Coping with Symptoms

Buddy Garfinkle, MSW

Definition of copingDefinition of coping

““To contend or strive especially To contend or strive especially

on even terms or with success”on even terms or with success”Changing coping strategies may reduce

stress

Why coping?Why coping?

The Stress VulnerabilityThe Stress VulnerabilityModel of SchizophreniaModel of Schizophrenia

Common Symptoms Associated Common Symptoms Associated With Mental IllnessWith Mental Illness

• Negative symptomsNegative symptoms

• Absence of expression, drive, emotion, Absence of expression, drive, emotion, thoughtthought

  

• Social WithdrawalSocial Withdrawal

Negative Symptoms-Lack of Interest Negative Symptoms-Lack of Interest or Pleasureor Pleasure

Psychotic SymptomsPsychotic Symptoms

• Shift topics, usually unrelated and Shift topics, usually unrelated and without logical sensewithout logical sense

  

• Difficulty in perceiving what is realDifficulty in perceiving what is real

Loose AssociationsLoose Associations

• Medications• Social skills training• Cognitive Behavioral therapy

– Originally developed for residual symptoms, developed mainly for anxiety and depression

Up to 60% of individuals taking prescribed medication still have persistent

symptoms

TreatmentTreatment

• Understanding persons experience irrespective of its connection to reality

• Interest in the person’s experience

Developing a Therapeutic AllianceDeveloping a Therapeutic Alliance

What appears to be a void, What appears to be a void, in fact, has a cognitive in fact, has a cognitive component of contemplation component of contemplation and observationand observation

Reduction of Negative SymptomsReduction of Negative Symptoms

• May be biological in nature, or

• May be reaction to past trauma

• May be a learned behavior, emotional blunting

Affective FlatteningAffective Flattening

AvolitionAvolition

Positive symptoms may be connected to aberrant thought process

Personalizing bias

• Jumping to conclusions

• Cognitive rigidity

Reduction of Positive SymptomsReduction of Positive Symptoms

Behavioral Basis of TreatmentBehavioral Basis of Treatment

Behavioral Response

• Go for a walk, listen to relaxing music

• Socialization

• Medication

Hallucinations-AuditoryHallucinations-Auditory

Distraction

Focusing: allow the voice to exist and relax with it

Rational Responding Anxiety or anger reducing techniques Induce the voice for time limited period Normalizing techniques, “this is my illness Confronting the omnipotence of the voices-they are only

voices and you don’t have to act upon them. Assertiveness with the voices-develop a dialogue with them

Cognitive Response

• Focus on the effects of stress, or sleep deprivation, rather than the etiology of symptoms

• Voice diary– Ties voices and intensity to time of day triggers– Identifies patterns, triggering coping strategies

Affective responses (anger, anxiety) may lead to unhelpful behaviors

Elicit the details of the experienceElicit the details of the experience

Patterns identified can lead to engaging Patterns identified can lead to engaging the voices constructivelythe voices constructively

Generate coping strategiesGenerate coping strategies

Social skills trainingSocial skills training

Relaxation techniques

Breathing Progressive

muscle relaxation

Guided imagery

Teach the connections between thoughts and feelings

Examine the evidence supporting the thoughts

Challenge and modify beliefs not supported by evidence

Explain automatic thoughts (biased thoughts)

Teach to challenge thoughts or develop coping strategies

Cognitive Re-Structuring

Activity Scheduling-Frontline Activity Scheduling-Frontline Intervention For DepressionIntervention For Depression

With the mastery of a skill,

developing a coping strategy for symptom

management the cognitive

mind-set will improve.

Mastery and Pleasure Techniques

• Observable

• Self-report

• Reduction of stress

• Attainment of recovery goals

How do we know when a person has How do we know when a person has mastered a coping strategy?mastered a coping strategy?