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UNIT 3 ■ Care of Patients With Psychiatric Disorders
graduated in terms of level of difficulty. The health- care provider may serve as a role model for some behaviors,—for example, “See how I sort of nod my head up and down and look at your face while you talk.” This demonstration is followed by the client’s role-playing. Immediate feedback is provided regard- ing the client’s presentation. Only by countless rep- etitions does the response gradually become smooth and effortless. Progress is geared toward the individual’s needs and limitations. The focus is on small units of behavior, and the training proceeds very gradually. Highly threatening issues are avoided, and empha- sis is placed on functional skills that are relevant to activities of daily living. Milieu therapy , which focuses on the client’s interaction within a social environment, may provide opportunities for social skills training. Cognitive Remediation Therapy As mentioned previously, many of the cognitive deficits common in schizophrenia have not been particularly responsive to existing pharmacological treatments. However, some evidence suggests that cognitive therapies, which include social cognition training, can be an effective treatment. Cognitive remediation is based on behavioral training aimed at helping the client to mend areas of cognitive dysfunc- tion, including attention, memory, social cognition, and executive functions. The intervention entails repetitive drills and practice. The evidence supports that this training results in significant improvements in memory, attention, problem-solving, cognition, social cognition, independent living skills, and social adjustment (Tripathi et al., 2018). Family Therapy Schizophrenia is an illness that can puzzle, disrupt, and sometimes tear apart families. Even when fami- lies appear to cope well, there is a notable impact on the mental and physical health of relatives when a family member has the illness. The importance of the expanded role of family in the aftercare of relatives with schizophrenia has been recognized, thereby stimulating interest in family intervention programs designed to support the family system, prevent or delay relapse, and help maintain the client in the community. These psycho- educational programs treat the family as a resource rather than a stressor, with the focus on concrete problem-solving and specific helping behaviors for coping with stress. These programs recognize the biological basis for schizophrenia and the impact
Behavior Therapy Behavior modification has a history of qualified suc- cess in reducing the frequency of bizarre, disturbing, and deviant behaviors and increasing appropriate behaviors. Features that have led to the most positive results include the following: ■■ Clearly defining goals and how they will be measured ■■ Attaching positive, negative, and aversive rein- forcements to adaptive and maladaptive behavior ■■ Using simple, concrete instructions and prompts to elicit the desired behavior In the treatment setting, the health-care provider can use praise and other positive reinforcements to help the patient with schizophrenia reduce the frequency of maladaptive or deviant behaviors. A limitation of this type of therapy is the inability of some individu- als with schizophrenia to generalize what they have learned from the treatment setting to the community setting.
Social Treatments Social Skills Training
Social skills training is used to help clients manage struggles with interpersonal relationships and com- munication, which are often complicated by clients’ inability to accurately perceive responses in others. Mueser and colleagues (2001) describe this training as follows: The basic premise of social skills training is that complex interpersonal skills involve the smooth integration of a combination of simpler behaviors, including nonverbal behaviors (e.g., facial expression, eye contact); paralinguistic features (e.g., voice loud- ness and affect); verbal content (i.e., the appropri- ateness of what is said); and interactive balance (e.g., response latency, amount of time talking). These specific skills can be systematically taught, and, through the process of shaping (i.e., rewarding suc- cessive approximations toward the target behavior), complex behavioral repertoires can be acquired. Social dysfunction is a hallmark of schizophrenia. Impairment in interpersonal relations is included as part of the defining diagnostic criteria for the con- dition in the DSM-5-TR (APA, 2022). Considerable attention is now being given to enhancement of social skills for this population. The educational procedure in social skills train- ing focuses on role-play. A series of brief scenarios are selected. These should be typical of situations that clients experience in their daily lives and be
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