Category Archives: Schizophrenia

Cognitive Pearl #096 Time & Mother Earth

Don't Look At The Jug

 

 

 

 

 

 

 

 

In my previous post, I introduced two ways to help reorient clients to the present moment. Here’s one more:

3. Strengthening their executive functions. Our minds are complex chaotic systems within systems. Yet, somehow our minds sustain us physically, emotionally, and so forth. This is all due to the blessing of our executive functions. You can read more about them here. Anxiety, depression, psychosis, as well as psychosis and many other states (including bereavement) levy a heavy price on these functions. Here are some of the things that I do with my clients to strengthen them, 

Get them writing. Shopping lists, budgets, schedules, reminders, sudoko games, and journaling help organize frenzied minds. Whether it’s with paper and pencil or using an app on a phone, the physical act of writing grounds and organizes. Grounding reduces cognitive stress so they can more easily focus on the challenges and opportunities of the moment. 

Get them physical. Anxiety, depression, psychosis, you name it, are states that remind me of a scene in the movie 2001: A Space Odyssey when one of the astronauts has been severed from the tether that connects him with the space ship. We see him horribly and helplessly floating away. My clients always relate to that image. My answer is to get them reconnected with Earth. They do this through bathing, cooking, cleaning, walking, peeling potatoes, dancing in their living rooms, or tossing a ball from hand to hand. Anything that gets them out of their ‘lost in space’ mind set and back to Earth will help them reorient to the now. 

Use Prostheses. Without getting into the spiritual and psychological downsides of smart phones, tablets, and all the rest, technology can really help our clients. Calendar apps, To Do List, apps, Journaling apps, and even Cognitive Therapy apps (here’s a good one). And let’s not forget how the convenience of music, lectures, and guided imagery meditation in the palm of the hand. This technology is no different than the prosthetic arms and legs and eyes that we use to the limited live again. And living brings people back to the now. 

To be continued!

Shabbat Shalom!

Cognitive Pearl #087 Sivan 20, 5775 Schizophrenia, Cognitive Therapy, & Possibilities

All truth Schopenhauer

 

 

 

 

 

 

 

 

 

 

 

Over the last 25 years of work with adults suffering from schizophrenia in all of it’s manifestations, I’ve seen some wonderful turn-arounds. By turn-around, I’m speaking of individuals who either made full recoveries or who made unexpected improvements in their functioning.

Let’s consider two of the full recoveries (1). In both cases the clients resumed their previous vocational activity (students) and social functioning. They remained in some form of aftercare and continued to take low maintenance doses of antipsychotic medications; as of this writing they still do. Interestingly and not surprisingly, both were young women in the early twenties. Both experienced a sharp descent into psychosis which lasted about six months; during this time there was increasing paranoia, irritability, depression, and then florid psychosis leading to hospitalization. In one case, there was heavy use of marijuana as a way to self medicate away anxiety; predictably it had  negative effects as well.

That’s the bad news. Now the good news.

Both of these women were fortunate to have parents who they were close with. Both had access to high quality hospitalization, well trained clinicians, and great aftercare. Both had social networks and extended family relationships so that their care didn’t fall only on their parents. Both had vocational arrangements which by law and basic human decency they could return to as they became more and more capable.

In addition to all of these blessings, both of these women participated in a ‘first break’ group, an educational program for young adults going through their first episode of severe psychiatric illness. Along with the manic, the severely depressed, and one soul terribly tortured by obsessions and compulsions, these two women learned skills to reduce stress, increase mastery, and intensify focus.

Cognitive therapy was an integral part of that. 

More on that in my next post!

Shavua tov to all!

 

(1) Aside from the fact that I met both of these individuals while I worked in various day treatment programs in the United States, all of the details have been obscured.

Cognitive Pearl #086 Sivan June 4, 15

You Know What The Problem Is With The World

 

 

 

 

 

In the decades since I began my study of cognitive therapy, its relevance in the treatment of schizophrenia was been excitedly discussed. The idea, for instance, that hallucinations and delusions involved thinking distortions seemed appealing. Or that the absence of motivation, the hallmark of the negative symptoms (for more information read here), could be improved with cognitive therapy techniques seemed plausible.

Unfortunately, all of this early enthusiasm was misplaced. For the most part we’ve found that cognitive therapy has little impact on the symptoms of schizophrenia (for a review of the scientific literature see here). This may be due to the pervasive effect of the disease on the client’s metacognitive ability, or in simpler terms, to think about his thoughts. Or it may be the effect of the brain dysfunction on the client’s interpersonal connectedness which interferes in his ability to benefit from any form of psychotherapy. Lastly, the absence of illness insight, or the lack awareness of disability gets in the way of treatment. After all, if the client doesn’t think that there’s anything amiss there’s no need for treatment.

This is not to say that cognitive therapy has no place in the treatment of the symptoms of schizophrenia. It does. As you will read in coming posts, clients have benefitted greatly from outside the box uses of cognitive therapy techniques (as well as psychodynamic psychotherapy). What we must remember however is that the scientific community is a long way from understanding schizophrenia. In spite of the excitement about new drugs, which really do help, we are still far from understanding how an invisible pathological process can wreak such havoc on the brain.

Stay tuned though: all is not lost. Many people diagnosed with schizophrenia do fully recover. And those who don’t can still live lives of richness and joy.