Disjunctive arousal changes as a consequence of nondrug clinical intervention

Sleeplessness and resting pulse rate were studied in relation to behavioral treatment of 34 chronic psychotics using an 18-week ABAB research design. These arousal measures, unrelated in the base line, showed significant opposing changes during four of the first ten treatment weeks. Sleeplessness improved proportionately with clinical response, gauged by social participation, whereas pulse rates were significantly exacerbated early in treatment. When treatment was withdrawn and reinstated, pulse rates correspondingly decreased and increased significantly. These results suggested that arousal changes transcend specific drug action and are a consequence of treatment -- possibly a hindrance -- rather than its source. The systematic differences supported a distinction between two arousal processes, on responsive and one resistant to treatment. It was proposed that the elevation of autonomic arousal with treatment may reflect dysphoria from threat to psychotic homeostasis and consequent therapeutic resistance. Implications were drawn regarding clinical intervention with poor prognosis psychotics, a two-factor model of arousal disorder, and a nonunitary approach to arousal research.