1. Schizophrenia Group Treatment
Schizophrenia is a lifelong condition requiring lifelong treatment, it’s important to build a network of family, friends, treatment professionals, and group relationships to help you. Group therapy can help you with social skills, social support and learn about and manage your symptoms.
Group Treatment

2. Assessments Brief Psychiatric Rating Scale
Positive and Negative Syndrome Scale
Before group started, we interviewed you to better understand your symptoms. You’ll see that knowing more about your symptoms will be helpful in treatment. We also found that completing the interview helps you understand more about your diagnosis.
Not part of the script:
Assessments: Two rating scales that have been most extensively used in schizophrenia trials:
• The Brief Psychiatric Rating Scale (BPRS;
Overall & Gorham, 1962)
• The Positive and Negative Syndrome Scale
(PANSS; Kay et al, 1987) which was
developed from the BPRS
Both are designed to be administered as semi-structured clinical interviews and have subscales whose analysis has helped to refine and to understand possible clinical subcategories of schizophrenia.

3. Is Group Therapy effective?
Medication is essential in schizophrenia.
The social aspect of group therapy seems to be especially important for people with schizophrenia.
Group therapy benefits:
Quality of life
Decreasing social anxiety
Decreasing symptoms
Medication is essential in schizophrenia. Research shows that individual therapy helps decrease psychotic symptoms. The social aspect of group therapy seems to be especially important for people with schizophrenia. Group therapy for people with schizophrenia seems to help with life happiness, decreasing social anxiety, and decreasing symptoms.
A study that reviewed a bunch of studies of non-medication interventions for schizophrenia showed three parts that are effective:
social skills training
psycho-educational coping-oriented interventions with families and relatives
Cognitive remediation
A few things make treatment difficult sometimes.
People with schizophrenia sometimes have difficulty with attention, concentration and memory.
Sometimes people with schizophrenia have “negative symptoms” like problems with motivation or social interaction.
At times, people may have hallucinations, suspiciousness of others, or delusions in the group.
Not part of the script
For the therapist:
Pfammatter, M., Junghan, U. M., & Brenner, H. D. (2006). Efficacy of psychological
therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia
Bulletin, 32, S64-S80.

4. What will the meeting be like?
Two therapists
5-7 group members
12 weekly sessions
Each session is minutes
 Group Structure/Therapist:
In GT for schizophrenia, your therapists should be active, warm and supportive.
For the therapist:
Patients should be In the same phase of illness (prodromal, first episode, acute, chronic, stable, or residual). It’s best if they have similar intellectual ability. You won’t want a group of all unmotivated clients. The atmosphere should be calm, so therapists should quickly manage expressions of anger.
Negative symptoms and cognitive deficits will lead some schizophrenic clients to appear uninterested in the group despite actually being highly interested and committed. It’s often very difficult to engage a client with schizophrenia in group therapy.
Upon questioning a group member who is not contributing much to conversation and appears uninterested in the group, the therapist may discover that the client actually looked forward to the group all week and treasures the contact it provides.
HMany clients with schizophrenia consider social functioning to be a key area of unmet needs.
Even if it appears that clients may not fully understand the concepts and techniques taught in group therapy, mere attendance and basic participation in a group can still provide them with significant benefits.

5. What will happen in meetings?
Greetings
Set an agenda
Review homework
New Information
Feedback
New homework
Each group meeting will have a similar structure. You can see that we’ll set an agenda, explaining what we’re going to do in this group meeting. We’ll go over homework, talk about some new skills, ask for your feedback, and assign some new homework.
For the therapist:
Use simple, closed-ended prompts with lower-functioning clients to reduce chances of clients becoming overwhelmed or frustrated and increase the likelihood that they will respond.
Be sensitive to the role that stigma can play in creating defensive denial—clients may protect their self-esteem by denying the existence of their illness.
Group CBT offers an opportunity for compassionate normalization to decrease the need for this form of self-protection.
Therapists should encourage group members with greater insight to share their experiences and model ways of acknowledging the illness that are consistent with good self-esteem and healthy disease management.
Important to “meet the client where he is” when working with clients with poor insight.
Includes noting and mirroring the language each client uses to describe his/her illness-related experiences
i.e., Many clients prefer not to apply the word “schizophrenia” to their experiences, opting to refer to “my illness” or “my episode”

6. Group Rules Confidentiality Attendance Psychotic symptoms during group
The therapists will work with the group to create some ground rules. It’s important to discuss confidentiality and attendance.
We will also talk about what should happen if someone has symptoms during group that make it difficult for the group to function.
Options might be:
Others pointing out the disruption of the client and reminding him of an agreement not to disrupt the session
Client excusing himself from the session
Client taking a short break outside
Therapist asking the client if he is able to control the behavior and then collaboratively deciding whether the member should remain in the room.

7. Session 1 Introduction of group members & therapists
Review group frequency and format
Group Purpose: to cope with voices and increase quality of life
Group ground rules and goals
Handout: Setting and reaching goals

9. Hearing Voices Hearing voices film What’s like your symptoms?
What’s unlike your symptoms?
Are we all the same – or different?
Handouts
What is psychosis
Continuum of madness
Spectrum of voices
We’ll watch a film about hearing voices, since that’s the most common psychotic symptom in schizophrenia. Then we’ll discuss it.
For the therapist:
Show hearing voices film stopping periodically for group reactions and commentary
Ask group to comment on similarities and differences with experiences in film
Make note of wide range of experience by those hearing voices

13. Models of Schizophrenia
Medication
Treatment options
Stigma video
Session 3- Continued Education about Voices and sharing of voice experiences
Psychoeducation and discussion including
Models of schizophrenia (psychological/biological)
Role of medication
Treatment options
Stigma (watch stigma of schizophrenia video -
Handout: why take medicine, medication reminder, telling others, stigma

14. Models of Schizophrenia
Handouts
Why take medication
Medication reminders
Telling others
Stigma
Session 3- Continued Education about Voices and sharing of voice experiences
Psychoeducation and discussion including
Models of schizophrenia (psychological/biological)
Role of medication
Treatment options
Stigma (watch stigma of schizophrenia video -
Handout: why take medicine, medication reminder, telling others, stigma

15. Voice Content What are your experiences with voices?
Handout: voice content form
Sessions 4-5 Content of voices
Solicit group members’ experiences with voices
Use the following probes to help elicit the voice themes:
Are the voices friendly or not friendly?
What do they usually say to you?
How do they make you feel?
Do you view the voices as weak or strong?
What would happen if you ignored/disobeyed the voices?
Seek reactions from group to common themes around voices
Review and assign voice content form
Handout: voice content form

17. ABC model ABC chart Handouts: Thought journal ABC model ABC of voices
Sessions 6-7- Behavioral analysis of voices
Teach ABC model
Use chart to demonstrate
Provide a general example of how beliefs in response to events can lead to negative consequences
Ask group members to give daily examples of ABC model (non-psychotic)
Shift the model to discussion of voices and look at specific ABC voices handout
Get a volunteer to provide an example in the past week of when they heard voices and examine the ABC’s surrounding that voice
Review and assign homework of monitoring the ABCs of voices daily
Handouts: cognitive journal, ABC model, ABC of voices

18. Increasing & Decreasing Strategies
Review thought journals
Stress vulnerability worksheet
Handouts:
Ask, don’t assume
Assertiveness
Session 8-9 increasing and decreasing strategies
Review cognitive journals for key antecedents for each group member
Discuss which situations/events make voices better/worse
Review and carry out stress vulnerability worksheet to help client detect their most vulnerable situations and most powerful antecedents
Handouts: stress vulnerability worksheet
Handouts: ask dont assume, aggressive assertive passive

19. Coping & Relapse Prevention
Brainstorm coping strategies
Role-play coping with voices
Go over coping strategies worksheets
Homework: Practice coping strategies
Relapse Prevention
Sessions Coping strategies and relapse prevention
Ask each group member for alternative coping strategies that he or she could use to cope with voices and write on a flip chart
Examine strategies that work consistently (which situations do they work in, ask group members to rate strategies and see if there is consistency)
Ask members what strategies they are currently using to cope with voices
Discuss relapse prevention
Assist clients in the development of a relapse prevention/safety plan
Look at recognizing triggers/early warning signs

20. Coping & Relapse Prevention
Handouts:
Social skills training handouts
Coping fire drill
Preventing relapse
Early warning signs
Self-management plan
Stress management
Sleep checklist
Drugs & Alcohol
Techniques or ideas UNIQUE to this particular diagnosis:
When establishing a set of group rules, the therapist should raise the issue of how to handle it when a client experiences symptom exacerbation during group.
For therapists: Negative symptoms and cognitive deficits will lead some schizophrenic clients to appear uninterested in the group despite actually being highly interested and committed.
Upon questioning a group member who is not contributing much to conversation and appears uninterested in the group, the therapist may discover that the client actually looked forward to the group all week and treasures the contact it provides.
Often very difficult to engage a client with schizophrenia in group therapy
Hallucinations, delusions, inability to complete thoughts, lack of emotion, and inappropriate emotional expression will make it hard for them to participate.
Many clients with schizophrenia consider social functioning to be a key area of unmet needs.
Even if it appears that clients may not fully understand the concepts and techniques taught in group therapy, mere attendance and basic participation in a group can still provide them with significant benefits.
Therapist acts differently when conducting a group of schizophrenics than with group members who are able to function at a higher level.
Aims of group work are related to the needs of the clients.

24. Credits Morgan Madsen Beth Leonard Mikalya Carr McKenzie Engram
Bonnie Cleaveland