The use of brief isolation to suppress delusional and hallucinatory speech

Isolation of 15 min duration (time-out, TO) was used to consequate the delusional and hallucinatory speech of a 33-yr-old female, chronic psychotic impatient. Delusional speech was defined as saying any one of 30 false statements; hallucinatory speech was defined as saying any audible verbalization to an unobservable stimulus. Delusional speech was recorded during two different types of conversations: six daily 5 min conversations conducted in a specific locale; 18 daily 1-min conversations conducted at any place on the patient's unit. TO was applied, withdrawn, and then reapplied first to the 5-min conversations and then to any delusional or hallucinatory verbalization emitted everywhere on the unit.Results indicated that TO was effective in suppressing delusional and hallucinatory speech, but the effects did not generalize from the 5-min to the 1-min conversations. When an attempt was made to fade TO from a continuous to an intermittent schedule, delusional speech increased to baseline levels. Additional observations made during the periods of TO indicated that the patient significantly increased the frequency of her delusional and hallucinatory verbalizations. This suggested that TO functioned as a punisher rather than as removal from social reinforcement which had initially been hypothesized as maintaining delusional and hallucinatory speech.