Psychiatric Quarterly

, Volume 70, Issue 1, pp 27–37

Behavioral Rehabilitation and the Reduction of Aggressive and Self-Injurious Behaviors with Cognitively Impaired, Chronic Psychiatric Inpatients

  • Stephen B. Bellus
  • Joseph G. Vergo
  • Peter P. Kost
  • Diane Stewart
  • Scott R. Barkstrom
Article

Abstract

Aggressive behavior has been identified as a significant concern and occupational hazard in psychiatric inpatient settings. Several factors, including lax or unclear ward structure, have been identified as contributing to the exhibition of aggressive behavior. Token economies are effective in increasing ward structure and reducing aggressive behavior. This study evaluated the effects of rehabilitation programming, based on Gordon Paul's social learning approach (SLA), on rates of aggressive and self-injurious behaviors in a group of cognitively impaired, chronic psychiatric inpatients, compared to three long-term wards of similar patients. While no differences were found between the two groups prior to implementing SLA procedures, lower rates of aggression and self-injurious behavior were observed at one and two years on the Paul-derived ward. These results support the use of Paul's approach with multiply-impaired psychiatric inpatients in reducing patient aggression.

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REFERENCES

  1. 1.
    Ball, GG: Modifying the behavior of the violent patient. Psychiatric Quarterly 64(4): 359–369, 1993.PubMedGoogle Scholar
  2. 2.
    Love, CC and Hunter, ME: Violence in public sector psychiatric hospitals: nursing staff injury rates from five sites. The Journal of Psychosocial Nursing 34(5): 30–34, 1996.Google Scholar
  3. 3.
    Carmel, H and Hunter, ME: Types of weapons and patterns of use in a forensic hospital. Hospital and Community Psychiatry 42: 586–588, 1993.Google Scholar
  4. 4.
    Lipscomb, J and Love, CC: Violence toward health care workers: an emerging occupational hazard. American Journal of Occupational Health Nursing 40(5): 219–228, 1992.Google Scholar
  5. 5.
    Rosenbaum, M: Violence in psychiatric wards—role of the lax milieu. General Hospital Psychiatry 13: 115–121, 1991.PubMedGoogle Scholar
  6. 6.
    Hertz, MI: Short-term hospitalization and the medical model. Hospital and Community Psychiatry 30(2): 117–121, 1979.PubMedGoogle Scholar
  7. 7.
    Mossion, EF: Theoretical modeling to predict violence in hospitalized psychiatric patients. Research in Nursing & Health 12: 31–40, 1989.Google Scholar
  8. 8.
    Moldin, SO: Episodic weekend psychosis on an intensive care unit. Hospital and Community Psychiatry 35(12): 1230–1232, 1984.PubMedGoogle Scholar
  9. 9.
    Flannery, RB, Hanson, MA, Penk, WE, et al.: Violence and the lax milieu?: preliminary data. Psychiatric Quarterly 67(1): 47–50, 1996.PubMedGoogle Scholar
  10. 10.
    Ayllon, T and Azrin, N: The token economy—A motivational system for therapy and rehabilitation. New York, Appleton-Century-Crofts, 1968.Google Scholar
  11. 11.
    Glynn, SM: Token economy approaches for psychiatric patients: progress and pitfalls over 25 years. Behavior Modification 14: 383–407, 1990.PubMedGoogle Scholar
  12. 12.
    Boudewyns, PA, Fry, TJ and Nightengale, E: Token economy programs in VA medical centers: where are they today? Behavior Therapist 6: 126–127, 1986.Google Scholar
  13. 13.
    Morisse, D, Bantra, L, Hess, L, et al.: A demonstration of a token economy for the real world. Applied and Preventive Psychology 5: 41–46, 1996.Google Scholar
  14. 14.
    Deegan, PE: The independent living movement and people with psychiatric disabilities: taking back control over our own lives. Psychosocial Rehabilitation Journal 15: 3–19, 1992.Google Scholar
  15. 15.
    Corrigan, PW: Behavior therapy empowers persons with severe mental illness. Behavior Modification 21(1): 45–61, 1997.PubMedGoogle Scholar
  16. 16.
    Corrigan, PW: Wanted—champions of psychiatric rehabilitation. American Psychologist 50(7): 514–521, 1995.Google Scholar
  17. 17.
    Dickerson, F, Ringel, N, Parente, F, et al.: Seclusion and restraint, assaultiveness, and patient performance in a token economy. Hospital and Community Psychiatry 45(2): 168–170, 1994.PubMedGoogle Scholar
  18. 18.
    Li, F and Wang, M: A behavioural training program for chronic schizophrenic patients: a three-month randomised controlled trial in Beijing. British Journal of Psychiatry 165(suppl 24): 32–37, 1994.Google Scholar
  19. 19.
    Corrigan, PW, Yudofsky, SC, Silver, JM: Pharmacological and behavioral treatments for aggressive psychiatric patients. Hospital and Community Psychiatry 44(2): 125–133, 1993.PubMedGoogle Scholar
  20. 20.
    Rimmerman, A, Finn, H, Schnee, J, et al.: Token reinforcement in the psychosocial rehabilitation of individuals with chronic mental illness: is it effective over time? International Journal of Rehabilitation Research 14: 123–130, 1991.PubMedGoogle Scholar
  21. 21.
    Paul, G and Lentz, R: Psychosocial Treatment of Chronic Psychiatric Patients: Milieu versus Social Learning Programs. Cambridge, MA, Harvard University Press, 1977.Google Scholar
  22. 22.
    Kazdin, AK: Response cost: the removal of conditioned reinforcers for therapeutic change. Behavior Therapy 3: 533–546, 1972.Google Scholar
  23. 23.
    Beck, NC, Menditto, AA, Baldwin, L, et al.: Reduced frequency of aggressive behavior in forensic patients in a social learning program. Hospital and Community Psychiatry 42(7): 750–752, 1991.PubMedGoogle Scholar
  24. 24.
    Diagnostic and Statistical Manual of Mental Disorders—III-R. Washington DC, American Psychiatric Association Press, 1987.Google Scholar
  25. 25.
    Hunter, RH: Benefits of competency-based treatment programs. American Psychologist 50(7): 509–513, 1995.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1999

Authors and Affiliations

  • Stephen B. Bellus
    • 1
  • Joseph G. Vergo
  • Peter P. Kost
    • 1
  • Diane Stewart
    • 2
  • Scott R. Barkstrom
    • 3
  1. 1.Staff psychologist and Program Manager of the BRITE I (Behavioral Rehabilitation and Interpersonal Treatment Environment I) Program at the Buffalo Psychiatric Center and Adjunct Assistant Professor of Counseling and Educational Psychology at the State University of New York (SUNY) atBuffalo
  2. 2.Treating psychiatrist for the BRITE I Program and is currently associated with the Clifton Springs HospitalClifton Springs
  3. 3.Graduate student at the Department of Counseling and Educational Psychology at SUNY at Buffalo during the third year of operation of BRITE I and is currently staff psychologist at the St. Francis HospitalPoughkeepsie

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