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