Conditioning and post-hospital generalization of nondelusional responses in a chronic psychotic patient.

The team worked with one adult who had chronic psychosis. The person often gave delusional answers to simple personal questions.

Staff used differential reinforcement. They praised and gave tokens each time the patient gave a factual answer. Delusional answers got no reaction.

They tracked three question sets in a multiple-baseline design. Training stayed in the hospital. After discharge, they ran short follow-up trials in the community.

Factual answers jumped from near zero to high levels during hospital training. The jump happened only after reinforcement began for each question set.

After the patient moved home, the gains held only when brief booster trials continued. Without them, delusional answers crept back.

Hansen et al. (1989) used the same design with Broca’s aphasia. Both studies show you can pull new verbal responses into place, but you must probe with new people and places to see real carry-over.

Fyfe et al. (2007) paired extinction with a warning stimulus to cut stereotypy. L et al. did the same thing without a warning cue—just silence after delusional talk. The two papers together say extinction works, but a cue can give faster stimulus control when you need it.

Oliver et al. (2002) reduced pica by raising response effort. L et al. reduced psychotic talk by raising the payoff for competing factual talk. Both target behaviors were automatically reinforced, yet each team picked a different lever—effort versus reward. The pair shows there is more than one way to displace self-sustaining behavior.

You can replace psychotic speech with ordinary facts the same way you teach any other response—reinforce the one you want and withhold payoff from the one you don’t. The trick is to keep brief practice sessions running after discharge. Plan for mini-booster trials in the grocery store, on the bus, or at day program. One five-minute probe a week can save the gain you spent months building.