 650
~ ^„b
9.08 247 628 11.82° 157 860 5.49a
a = significant at .05 level (one-tailed test),
b = significant at .01 level (one-tailed test).
c = significant at .005 level (one-tailed test).
Note: F scores are underlined if the direction of change favors the second
group in the comparison.
101
basic underlying assumption was that the treatment groups
would show a gradual improvement from the beginning to the
end of the treatment sessions. This assumption was primar
ily based on the hope that the student-subject relationship
would gradually grow in closeness, and that a closer rela
tionship would result in more effective treatment. Also, in
terms of the Role Play Group, it was felt the subjects would
gradually become more proficient with practice in the role
play procedure. If the foregoing assumptions were correct,
the latter treatment sessions would produce the greatest
treatment effects. Consequently, the formal evaluations of
the predictions in this study, and all of the foregoing an
alyses used difference data from the first session of the
program to a session near the end of the program. However,
if the basic assumptions are not correct and treatment
effects are not partially a function of time, then the use
of other techniques of analysis would be advisable.
Since ACL data were gathered after each of the ses
sions in the program, a statistical technique was needed
that would make use of all the data rather than just a por
tion. A two factor repeated measurement analysis of covar
iance (Winer, 1962) was selected for this purpose. Not only
does such a technique make use of all of the data that were
102
available, but it also makes possible the testing of the
assumption that treatment effects improve with Time. It is
possible to analyze the separate factors of Time and Treat
ment as well as their Interaction, which would be an indi
cation of the correctness of this assumption. An analysis
of covariance was used in order to control for the initial
levels of positive word scores. In preceding analyses this
initial level was automatically controlled through the use
of difference scores. While there were no significant dif
ferences between groups (Table 2) on the initial level of
positive word score the covariance technique was used to in
crease the precision of the analysis by adjusting for any
small differences that did exist. The positive word scores
from the ACL data that were gathered after the first session
were used as the covariates.
Therefore, a Two Factor Repeated Measurement Analy
sis of Covariance was applied to the positive word scores
for both five and six treatment sessions. Table 7 summar
izes the results of the over-all analyses as well as the
comparison of means between separate groups. In the over
all analyses, the adjusted main Treatment effects were sig
nificant for both the evaluations of five and six treatment
sessions. Using data from all six sessions resulted in an
TABLE 7
SUMMARY OF RESULTS OF EVALUATION OF TOTAL POSITIVE WORD SCORE FROM ACL AS
ASSESSED BY A TWO FACTOR REPEATED MEASUREMENT ANALYSIS OF COVARIANCE
(COVARIATE * SCORE ON POSITIVE WORDS FROM THE FIRST SESSION)
1. F scores from the over-all analysis:
Treatments
df = 2,45
Treatments,
(adjusted)
df * 2,45
Occasions
df ■= 1,45
Interaction
df = 2,45
Using data from all
six treatment sessions 2.30 3.88a 1.56 1.69
Using data from first
five treatment sessions 2.31 4.63b 0.19 0.96
2. F scores (df = 1.29) from comparison of means:
Adjusted Means
a
s
O C l
a
3
0 a
a a
3 3
0 0
Companion
Group
Role Play
Group
Control
Group
Companion G:
compared tc
Control Groi
Role Play Gi
compared tc
Control Groi
Role Play Gi
compared tc
Companion Gi
Using data from
all six treat
ment sessions 25.9 29.5 25.4 o.os 6 64b 5.40®
Using data from
first five treat
ment sessions 26.4 29.9 25.5 0.37 8.72C 5.42®
a = significant at .05 level (one-tailed test),
b = significant at .025 level (one-tailed test).
c = significant at .01 level (one-tailed test).
103
104
F score of 3.88 which was significant at the .05 level with
2,45 degrees of freedom. The five session analysis produced
an F score of 4.63 which was significant at the .025 level
with 2,45 degrees of freedom. The unadjusted main Treatment
effects were not significant. The second factor of Occa
sions (Time) was not a factor that by itself carried any
formal or informal predictions and F scores for this factor
were not significant. However, Interaction effects between
Treatments and Occasions were of interest as previously dis
cussed. Results of the analysis of this factor were nonsig
nificant. The evaluations of both factors of Occasions and
Interactions were based on conservative degrees of freedom
as recommended by Winer. However, testing the F scores with
the standard degrees of freedom also produced nonsignificant
results.
A comparison of the adjusted means for positive word
scores from the above over-all analyses produced significant
results for the evaluations of the Role Play Group compared
to both the Control Group and the Companion Group. These
evaluations were significant for both the five and six ses
sion analyses. For all six treatment sessions the Role Play
Group had an adjusted mean positive word score of 29.5 as
compared to 2 5.4 for the Control Group and 2 5.9 for the
105
Companion Group. This resulted in an F score of 6.64 and a
significance level of .025 in the comparison of the Role
Play Group to the Control Group. In the comparison of the
Role Play Group to the Companion Group an F score of 5.40
and a significance level of .05 was obtained. For the five
session analysis the Role Play Group had an adjusted mean
positive word score of 2 9.9 as compared to 26.4 for the Com
panion Group and 25.5 for the Control Group. These differ
ences resulted in an F score of 8.72 and a significance lev
el of .01 when comparing the Role Play Group to the Control
Group. In the comparison of the Role Play Group to the Com
panion Group an F score of 5.42 and a significance level of
.05 was obtained. None of the analyses comparing the Com
panion Group to the Control Group produced significant
results.
Therefore, not only did the analysis of covariance
add further support to the already clearly supported pre
diction that the Role Play Group would achieve greater
positive word scores in comparison to the Companion Group,
but it also strongly supported the previously only partially
supported prediction that the Role Play Group would score
higher on positive word score than the Control Group.
In addition to the evaluation of the basic hypothe-
106
sis through use of ACL data, an analysis was carried out
which used the rating scale data from the first and last
sessions. The Friedman procedure was used to evaluate dif
ference scores from these two ratings. The treatment groups
were separately compared to the Control Group as well as to
each other and these results are summarized in Table 8.
Significant results were produced on only the Fear scale.
Both the Role Play Group and the Companion Group showed a
significant decrease in Fear ratings from the first to the
last session. The analyses produced a ~ 4.00 for the
Companion Group which was significant at the .05 level, and
a Xr = 5.60 for the Role Play Group which was significant at
the .02 level. The predicted changes in ratings on the
other scales of Anger, Depression, Tired, Energy, and
Happiness were not supported.'*'
In the evaluation of mood hypothesis two types of
data have been used as indices of mood. The data from the
Evaluations of the affect rating scale data were
also computed without consideration for the initial match
ing of subjects. For these evaluations a Chi Square
Analysis was used to compare groups on number of subjects
who increased, decreased, or showed no change on each of
the rating scales from the first to the last session. This
procedure allowed the use of a larger N since there was no
requirement that the original matched groups remain intact.
Results are summarized in Appendix 0, and are essentially
the same as for the Friedman analyses except for small
changes in significance levels.
107
TABLE 8
SUMMARY OF X§- VALUES FOR BETWEEN GROUP ANALYSES OF
DIFFERENCE SCORES FROM THE RATING SCALES OF
AFFECT AS ASSESSED BY THE FRIEDMAN TWO
WAY ANALYSIS OF VARIANCE BY RANKS
Scale
Companion Gp.
Compared to
Control Gp.
Role Play Gp.
Compared to
Control Gp.
Role Play Gp.
Compared to
Companion Gp.
Fear
. c l
4.00
r- ^ ~ b
5.60 1.00
Anger 1.00 2.25 0.25
Depression 0 .60 0.60 0.25
Weakness
(Tired)
0 .06 1.60 0.60
Energy 0 .00 1.00 0.25
Happy 0.60 0.25 1.60
a = significant at the .05 level (one-tailed test),
b = significant at the .02 level (one-tailed test).
Note: Xr values are underlined if the direction of
change favors the second mentioned group in the comparison.
108
ACL are self-report data while data from the rating scales
are a measure of affect as assessed by a second person.
In order to evaluate whether these two indices of mood are
measuring the same entity a correlational analysis was com
puted. Spearman correlations were calculated at both the
first and last rating sessions. The scores obtained by the
subjects on each of the six separate factors of the ACL were
correlated to the total of the two students1 ratings on the
subject's affect for that particular session. The results
are summarized in Table 9 and the only significant correla
tions were obtained on the factor of Happy. At the first
rating session the correlational coefficient was .3 73 which
was significant at the .01 level and at the last session it
was .3 52 which was significant at the .02 level. None of
the other five correlations produced significant results.
All of the analyses on the total positive and nega
tive word scores from the ACL were also used to evaluate the
six separate ACL factors. It was hoped that such analyses
would produce results that would help to explain treatment
effects, and to provide data which might point to directions
for future research. The results of these analyses are
summarized in Appendices G, H, and I. With regard to the
factor Fear, more subjects in the Companion Group showed a
109
TABLE 9
SPEARMAN CORRELATIONS (rs) BETWEEN THE STUDENTS’
RATINGS OF AFFECT AND THE SUBJECTS'
SELF-REPORTED AFFECT SCORES
FROM THE ACL ( N=53 )
At First Rating
Session
At Final Rating
Session
Fear .114 .154
Anger .055 .062
Depression .112 .201
Weakness
(Tired)
.046 .030
Energy .227 .212
Happy .373 .352a
b = significant at the .01 level for two-tailed t test,
a = significant at the .02 level for two-tailed t test.
110
significantly greater decrease in score than subjects in the
Control Group at both the seventh and sixth sessions com
pared to the first session. The result for the sixth ses
sion analysis was significant at the .01 level while at the
seventh session a .02 level was obtained. Significant re
sults were not obtained when comparing the last session to
the first session. All evaluations for the Role Play Group
compared to both the Control Group and the Companion Group
were nonsignificant.
On the factor of Anger none of the nine separate
evaluations produced significant results.
On the factor of Depression only one of the nine
evaluations was significant. More subjects in the Role
Play Group scored significantly lower than subjects in the
Control Group when comparing the sixth session to the first
session. This result was significant at the .05 level.
Also, on the factor of Weakness only one of nine
evaluations was significant. More subjects in the Compan
ion Group scored lower than subjects in the Control Group
when comparing the seventh session to the first session.
This result was significant at the .02 level.
On the two positive factors of Energy and Happy,
parametric analyses were used as well as the Friedman
Ill
nonparametric analyses. Consequently, there were 24 separ
ate evaluations on each of the factors. On the factor of
Energy there were six significant results from these analy
ses. In two instances basic comparisons were supported by
two of the significant results. The Role Play Group was
significantly superior to the Companion Group on both the
parametric and nonparametric evaluations of the Energy score
at the sixth session compared to the first session. Also,
the Role Play Group scored significantly higher than the
Control Group on the factor of Energy for both the five and
six repeated measurement analysis. Of the five significant
results for the factor of Happy there was one comparison
that was supported by two separate evaluations. The Role
Play subjects scored significantly higher than the Companion
subjects on both the parametric and nonparametric evalua
tions of the difference in score between the sixth session
and the first session.
Hypothesis B
It was hypothesized that the social responsiveness
of chronic institutionalized schizophrenics could be im
proved through a social therapy program that utilized col
lege students. This hypothesis was tested by analyzing dif
ferences in rating from the first to the last session in the
112
program. Using these data, each group was compared to the
other two groups by means of the Friedman Two Way Analysis
of Variance by Ranks. It was predicted that subjects in
both the Companion and Role Play Groups would show a greater
increase in rating on all four scales of social responsive
ness than the subjects in the Control Group. Also, it was
predicted that subjects in the Role Play Group would show a
greater increase in rating on all four scales than the sub
jects in the Companion Group. Although it was not formally
predicted, the above analyses were also applied to the sum
total ratings of the four scales.
As predicted (see Table 10), significant results
were obtained on scales #2 (Showing Interest), #4 (Openness),
and the sum total ratings on all four scales when comparing
the Companion Group to the Control Group. A significance
level of .02 was obtained for scale #4 while scale #2 and
the total rating were significant at the .05 level. Also
the comparison of the Role Play Group to the Control Group
produced a significant result at the .05 level for scale #2
(Showing Interest). No results from the comparison of the
Role Play Group to the Companion Group were significant.
Also, no results were significant for any of the evalua
tions of scales #1 (Initiative) and #3 (Two Way
113
TABLE 10
SUMMARY OF Xr VALUES FOR BETWEEN GROUP ANALYSIS OF
DIFFERENCE SCORES FROM THE RATINGS OF SOCIAL
RESPONSIVENESS AS ASSESSED BY THE FRIEDMAN
TWO WAY ANALYSIS OF VARIANCE BY RANKS
Scale
Companion Gp.
Compared to
Control Gp.
Role Play Gp.
Compared to
Control Gp.
Role Play Gp.
Compared to
Companion Gp.
#1
(Initiative) 1.60 0.25 1.60
#2
(Showing
Interest) 4.00a 4.00a 0.06
#3
(Two-Way
Conversation) 1.00 0.06 1.60
#4
(Openness) 5.60b 1.00 0.25
Sum of All
Four Scales 4.00a 0.60 0.06
a = significant at the .05 level (one-tailed test).
b = significant at the .02 level (one-tailed test).
Note: x|- values are underlined if the direction of
change favors the second mentioned group in the comparison.
114
2
Conversation).
Since all four scales of social responsiveness were
designed to tap a separate aspect of normal interpersonal
relationships, an intercorrelational matrix was computed to
assess the independence of these scales- Results of the
Spearman correlations are summarized in Table 11. All
intercorrelations are significant at the .001 level and the
scales are quite highly intercorrelated. The same results
were obtained at the first rating session as at the last
rating session.
Hypothesis C
It was predicted that the attitudes of college stu
dents towards mental illness would change after they partic
ipated in a program of social therapy with chronic institu
tionalized schizophrenics. Specifically, it was predicted
that the scores on the two factors of Benevolence and Mental
Health Ideology from the OMI questionnaire would show a
greater increase, and the scores on the factor of Social
Restrictiveness would show a greater decrease for Treaters
Evaluations of the social responsiveness data were
also computed without consideration for the initial matching
of Ss. For these evaluations a Chi Square analysis was used
to compare groups on the number of subjects who increased,
decreased, or showed no change on each of the rating scales
from the first to the last session. This procedure allowed
the use of a larger N since there was no requirement that
the original matched groups remain intact. Results are sum
marized in Appendix P, and are essentially the same as for
the Friedman analyses except for changes in significance
levels.
115
TABLE 11
SPEARMAN INTERCORRELATIONAL MATRIX (rs) ON THE FOUR
SCALES OF SOCIAL RESPONSIVENESS ( N = 51 )
With Data from First
Rating Session
With Data from Final
Rating Session
Scale #2 #3 #4 #2 #3 #4
#1 . 586 .682 .592 . 512 .589 .601
#2 .594 .388 .613 .362
#3 .667 .654
All values significant at the .001 level or better on
a two-tailed t test.
116
than for Raters who were used as a Control Group. These
predictions were tested by a one way analysis of variance
on the difference scores between the pre and post treatment
scores on the OMI questionnaire. Even though the factors
of Authoritarianism and Interpersonal Ideology carried no
formal predictions, they were also included in the analysis.
Results of the analyses are summarized in Table 12. None
of the results proved significant and consequently no pre
dictions were supported.
In the course of the study several groups of data
were collected such as Social History scores on each of the
subjects; ratings by the students on the Role Play Group
with regard to their role involvement during- the role play
sessions; and ratings by the investigator on the student's
role involvement as assessed during a prestudy training
session. While no specific predictions were tied to these
data, correlations were computed with the main dependent
variables. If either of the main dependent variables proved
to be correlated to these variables, then the data could be
used as an additional control in the evaluations of the
treatment effects. Results of these correlations are sum
marized in Table 13. None of the variables produced a
significant correlation so the data were not used in further
analyses.
TABLE 12
SUMMARY OF ANALYSES OF VARIANCE USING DIFFERENCE SCORES BETWEEN
INITIAL AND FINAL MARKINGS OF OMI QUESTIONNAIRE BY
TREATERS AND RATERS
Mean Mean
Sums of Squares
Treaters
N = 40
Raters
N = 40 Treatments Within Groups
F*
Score
Pre Post Pre Post df = 1 df = 78 df = 1.78
Authoritarianism 16.65 16.88 16.98 17.40 1.00 1141 0.07
Benevolence 47.30 47.35 49.00 49.20 0.00 1677 0.00
Mental Health
Ideology 28.50 29.83 29.15 29.08 4.00 1098 0.28
Social Restric
tiveness 19.35 19.38 19.45 19.53 9.00 1348 0.51
Interpersonal
Etiology 20.20 22.23 21.28 22.15 21.00 1114 1.44
*No results were significant.
TABLE 13
SPEARMAN CORRELATIONS (rs) ON SUBJECTS' SOCIAL HISTORY SCORES; RATINGS BY
STUDENTS ON SUBJECTS' ROLE INVOLVEMENT; AND RATINGS BY INVESTIGATOR
ON STUDENTS' ROLE INVOLVEMENT; ALL COMPARED TO THE MAIN
DEPENDENT VARIABLES IN THE STUDY
Companion Group
Role Play Group
Role Play Group
Role Play Group
ACL Data Social Responsive
ness Data
Total Score For All
Six Treatment Sessions
Total Score Ob
tained On All Four
Variable
Positive Word
Score
Negative Word
Score
Scales at the Last
Rating Session
Subjects' social
history score
.029 .012 .175
Subjects' social
history score
.112 .195 .194
Students' ratings
of subjects' role
involvement
.050 .210 .060
Investigator 1s
ratings of students
role involvement
.082 .153 .095
M
H
00
*No correlations significant at .05 or better on a two-tailed _t test
CHAPTER V
DISCUSSION
The results of the study give strong support to the
conclusion that the mood level and social responsiveness
of chronic institutionalized schizophrenics can be improved
through a social therapy program employing college students.
The following chapter will be directed to a discussion of
theoretical implications, implications for treatment and
rehabilitation, inconsistencies in the results, and to areas
where additional experimental investigation is needed.
Theoretical Implications
Social therapy programs are grounded on the
assumptions that social factors play a part in contributing
to the symptomatology of mental illness, and that the symp
tomatology of institutionalized patients results not only
from their pathology but also from the impoverished social
situation that is a part of institutional living. The
results of the study being reported will be considered in
119
120
relation to both factors together since it is not possible
to separate the effect of treatments on each.
Several theories of schizophrenia present plausible
explanations for the results achieved. The results per
taining to fear and social responsiveness are particularly
consistent with Sullivanian theory which sees schizophrenic
behavior as being caused by a repression of the self
dynamism due to anxiety arousing interpersonal experiences.
Sullivan would predict that a reduction in interpersonal
anxiety would permit a partial re-establishment of the self
dynamism and a consequent improvement in interpersonal
communication. In the present study— one of the primary
goaTs of the students was to relate to the subjects in such
a way so as to avoid the elicitation of anxiety. Although
there was no direct measure of the self dynamism concept,
Sullivan would predict that social responsiveness would
increase if the treatment approaches were successful in
reducing anxiety. Both treatment groups showed reductions
in Fear ratings as well as increases in ratings of social
responsiveness as predicted. Also, the change in ACL scores
on the factor of Fear from the first to the last session,
while not significant, was in the predicted direction for
the Companion Group but showed no change for the Role Play
/
121
Group.
Sullivan would further predict that the degree of
improvement in interpersonal communication would be a
function of the degree to which anxiety was reduced. The
results of the comparison of the two treatment groups indi
cate that the Companion Group tended to show a greater
improvement in ratings of social responsiveness and a
greater decrease in Fear, as measured by both ratings and
ACL data, than the Role Play Group although none of the
comparisons produced significant results. Such tendencies
suggest that the Companion Group had a greater anxiety re
ducing capability than the Role Play Group. This would be
expected due to the different organization of the two treat
ment sessions. The sole objective of the Companions was
to establish a friendly relationship with their subjects
and to avoid the elicitation of anxiety. The Companions
had complete freedom in structuring their sessions in order
to achieve this goal. The Role Play students also had the
same goals, but they did not have as much freedom in
structuring their sessions to this end. They were required
to use the role play procedure for a portion of the session
which in itself might have been an anxiety eliciting agent.
Also, the use of the role play procedure reduced the amount
122
of time available to the Role Play Group for the achieve
ment of an anxiety free relationship.
Other than Sullivan's emphasis on anxiety eliciting
interpersonal relationships* Meyer's conceptualization of
schizophrenic symptomatology as being the outcome of a
replacement of "good habits" of environmental interaction
with "bad habits" of fantasy gratification can also accom
modate the results of this study. Meyer (1910) suggests
that complex skills and habits are developed through
rewarding social experiences and unreinforced responses
are eliminated from the individual's behavior. The social
therapy sessions can be concepualized as training experi
ences where the subjects are given practice in socialization
within the context of a rewarding social atmosphere.
Therefore* such training can be seen as a means of reversing
the process of replacing "good habits" of environmental
interaction with "bad habits" of fantasy gratification.
With such a conceptualization it is important
that we ask what behaviors were being rewarded in our
treatment sessions. The primary effort in the Companion
sessions was to establish a friendly social relationship
with the content of the interaction of minimal importance.
Therefore* such sessions would be reinforcing for social
123
communication per se. However, in the Role Play sessions
the subjects not only participated in casual socializing
but they had the additional task of reading role play mater
ials. All of the assigned roles called for the expression
of positive affect and it was emphasized to the subjects
that they should attempt to experience these feelings and
to express them during the role play. Therefore, the role
play sessions were reinforcing for both social communica
tion and for the feeling and expressing of positive moods.
Since the Role Play Group used a portion of the
session for role playing, they had less time than the
Companion Group to participate and obtain social rewards
from the students for casual socializing. Consequently,
Meyer would predict that the Companion Group would improve
to a greater extent than the Role Play Group on the measures
of social responsiveness. This prediction fits nicely with
the results of the analysis of the social responsiveness
data where the Companion Group tended to show a greater
improvement than the Role Play Group as outlined in our dis
cussion of Sullivanian theory.
Meyer also would predict that the Role Play subjects
would improve in positive mood to a greater extent than
either the Control Group or the Companion Group who received
no socially rewarded practice in experiencing and express
ing such moods. This prediction is strongly supported by
the ACL data that indicates the Role Play Group showed a
significant increase in positive word score in comparison
to both the Control and Companion Groups. The only analysis
of positive word data for the Role Play Group that did not
produce significance was the comparison with the Control
Group that used data from the seventh session. However, as
shown in Table 5, there is evidence that the last meeting
(seventh session) resulted in some worsening of mood on
the part of the subjects. If such an "end effect" was due
to the ending of the student-subject relationship as sus
pected, it should affect the Companion Group in the same
manner as the Role Play Group. Therefore, such a phenomenon
should not affect the analysis comparing the Role Play
Group and the Companion Group. The actual results agree
with this conclusion since the Role Play Group showed a
significantly higher positive word score than the Companion
Group when using data from both the sixth and seventh ses
sions. Such evidence and results give support to the
existence of the "end effect," but further experimental
investigation is needed to conclusively establish its ex
istence, nature and magnitude.
125
Along with the ACL data Meyer would also predict
that the Role Play Group would show significant improvements
in the positive affect rating scale data. This prediction
was not supported since the Role Play Group showed no sig
nificant change on either rated Energy or rated Happiness.
If we assume that the students could rate positive affect
reliably, then these results indicate that the role play
treatment was not effective in causing a change in the
expression of positive mood. Since the self-report ACL
data indicated there was a change in positive mood, these
results would indicate that the Role Play treatment was
effective in the establishment of positive mood, but not
in the dvelopment of positive mood expressive behavior.
Perhaps a longer period of training in positive mood expres
sive behavior is necessary to produce measurable changes.
In any event, this is an area where further research is
needed to explain the failure of the positive mood ratings
to change as expected.
Cameron has made an extension of Meyer's concep
tualizations that is also useful in considering the results
of this study. He sees the schizophrenic as a person who,
long before developing overt symptoms, was a socially im
mature person, "poorly established in his culture." Under
126
stress he has a tendency to become desocialized, i.e., to
become cut off from participation in daily social behavior.
Cameron (1951) further suggests that such social isolation
is reduced if individuals continually engage in partici
pative activities with other social persons so that "con
clusions privately arrived at can be publically verified
or contradicted" (p. 436). Therefore, the increases in
social responsiveness in this study would be predicted by
Cameron.
However, Cameron would not predict the results
from the positive word scores from the ACL. The purpose
of the role play procedure was to directly elicit positive
affect through the process of role taking which is a pro
cedure that Cameron sees as an impossibility for the
schizophrenic. He along with Sarbin (1943) and others see
schizophrenics as being basically deficient in terms of
this ability. Other investigators (Thrasher and Smith,
1964) suggest that such an ability is present, but dormant,
in institutionalized schizophrenics.
While these results could be a function of the
subject's role taking ability, there is also the possibility
that a set on the part of the role play subjects to conform
to their expectancies about the goals of the experiment
could have influenced the results. It has been shown
(Orne, 1962; Rosenthal, 1963) that such a role demand var
iable must be considered. While an attempt was made to
control for this factor in the present study by exposing
the role play materials to the Companion and Control Groups,
it was not possible to achieve a perfect control. The Role
Play subjects necessarily received precise instructions on
the purpose of the role playing exercise, while the Com
panion and Control Groups did not receive such information.
It is possible that such information caused the role play
subjects to regard an increase in positive mood as the
goal of the experiment. Because of this possibility the
results of the evaluations of positive word score data must
be accepted with some reservation. Further research is
necessary that better controls for the role demand factor.
As mentioned earlier, other than the theoretical
schemes regarding the etiology of schizophrenia, the results
of this study can be related to the effects of institution
alization. Investigators (Greenblatt and Lidz, 1957;
Barton, 1959; Schwartz, 1959; and others) have suggested
that the social symptoms of the chronic schizophrenic are
at least partially a result of the effects of an impover
ished and restricted environment and are not entirely a
128
direct outcome of schizophrenia per se. Even Cameron,
although attributing much of the schizophrenic's desocial
ization to a self-imposed isolation, recognized the
additional debilitating effects of living in a "dreary,
unstimulating environment that is so often found in our
large mental hospitals." Stated in more detail, Cameron
maintains (1951) :
. . . in socially stagnant atmosphere, the bio
social behavior of a person tends to grow repeti
tive, stereotyped, and automatic. Social
isolation . . . favors a reduction in an individ
ual ' s general effectiveness and may lead to serious
behavioral impoverishment and distortion.
Wing (1962) also concurs, and states:
. . . Institutionalization, in the sense of a
gradually acquired contentment in institutional
life and apathy toward events outside the hospital,
does seem to be a factor of major importance even
in good mental hospitals in increasing the
schizophrenic's handicaps.
Therefore, the possibility exists that the changes in symp
toms of the subjects in this study may not be solely due to
a diminution of that part of the symptom picture that re
sults from the social isolation brought about by institu
tionalization.
129
Treatment Implications
While the theoretical implications of the present
study offer several interpretations, the treatment implica
tions for the chronic institutionalized schizophrenic are
more definite. This study adds further support to the many
studies which indicate that social stimulation can help to
combat the primary symptomatology of withdrawal and apathy
in chronic schizophrenia (Smith et al. , 1965? Sanders
et al., 1962? Wing, 1960; and others). These studies all
indicate that such symptomatology is not the necessary
outcome of the schizophrenic disorder. Rather, they are at
least partially a product of:
. . . being compelled to sit out one's life in a
dreary, unstimulating environment . . . a situa
tion which, in the case of the schizophrenic, can
only hasten their deterioration and may even render
it finally irreversible. (Cameron, 1951)
Until recently the major drawback in making avail
able such social stimulation to the large groups of the
chronically hospitalized has been the lack of available
manpower. While recent evidence (Holzberg, Whiting, and
Lowy, 1964) suggested that student volunteers could be used
effectively to provide such stimulation, such a program had
never been investigated within the framework of a controlled
130
experimental design. The present study shows that such
personnel can be used effectively in social therapy programs
aimed at improving the social responsiveness and mood level
of the chronic schizophrenic.
In terms of the two approaches of unstructured and
structured role playing treatment sessions, the present
study indicates that both the Companion and Role Play Groups
showed an increase in social responsiveness and a reduction
in negative mood level. While there was no statistical
differences between the two treatment groups on these fac
tors there were indications that the Companion Group showed
a greater improvement on both factors than the Role Play
Group. However, on the factor of positive mood level the
Companion Group showed no improvement both in comparison to
the Control Group and the Companion Group. Therefore, the
two treatment approaches have somewhat different effects
and the superiority of one over the other would depend on
the aims of the program. The important point is that the
results of this study indicate that treatment programs can
be devised to produce rather specific results. Since the
primary focus of rehabilitation is necessarily upon improv
ing the social functioning of the chronic schizophrenic,
any treatment that is effective in this direction is to be
131
preferred. In terms of social functioning, the results
of this study slightly favor the Companion Group, but per
haps a structure can be devised that would be even more
effective.
While the present study gives broad support for
the effectiveness of a social therapy program that employs
college students, the finer details of what could make such
a program most effective must be evaluated in future re
search. Such variables as length of sessions, intensiveness
of program, length of program, number of students in each
session, characteristics of most effective students, and
characteristics of the most responsive subjects are all
variables that would be important to study in future re
search .
Another implication for treatment refers to the
students rather than the subjects. Originally this study
was conceived as a means to effect changes in both the
chronic patients as well as the students. It was felt that
the students' attitudes toward the mentally ill could be
improved through such a program and in that sense the pro
gram would be a method of "treating" the community.
However, the results on the OMI questionnaire were all
nonsignificant which indicated that the students1 attitudes
132
toward the mentally ill were not changed in relation to the
Control Group.
In regard to these results there are two basic
problems. In the first place, a good Control Group was not
available for the study since all available students were
required to participate in the program. Therefore, our
Control, rather than having no exposure to the subjects,
had one expedience in a rating session between pre and post
administrations of the OMI. While such an experience
probably resulted in changes in the students that reduced
their effectiveness as a Control, it does not appear that
any significant results would have been obtained even if
the Control Group had not had this experience. Since other
studies (Holzberg and Gewirtz, 1963; Holzberg, Gewirtz,
and Ebner, 1964) have shown that such programs are effective
in bringing about changes in the attitudes of the students
toward the mentally ill, our second problem seems to relate
to a poor choice of instrument by which to measure the pre
dicted attitude changes. Three factors on the OMI, Authori
tarianism, Benevolence, and Social Restrictiveness, are
most probably rather deeply seated personality traits that
could not be expected to change very readily. The other
two factors of Mental Health Ideology and Interpersonal
133
Etiology appear to- beT^ctors that' are most easily altered
through the learning of certain facts and positions as would
be taught in an Abnormal Psychology class. In actuality,
these two factors appeared to show the most change, but
both the Raters and Treaters changed in the same direction
which could either be a result of the program or of class
room instruction or both. In any event, it appears that
both a better Control Group and a better measuring instru
ment were needed in this study. Perhaps an instrument that
measures social distance would possess the required sensi
tivity to be effective in future experimentation.
CHAPTER VI
SUMMARY
The present study was concerned with the effects
of a social therapy program that used college students on
the mood level and social responsiveness of chronic insti
tutionalized schizophrenics. Drawing from an analysis of
existing theory and research concerned with social therapy
programs, three general hypotheses were formulated.
The first (Hypothesis A) predicted that the
application of a social therapy program that used college
students would produce a decrease in negative affect and
an increase in positive affect as measured by both self re
ports from an adjective checklist an^_ratings from student
assessments in groups of chronic institutionalized
schizophrenics.
The second (Hypothesis B) predicted that the
application of a social therapy program that used college
students would produce an increase in rated social respon
siveness in treatment groups of chronic institutionalized
134
135
schizophrenics.
The third (Hypothesis C) predicted that the
application of a social therapy program that used college
students to interact with chronic schizophrenics would
produce an improvement in attitudes toward the mentally ill
in the students.
The subjects were all males, not older than 5 5,
native born, formally educated for at least six years with
a minimum verbal age of 13.0 on the Shipley-Hartfor Intel
ligence Test, free from organic brain disorders and
possessing normal hearing, sight, and speech. In addition,
they all carried a formal diagnosis of schizophrenia on
their official medical records and had been continuously
institutionalized for a period of no less than two years
prior to the start of the study. Finally, all subjects
were willing to voluntarily participate in the study.
The students used in the program were all members
of an undergraduate class in Abnormal Psychology at the
University of Southern California. They were given a choice
to participate or to write a term paper. None accepted the
latter choice.
Fifty-seven subjects participated in the study.
Based on a matching for number of adjectives marked on the
136
ACL, the subjects were divided into groups of three who
were then randomly assigned to two treatment groups and a
Control Group. Both treatment groups participated in a
six week program of social therapy which consisted of weekly
sessions of 20 to 30 minutes duration with a pair of
students. For one treatment group, called the Companion
Group, the weekly sessions consisted of unstructured social
interaction whose only aim was to establish a friendly re
lationship. For the other treatment group, called the Role
Play Group, the weekly sessions consisted of unstructured
social interaction plus a role playing exercise whose
primary purpose was an attempt to elicit positive affect
through the process of role taking. The Control Group did
not participate in any social interaction with the students
during these six weeks, but in all other respects were
treated in an identical manner to the treatment subjects,
such as reporting to the Psychology office where they
completed the ACL form each week.
Ninety-eight students participated in the program.
They were randomly assigned to two equal groups within the
limits of scheduling problems. One group, called Treaters,
participated in the six treatment sessions of the program
and met in pairs with the same subject for the six
137
treatment weeks. The other group, called Raters, partici
pated in the pre and post rating sessions where they met
in pairs with the same subject for these two sessions.
All subjects were rated on scales of social
responsiveness and affect during the rating sessions which
took place in the weeks before and after the six treatment
weeks. Also, all treatment subjects completed an adjective
checklist eight times immediately after each session in
the program. The Control Group also completed the ACL eight
times, immediately after the two rating sessions and once
during each of the six treatment weeks. Likewise, all
students completed the OMI questionnaire twice: both the
Raters and Treaters completed the form before the study
began and the Treaters completed the form before and after
their last treatment session. The Raters completed their
form a second time before the start of their last session
with the subjects.
Comparisons were then made between the Control and
treatment groups and between the two treatment groups with
respect to the differences in performance on the first and
second measures of social responsiveness and rated affect.
With respect to the ACL data the same group comparisons,
were made for the differences in performance on three sets
138
of difference scores from the first to the sixth, seventh,
and last sessions respectively; and for differences in
performance on the ACL when using all the data from both
the first five and all six treatment sessions as a unit.
Comparisons were also made between the Treaters
and Raters with respect to the differences in performance
on the first and second measures on the OMI questionnaire.
The results showed that the rated social respon
siveness of chronic institutionalized schizophrenics could
be improved through interaction with college students.
Also, although not conclusively shown, there were indica
tions that there was greater improvement in social
/ /
responsiveness for the Companion Group than for the Role
Play Group.
In terms of mood level, results showed that both
the Companion and the Role Play Groups showed a reduction
in rated Fear while the ratings of Anger, Depression,
Weakness, Energy, and Happiness showed no change. Also,
data from the ACL indicated a reduction in negative word
score for the Companion Group at both the fifth and sixth
sessions in comparison to the first session. The Role Play
Group showed such a reduction in negative word score at the
fifth session, but not at the sixth session. Neither
139
treatment group showed any reduction in negative word score
after the last session (rating session) in comparison to
the first session.
In terms of positive word scores from the ACL, the
Companion Group showed no changes. However, the Role Play
Group showed an increase in score in comparison to the
Companion Group on all statistical analyses. ^The Role Play
Group also showed an increase in positive word score in
comparison to the Control Group on all analyses except the
one which used data from the last treatment session. There
was some evidence that the last treatment session resulted
in both a decrease in positive mood and an increase in
negative mood due to the termination of the student-subject
relationship.
B I B L I O G R A P H Y
140
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A P P E N D I X A
QUESTIONS FOR CONTROL GROUP AFTER EXPOSURE
TO ROLE PLAY MATERIALS
150
A P P E N D I X A
QUESTIONS FOR CONTROL GROUP AFTER EXPOSURE
TO ROLE PLAY MATERIALS
Week 3. Tom Sawyer
1. What was Ben doing when he first came on the
scene?
a. Playing hop scotch
b. Impersonating a steamboat
c. Singing a song
2. Who made Tom whitewash the fence?
a. His father
b. His mother
c. Aunt Polly
3. What happened at the end of the scene?
a. Ben started to whitewash
b. Tom continued to whitewash
c. Ben left to go fishing
Week 4. Wednesday's Child
1. Bobby 1s parents are
a. Divorced
b. On vacation
c. Live together with Bobby
2. Bobby and his father prepare to play a game
called
a. Monopoly
b. Governor of South Carolina and
Governor of North Carolina
c. Gin Rummy
151
152
3. Bobby's father leaves to
a. Go to the store
b. Keep an appointment
c. Meet his wife
Week 5. Abie's Irish Rose
1. Solomon wants to call Abie's girl
a. Rose Mary
b. Rose
c. Rosie
2. Rose Mary is
a. Jewish
b. Irish
c. German
3. Solomon believes Rose Mary to be
a. Jewish
b. Irish
c. German
Week 6. Robinson Crusoe
1. Robinson Crusoe has been on the island for
a. 18 years
b. 8 years
c. 28 years
2. Friday is
a. A fellow shipwrecked sailor
b. A native of the island
c. An English trader
3. At the beginning of the scene Friday is sing
ing while he
a. Keeps watch from the lookout
b. Cleans up the cabin
c. Finishes cooking a meal
153
Week 7. The Male Animal
1. The outcome of the scene is
a. A badly run football play
b . A touchdown
c. A penalty
2. Joe Furguson is
a. A former football All-American
b. Never played football
c. Was coach of the team
3. Joe Furguson describes the football play
a. With the help of chalk and balckboard
b. With the help of knives and forks etc.
c. With the help only of his talk
A P P E N D I X B
TOTAL SCORE AND RANKINGS OF ROLE PLAY MATERIALS
ACCORDING TO THE PREFERENCE INDICATED BY SIX
SUBJECTS WHO PARTICIPATED IN THE
ROLE SUITABILITY PROCEDURE
154
A P P E N D I X B
TOTAL SCORE AND RANKINGS OF ROLE PLAY MATERIALS
ACCORDING TO THE PREFERENCE INDICATED BY SIX
SUBJECTS WHO PARTICIPATED IN THE
ROLE SUITABILITY PROCEDURE
Play Total Score
1. Robinson Crusoe 13
2. Tom Sawyer 19
3. ./ednesday's Child 24
4. The Male Animal 2 5
5. Abie's Irish Rose 28
6. Yes, My Darling Daughter 33
7. The Glass Menagerie 36
8. Candida 38
155
A P P E N D I X C
ROLE PLAY MATERIALS USED DURING THIRD WEEK
156
A P P E N D I X C
ROLE PLAY MATERIALS USED DURING THRID WEEK
From Tom Sawyer:
Background: Tom lives with Aunt Polly who is mad at him
for having played hooky from school. As punishment, Tom
has to whitewash the front fence. As the scene begins Tom
is whitewashing the fence when Ben a neighborhood boy comes
along. Ben is impersonating a steamboat. . . .
Ben: Confound it.! Can't you get out of my way, Tom
Sawyer? Don't you know I'm the "Big Missouri," and
I'm a-drawing nine feet of water?
Tom: (Looks at his work carefully; sweeps his brush across
the board; looks at the result) Why, it's you Ben. I
was'nt noticing. . . .
Ben: You're up a stump, ain't you? Played hooky and now
you got to work, I'm going in a-swimming, I am. Don't
you wish you could? Course you'd druther work . . .
wouldn't you? Course you would.
Tom: (Looks at Ben; takes another sweep with the brush)
What do you call work?
Ben: Why, ain1t that work?
Tom: (Carelessly, as he goes on with the whitewashing) Well
maybe it is and maybe it ain't. All I know is it
suits Tom Sawyer.
157
158
Ben: Oh, come on, now. You don't mean to let on you like
it?
Tom: (Whitewashing with his back to Ben) Like it? Well, I
don't see why I oughtn't to like it. Does a boy get
a chance to whitewash a fence every day? (He steps
back to note the effect of his last strike; adds a
touch here and there, turns his head to one side to
criticize the effect)
Ben: (After a pause) Say, Tom, let me whitewash some?
Tom: You? (He pauses, considers) No, no, I reckon it
wouldn't hardly do, Ben. You see, Aunt Polly's awful
particular about this fence . . . right here on the
street. If it was the back fence, I wouldn't mind,
and she wouldn't; but this fence has got to be done
very careful. I reckon there ain't one boy in a
thousand, maybe not in two thousand, that can do it
the way it's got to be done.
Ben: No I Is that so? Come on . . . lemme just try, only
just a little. . . . Say, I'd let you if you was me,
Tom. . . .
Tom: Ben, I'd like to, honest Injun, but there's Aunt
Polly. Well, Sid wanted to do it the worst way, and
she wouldn't let Sid. You see how I'm fixed. If you
was to tackle this fence and anything was to happen
to it . . .
Ben: Oh, shucks I I'll be just as careful . . . now lemme
try. . . . Say, I'll give you the core of my apple.
Tom: Well . . . (Hesitating) No, Ben, no. I couldn't. I'd
be afeard.
Ben: I'll give you all of it.
Tom: Well, here . . . (Giving Ben the brush) I reckon it's
taking chances, but seeing it's you, Ben. . . .
A P P E N D I X D
ROLE PLAY MATERIALS USED DURING FOURTH WEEK
159
A P P E N D I X D
ROLE PLAY MATERIALS USED DURING FOURTH WEEK
From Wednesday's Child:
Bohby is a "real" boy of about 10. He is very sensitive
about the divorce of his parents. He is visiting his father
and he is very happy and feels that he has a place in life.
His father is just as happy to be with Bobby and they both
thoroughly enjoy their get together.
Father: We ought to celebrate this in some way. Reunion
of father and son.
Bobby: How'll we celebrate?
Father: Well . . . there was a carnival here last week but
that's not much good now . . . and we've had din
ner . . . want to go to a movie?
Bobby: I'd rather go to the movies when I can't be with
you.
Father: Movies aren't my idea of celebration either. You
ought to be a couple of years older . . . then
we'd . . .
Bobby: We'd play Governor of North Carolina and Governor
of South Carolina, then, wouldn't we?
Father: Hey, where did you pick that up?
Bobby: I don't know. . .
160
161
Father: (Grinning) Taking after the old man, huh?
Bobby: Sure !
Father: All right! We'll play the game of governor.
Bobby: I want to be governor of North Carolina.
Father: Right! You'll drink ginger-ale and I'll drink
ginger-ale and . . . (He winks) Okay?
Bobby: We'll get drunk and . . .
Father: Bobby, your father is a gentleman.
Bobby: We won't really get drunk will we?
Father: (Laughing) Nope. You leave that to Dad. Now, if
you'll set the glasses on the table, I'll get the
ginger-ale.
Bobby: (Goes to get glasses)
Father: I'll get some ice cream too, huh? What'll you
have? Stromberry, peach, chocolatti, or vanilly?
Bobby: (Laughing) Stomberry and Vanilly.
Father: Right. You won't be scared here alone will you?
Bobby: Me? No!
Father: Back in a jiffy. Wait for me, Pardner!
Bobby: OK, Pardner!
(His father leaves. Bobby runs to the door and looks after
his father until the other door closes. Then he turns and
with a sudden ecstacy of joy, he awkwardly tries a cartwheel
only to land on his seat. He is astonished but then breaks
into laughter. He is half laughing, half crying. He runs
around the room.)
A P P E N D I X E
ROLE PLAY MATERIALS USED DURING FIFTH WEEK
162
A P P E N D I X E
ROLE PLAY MATERIALS USED DURING FIFTH WEEK
From Abie's Irish Rose:
Abie is a young, likeable Jewish boy who has fallen in love
and married an Irish girl. He has brought her home to meet
his father. Solomon is delighted with Rose Mary, believing
her to be of his faith.
Abie: You like her, Dad?
Solomon: She's a nice girl, Jewish and everything.
Abie: YehI
Solomon: How much money has she got?
Abie: Oh, I don't know exactly. Her father is comfortably
fixed, that is all I know.
Solomon: And your father is comfortably fixed, tooi
(Smiling knowingly)
Abie: What do you mean?
Solomon: You like her, don'd you?
Abie: Do i: (This speaks volumes)
Solomon: Who could help it?
Abie: Do you really like her, Dad?
163
164
Solomon: Shes's a nice girl. Didn't I told you to vait
ven you brought all those girls around, those
Christian girls? Didn't I say, "Abie, vait—
someday you'll meet a nize little Jewish girl.
Didn't I say that?
Abie: You did, Dad!
Solomon: Uh— Bahama, aren't you glad you vaited?
Abie: I'm glad I waited for Rose Mary! >
Solomon: Please don'd call her Rose Mary. (Smiles) She's
Rosie
Abie: All right . . . Rosie I But I don't care what she
is; it's the girl I like, not her religion.
Solomon: All right, vhey don'd you marry her quick?
Abie: Dad, have I your consent?
Solomon: Do you vant me to ask her for you?
Abie: No, I can do that.
Solomon: Veil do it, and . . . if she says yes, I'll start
you in some kind of business. What would you
like?
Abie: I hate business.
Solomon: You'll need a business when you start raising a
family! Ask Rosie! She’s got common sesses!
Abie: Say, Dad . . . don't mention anything about a family
to Rose Mary.
Solomon: Oi— ich platz. Didn't I just tell you not to call
her dad Rose Mary. (Smiles) She's Rosie;
Abie: All right, Rosie!
A P P E N D I X F
ROLE PLAY MATERIALS USED DURING SIXTH WEEK
165
A P P E N D I X F
ROLE PLAY MATERIALS USED DURING SIXTH WEEK
From Robinson Crusoe:
Background: Robinson Crusoe has been shipwrecked on an
island for 28 years. He has been alone on the island for
most of those years, but in the past year he has had a na
tive companion . . . Friday. One sunny morning, Friday is
sitting high up in lookout, singing. His words are under
standable, though with considerable accent . . .
Friday: Hail-1 to Brittangia,
God save Keeng
Dees time be gude time
El-se we wounna seeng
Hokey pokey
Pengya Lofeya
Tase before you buy
Seeging Oh, what a merry Ian' ees Eenglang.
(He laughs and claps his hands)
Friday seeng much gude.
(All of a sudden leaps to feet and rushes down
ladder)
Oh master! Oh master! Oh sorrow! Oh bad! Master!
Oh master!
Crusoe: What is it Friday!
Friday: Oh, yonder, there!
Crusoe: Out of the way.
Friday: One, two, three . one, two, three. They come
166
16 7
Crusoe:
Friday:
Crusoe:
Friday:
Crusoe:
Friday:
Crusoe:
look for Friday! They cut Friday in pieces! Eat
him! Oh sorrow! Oh bad!
Now, don't be frightened. Master's here. We must
fight them. Will you fight Friday?
Me shoot. But there come many great number.
Our guns will frighten them off if they don't kill
them. Go down and bring them. Stand by me. Do
just what I bid you.
(Fervently) Me die, if Master bid. (Crusoe looks
with his telescope and gives a great cry)
A ship! An English ship! You meant as large as
three canoes! Yes, and larger, Friday . . . It's
from my country! It will be manned by my own
countrymen, and friends! Deliverance! After 28
years! Deliverance! Deliverance!
Master be much 0 glad! Make Friday laugh! Oh joy!
Oh glad!
We'll go down the coast to meet them! We'll fire
our guns to let them know there are people on the
island. Go down and fetch the guns, Friday! We'll
give them a rousing welcome! An English ship!
A P P E N D I X G
ROLE PLAY MATERIALS USED DURING SEVENTH WEEK
168
A P P E N D I X G
ROLE PLAY MATERIALS USED DURING SEVENTH WEEK
From The Male Animal:
Background: Ten years ago Joe Ferguson was a great All-
American. He returns to the scene of his former glory . . .
prosperous, dynamic, good-natured.
Joe, with coat off, is arranging plates, knives,
saucers, and forks on the floor in the form of a football
formation. As he begins to describe a football play he
gradually becomes more and more excited and involved; as
he relives a part of the past.
Joe: Now here . . . it's a balanced line. Move those two
men out a little more. (Pat moves the men out) This
is a wonderful play! The coach gave it to me in the
strictest confidence. . . . Now, study this play,
girls, or you won't know it when you see it this
afternoon. This is Michigan. And this is Midwestern.
. . . Now.! From the balanced line, we shift. Hup!
(He executes a Notre Dame shift, grimaces a little as
his right knee resents this activity) Wally takes the
left-ends place, but he plays out a little . . .
Michigan spreads out. They're watching the wide end,
but it's too obvious. They're watching the other
side of the line too. . . .The ball is snapped back.
Now look, here we go! Both of us . . . (Carrying a
plate and a napkin) Close together. Fading back, but
threatening a left-end run as well as a pass . . .
I'm both of them— Linstrom and Wierasocka— Stolsky
cuts down the left sideline deep and takes out Wupper-
man . . . that's the jam pot. Wally is running wide
169
170
around right-end. Faking as though he had the ball,
but hasn't really got it, apparently! . . . Now. Just
as Michigan is charging in on Lindstrom and Wiera-
socka, trying to decide which one has the ball, Wally
lets himself out'. He's really got it! . . . It’s a
fake fake. It's an old play, so corny only a football
genius like Coach Sprague would use it. With no
interference at all, Wally cuts over and goes straight
down the right side of the field! He stiff arms the
safety man. . . . (Running with the cream pitcher)
Touchdown!!
A P P E N D I X H
SCALES FOR USE BY STUDENTS IN RATING THE
SUBJECTS' SOCIAL RESPONSIVENESS
171
172
APPEND T X H
SCALES FOR USE BY STUDENTS IN RATING THE SUBJECTS'
SOCIAL RESPONSIVENESS
Instructions: Circle a number on each of the following four scales
according to your impression of the subject's performance during
the session.
1. Did the subject exercise initiative during the session in doing
his share to maintain the interaction?
0
not at
all
only about
2 5% of his
share
did about
7 5% of his
share
fully did
his share
2. Did the subject show interest in the students or their
activities?
not at
all
about 2 5%
socially
adequate
performance
about 75%
socially
adequate
performance
100%
socially
adequate
performance
3. Did the subject take part in sensible "back and forth" conver
sation, listening as well as talking, not just short answers
to your question, but a "give and take" conversation?
0
not at
all
about 2 5%
socially
adequate
performance
about 75%
socially
adequate
performance
100%
socially
adequate
performance
4. When questioned about himself and his activities did the subject
respond with a socially appropriate amount of elaboration and
openness?
0_______ 1_______ 2_______ 3_______ 4________5_______ 6_______ 7
never about 2 5% about 75% 100%
responded socially socially socially
adequate adequate adequate
performance performance performance
A P P E N D I X I
SCALES USED BY STUDENTS TO RATE THE SUBJECTS 1
AFFECT AND ROLE INVOLVEMENT
173
174
APPENDIX I
SCALES USED BY STUDENTS TO RATE THE SUBJECTS’
AFFECT AND ROLE INVOLVEMENT
Instructions for affect rating scales: Circle a number on each of
the following six scales according to your impression of the subject
during the preceding session.
0________1________2________3 4________5_______ 6________7
not happy
at all
0 1 2 3 4 5 6
high spirits
very happy
7
not fearful
at all
0 1 2 3 4 5 6
very fearful
anxious
7
no energy
at all
0 1 2 3 4 5 6
great energy
and drive
7
not de
pressed
at all
0 1 2 3 4 5 6
very
depressed
7
not angry
at all
0 1 2 3 4 5 6
very
angry
7
not tired entirely
at all worn out
Instructions for role involvement rating: Circle a number on the
following scale according to your impression of the degree to which
the subject involved himself in the role for the preceding session.
0________1________2________3________4________5________6________7
not in- about about completely
volved 25% 75% involved in
at all involved involved the role
A P P E N D I X J
ADJECTIVE CHECKLIST
175
176
A P P EN D IX J
ADJECTIVE CHECKLIST
Instructions: How much does each word apply to your feelings at
this very moment. Mark an X through 0, 1, or 2 beside each word
depending on how the word applies to you.
0 = not at all 1 = a little 2 = a lot
0 1 2 gay
0 1 2 downcast
0 1 2 task-involved
0 1 2 weak
0 1 2 panicy
0 1 2 irritated
0 1 2 merry
0 1 2 depressed
0 1 2 engrossed
0 1 2 discouraged
0 1 2 terrified
0 1 2 disgusted
0 1 2 happy
0 1 2 downhearted
0 1 2 concerned
0 1 2 inadequate
0 1 2 horrified
0 1 2 annoyed
0 1 2 jolly
0 1 2 sad
0 1 2 absorbed
0 1 2 hopeless
0 1 2 dreadful
0 1 2 quarrelsome
0 1 2 joyous
0 1 2 gloomy
0 1 2 occupied
0 1 2 failing
0 1 2 shocked
0 1 2 exasperated
0 1 2 lively
0 1 2 cheerless
0 1 2 vigorous
0 1 2 dull
0 1 2 tense
0 1 2 infuriated
0 1 2 cheerful
0 1 2 unhappy
0 1 2 aggressive
0 1 2 sluggish
0 1 2 uneasy
0 1 2 resentful
0 1 2 pleased
0 1 2 cranky
0 1 2 inventive
0 1 2 tired
0 1 2 nervous
0 1 2 enraged
0 1 2 energetic
0 1 2 dismal
0 1 2 enterprising
0 1 2 lazy
0 1 2 unsure
0 1 2 mad
0 1 2 glad
0 1 2 miserable
0 1 2 strong
0 1 2 listless
0 1 2 worried
0 1 2 remorseful
0 1 2 complacent
0 1 2 ashamed
0 1 2 excited
0 1 2 dizzy
0 1 2 scared
0 1 2 pugnacious
0 1 2 leisurely
0 1 2 guilty
0 1 2 aroused
0 1 2 nauseous
0 1 2 frightened
0 1 2 war-like
0 1 2 contented
0 1 2 embarrassed
0 1 2 stimulated
0 1 2 sick
0 1 2 fearful
0 1 2 hostile
0 1 2 carefree
0 1 2 disgraced
0 1 2 enthusiastic
0 1 2 faint
0 1 2 anxious
0 1 2 courageous
0 1 2 satisfied
0 1 2 humiliated
0 1 2 emotional
0 1 2 pale
0 1 2 afraid
0 1 2 assertive
A P P E N D I X K
TOTAL SCORE OBTAINED ON INDIVIDUAL FACTORS OF THE
ACL AFTER EACH SESSION BY EACH OF THE
THREE GROUPS IN THE PROGRAM
177
APPENDIX K
TOTAL SCORE OBTAINED ON INDIVIDUAL FACTORS OF THE ACL AFTER EACH
SESSION BY EACH OF THE THREE GROUPS IN THE PROGRAM
Rating
Sess. Treatment Sessions
Rating
Sess.
Session i: 1 2 3 4 5 6 7 8
Companion
Group
N = 16
Fear
Anger
Depression
Weakness
Energy
Happy
122
100
113
119
197
211
92
86
99
109
183
210
93
87
90
97
191
214
73
81
80
90
178
205
80
76
81
96
183
204
72
71
66
73
171
201
90
83
91
88
160
186
90
71
75
83
176
200
Fear 116 118 107 100 92 104 93 97
>1
(d
Anger 102 107 86 87 77 78 83 83
i —i
Depression 74 87 73 62 50 62 62 67
Ci iH Weakness 84 93 76 76 73 72 74 77
d) 3
H 0 I I Energy 244 227 249 262 254 267 241 249
0 > H
0 a
Happy 250 248 274 287 282 273 266 269
Fear 102 109 99 109 92 87 92 85
Anger 104 106 92 114 92 99 92 88
pH
0
Depression 93 108 104 90 85 97 100 84
J H rH
+J 3
Weakness 93 108 106 120 106 105 118 102
C 0 I I
n L i
Energy 197 197 178 188 171 202 175 168
O O £ Happy, 232 218 199 211 207 221 217 193
A P P E N D I X L
SUMMARY OF Xr VALUES FOR ALL ANALYSES OF DIFFERENCE
SCORES ON ACL FACTORS OF FEAR, ANGER, DEPRESSION,
AND WEAKNESS AS ASSESSED BY FRIEDMAN
TWO WAY ANALYSIS OF VARIANCE
179
APPENDIX L
SUMMARY OF x| VALUES FOR ALL ANALYSES OF DIFFERENCE SCORES ON ACL FACTORS
OF FEAR, ANGER, DEPRESSION. AND WEAKNESS AS ASSESSED BY
FRIEDMAN TWO WAY ANALYSIS OF VARIANCE
Difference Scores
from First to
Sixth Session
Difference Scores
from First to
Seventh Session
Difference Scores
from First to
Last Session
Fear Anger Fear Anger Fear Anger
Companion Group
compared to
Control Group
7.60C 0.25 5.60b 0.00 3.10 0.06
Role Play Group
compared to
Control Group
1.60 0.25 0.60 0.00 0.00 0.25
Role Play Group
compared to
Companion Group
3.10 0.00 1.60 0.00 3.10
I
1
0.25
Depression Weakness Depression Weakness Depression
i
Weakness *
Companion Group
compared to
Control Group
1.60 3.10 1.60 6.25° 3.10
!
2.25
Role Play Group
compared to
Control Group
4.003 0.25 1.00 1.60 0.06 0.00
Role Play Group
compared to
Companion Group
0.60 1.60 0.00 2.25 0.60 1.60
a = .05 level of significance,
b = .02 level of significance,
c = .01 level of significance.
2
Note: Xr values are underlined if the direction of change favors the second croup
in the comparison
180
A P P E N D I X M
SUMMARY OF RESULTS FOR ALL ANALYSES OF
POSITIVE WORD DIFFERENCE SCORES ON
ACL FACTORS OF ENERGY AND HAPPY
181
APPENDIX M
SUMMARY OF RESULTS FOR ALL ANALYSES OF POSITIVE WORD DIFFERENCE
SCORES ON ACL FACTORS OF ENERGY AND HAPPY
1. Xf values from Friedman two way analysis of variance:
Positive Word Dif
ference Scores from
First to Sixth
Session
Positive Word Dif
ference Scores from
First to Seventh
Session
Positive Word Dif
ference Scores from
First to Last
Session
Energy Happy Energy Happy Energy Happy
Companion Group
compared to
Control Group
1.00 0.25 0.60 0.06 0.06 0.60
Role Play Group
compared to
Control Group
0.60 3.10 0.06 0.25 1.60 4.00®
Role Play Group
compared to
Companion Group
5.60b 5.60b 2.25 3.10 1.00 1.60
2. F scores from one way analysis of variance with 1.30 degrees of freedom:
Companion Group
compared to
Control Group
3.66 0.34 0.64 1.09 0.13 0.11
Role Play Group
compared to
Control Group
1.20 3 .90 2.20 2.91 4.2?S 3.60
Role Play Group
compared to
Companion Group
7.76C 6.31C 5.3 2 a 6.16b 2.43 4.27®
a = .05 level of significance (one-tailed test) .
fc = .025 level of significance (one-tailed test).
c = .01 level of significance (one-tailec test).
Note: Xr values and F scores are underlined if the direction of change favors the
second group in the comparison.
182
A P P E N D I X N
SUMMARY OF RESULTS OF EVALUATION OF POSITIVE WORD
SCORES FROM ACL FOR FACTORS OF ENERGY AND
HAPPY AS ASSESSED BY USE OF A TWO
FACTOR REPEATED MEASUREMENT
ANALYSIS OF COVARIANCE
183
01
I I
IA
H -
< Q
3
W*
Hi
H-
0
I I I
3
f t
H
( D
0 1
C
h*
f t
0 i
f t
I D
O
< J 1
It)
<
< D
0
3
C D
I
r f
0 >
H-
M
( D
o .
ft
( 0
0 )
f t
Energy
Happy
Energy
Happy
U1 O'
Number of Ses
sions used in
the Analysis
H* H - *
^ to
• •
U) i n
M M
^ to
• ■
H* tO
Companion
Group
Adjusted Means
H1 M
in 4*
• ■
01 to
I - 1 M
U1 ^
• »
in h
Role Play
Group
H H*
Ul H
• •
K) v0
M M
U h - >
• •
to 00
Control
Group
O O
• «
O' w
tn o
O O
• •
O' t ~ *
vO O'
Companion Group
compared with
Control Group
W
• •
O u i
10 0 0
3
to L n
• I
« s l 4*
in u i
Q >
Role Play Group
compared with
Control Group
O M
• •
09 W
10 01
M U)
* •
O O'
® t-
Role Play Group
compared with
Companion Group
M
HI
scores (df = 1,29) from comparison of means:
Energy
Happy
Energy
Happy
I
< J1 O'
Number of Ses
sions used in
the Analysis
M N >
t •
4^ NJ
V O 0^
M tO
ro to
o C D
Treatments
df = 2,45
O fo
10 U
U
M M
£» V D
u) ID
Treatments
(adjusted)
df = 2,45
o o
• •
NJ 10
NJ 10
O H*
^ 10
03 O'
Occasions
df = 1,45
fO H
* •
O GJ
co co
O
• •
to ®
to x.
Interaction
df * 2,45
01
n
0
H
m
0)
Hi
H
0
3
r t
3*
< t >
0
<
( 0
H
1
D )
f l l
3
C l
t-
<
( 0
H-
0 1
HI
>
n
H
O
7 0
3
> 3
M
>
* 3
M
a
3
>
cn
C
3
0
H I
n
1
»
M
>
z
o
M
7 0
*<
H]
> O
o HI
* 3
O 7 0
7 0 M
cn cn
C
O P
HJ h3
cn
n
z O
M ng
7 0
M
<
> >
> P
5 2 a U
0 >
H u
H
5 o r a
• oz
u z
*
o
H I a
>
cn H
o
> cn X
cn H
cn i-3
M H
cn < z
cn m
M
a X
o
CD »
* 6
c cn
cn o
M o
* 9 1
O §
HJ cn
>
7 0
o
X 3
o
>
n
p
na
O
7 0 184
A P P E N D I X O
SUMMARY OF CHI SQUARE ANALYSIS OF THE
CHANGE IN RATINGS OF AFFECT FROM
THE FIRST TO THE LAST SESSION
185
186
APPENDIX O
SUMMARY OF CHI SQUARE ANALYSIS OF THE CHANGE IN RATINGS
OF AFFECT FROM THE FIRST TO THE LAST SESSION
Fear
Anger
[Depression
i
1 " ‘
Tired
Energy
Happy
i ___________
Companion Group 7 10 7 8 8 9
No. of subjects
who increased Role Play Group 4 9 3 7 5 5
in rating
Control Group 11 8 5 9 10 9
Companion Group 10 2 8 9 5 6
No. of subjects
who decreased Role Play Group 10 3 7 9 8 7
in rating
Control Group 3 5 8 8 5 5
Companion Group ■ 1 6 3 1 5 2
No. of subjects
who showed no Role Play Group 3 5 1 1 4 5
change in rating
Control Group 4 5 5 1 3 4
Chi Square value for Companion
Group compared to the Control 6 ,47a 1.60 N.S. N.S. N.S. 1.56
Group df = 1
Chi Square value for Role Play
Group compared to the Control 7.20* N. S . N.S. N.S. 2 .52 N.S.
jGroup df = 1
a = significant at the .025 level.
A P P E N D I X P
SUMMARY OF CHI SQUARE ANALYSES OF THE CHANGE IN
RATINGS OF SOCIAL RESPONSIVENESS FROM THE
FIRST TO THE LAST RATING SESSION
187
188
APPENDIX P
SUMMARY OF CHI SQUARE ANALYSES OF THE CHANGE IN RATINGS
OF SOCIAL RESPONSIVENESS FROM THE FIRST TO THE
LAST RATING SESSION
Scale #1
(Initiative)
Scale #2
(Showing
Interest)
Scale #3
(Tw(~ -way
Conversation)
Scale #4
(Openness)
Sum of All
Four Scales
Companion Group 9 12 11 9 16
No. of subjects
who increased Role Play Group 6 11 6 6 11
in rating
Control Group 6 7 8 3 8
Companion Group 6 2 5 3 1
No. of subjects
who decreased Role Play Group 5 2 5 4 4
in rating
Control Group 4 8 7 8 8
Companion Group 3 4 2 6 1
No. of subjects
who showed no Role Play Group 6 4 6 7 2
change in rating
Control Group 8 3 3 7 2
Chi Square values for Companion
V
Group compared to the Control 3.27 5.06a 1.00 5.36a 8.43
Group df = 1
Chi Square values for Role Play
Group compared to the Control 0.34 4.76a 1.53 2.24 1.78
Group df = 1
Chi Square values for Role Play
Group compared to the Companion 1.63 0.00 3 .34 0.40 3.07
Group df = 1
a = significant at the .05 level,
b = significant at the .01 level.
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Empathy And Social Perception
Asset Metadata
Creator
Konrad, William Edward
(author)
Core Title
Use Of College Students In A Social Therapy Program With Chronic Schizophrenics To Produce Changes In Mood And Social Responsiveness
Degree
Doctor of Philosophy
Degree Program
Psychology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
OAI-PMH Harvest,Psychology, clinical
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Jacobs, Alfred (
committee chair
), Ofman, William V. (
committee member
), Priest, Robert F. (
committee member
), Slucki, Henry (
committee member
)
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