Full Research Paper: How Occupationally High-Achieving Individuals With a Diagnosis of Schizophrenia Manage Their Symptoms

This is a repost of the earlier story by Firemonkey but with more details - it seems like really important information. Review the full paper at the bottom of this post and let us know your thoughts…

The study objective was to elucidate coping strategies utilized by individuals recovered from schizophrenia.

This qualitative study enrolled individuals with schizophrenia who had reached a level of recovery defined by their occupational status. Diagnosis of schizophrenia was confirmed with the Structured Clinical Interview for DSM-IV. Current symptoms were objectively rated by a clinician. Surveys gathered information on demographic characteristics, occupation, salary, psychiatric history, treatment, and functioning. Audio-recorded person-centered qualitative interviews gathered accounts of coping strategies. Transcripts were summarized and coded with a hybrid deductive-inductive approach.

Twenty individuals were interviewed, including ten men. The average age was 40 years. Sixty percent of participants were either currently in a master’s-level program or had completed a master’s or doctoral degree. Eight categories of coping strategies were identified: avoidance behavior, utilizing supportive others, taking medications, enacting cognitive strategies, controlling the environment, engaging spirituality, focus on well-being, and being employed or continuing their education. Some strategies were used preventively to keep symptoms from occurring; others were used to lessen the impact of symptoms. Strategies were flexibly utilized and combined depending on the context.

Use of strategies in a preventive fashion, the effectiveness of the identified strategies, and the comfort individuals expressed with using several different strategies supported these individuals in achieving their occupational goals. The findings contribute to an overall shift in attitudes about recovery from schizophrenia and highlight the importance of learning from people with lived experience about how to support recovery.

Some excerpts that seem interesting:

Person-Centered Interviews:

Coping Strategies
Eight categories of coping strategies were identified:
avoidance behavior, utilizing supportive others, taking
medications, enacting cognitive strategies, controlling the
environment, engaging spirituality, focusing on well-being,
and being employed or continuing their education. The
16 individuals who identified strategies typically identified
multiple strategies. Use of strategies varied, with some
used consistently and others used only when the person was
faced with a particular symptom. Illustrative quotes are
provided below. [Additional quotes are available in an online

Avoidance behavior. Participants discussed avoiding specific
behaviors or situations to maintain stability. Individuals
discussed avoidance of alcohol and illegal drugs to circumvent
symptom exacerbation. Participants also mentioned
avoiding situations that could be personally stressful or
interpreted as chaotic. If such situations arose without their
effects being anticipated, the situation was abandoned. For
example, one individual said, “If I’m seeing something that is
frightening . . . I can’t watch the sci-fi channels ‘cause if it’s
gory and bloody I know it’ll start my symptoms, so I get away
from that.” Avoidance of specific behaviors or situations
most often was the result of a trial-and-error process over
the individual’s lifetime rather than a result of education or
instruction that these should be avoided. Typically, the individual
experienced the situation multiple times, always or
often followed by an exacerbation of symptoms, and then
decided that it was best avoided.

Utilizing supportive others. Most participants described
connecting with family, friends, or professional supports as
an important strategy to provide objective insights into
symptom exacerbation (for example, psychotic thoughts and
odd behavior) and nonjudgmental support during those
times. One participant said, “I think, ‘Who can I talk this
[symptom] out with?’ and generally it’s [a friend]. It is not
to fix what’s going on [symptoms] but to restore me to
where I am comfortable.” Several discussed participating in
therapeutic groups (for example, NAMI) that provided
considerable peer support. Some participants highly valued
working or being involved in a recovery-oriented group or
organization, where they were with like-minded individuals
and felt implicitly understood.

Taking medications. Most participants discussed medications
as a key part of their regimen to maintain or regain
stability. For some there was a distinct point (for example,
a specific hospitalization or achieving a desired life goal) at
which they recognized the necessity of medication, and for
others it was knowledge gained after many medication trials.
One individual stated, “I realized that I felt better on the
medication. . . . A light bulb went off on my head. And then
after that I pretty much understood the importance of taking
the medication, which became more fully engrained into
me.” Individuals discussed the challenge and frustration of
finding the medication that best addressed symptom reduction
and dealing with troublesome side effects (for example,
lethargy and weight gain).

Participants explained
that medication adherence did not mean disappearance of
symptoms, but rather enhanced stability. Medication adherence
was varied, with a few participants saying they had
always been adherent, whereas others said they had been
nonadherent intentionally at times during their lives.

Enacting cognitive strategies. Participants discussed
specific cognitive strategies that they used in the face of
symptoms—some self-taught and others learned from a
professional. These strategies involved ways to systemically
reason through their problematic thinking, its basis in reality,
and possible alternative interpretations. For example, one
person said about hearing derogatory comments from voices
when driving alone down the road, “I think to myself is this—is
this logical. I mean, we both have our windows closed, we’re
on opposite sides of the freeway. . . that couldn’t be possible.”

The cognitive strategies mentioned are similar to those taught
and practiced as part of evidence-based cognitive-behavioral
therapy (CBT) for psychosis (26), and although individuals did
not specifically speak of engagement in CBT, they discussed
how professionals had taught them cognitive techniques.

Controlling the environment. Participants described adjusting
their surroundings to help prevent, minimize, or address
symptom exacerbation. One participant said, “I have to
kinda prep my environment around me to be able to be the
way I am because I don’t like to be alone in my bedroom
when I’m symptomatic. It just freaks me out, ya’ know.”
Some participants preferred quiet, calming environments
that are clear of clutter or distraction, and others liked to
drown out the thoughts and voices with environments filled
with sounds and activity.

Engaging spirituality. A few participants described ways in
which they found support through religion and spirituality,
including one who said, “I [use] my Buddhist meditations.”
Use of spirituality was for some a form of social support and
for others a place to avoid stress and find solitude.

Focus on well-being. A few participants talked about the
importance of exercise, diet, or wellness as a component
of staying psychiatrically stable or combatting symptoms.
One participant said, “I started working out like five days a
week and that helped immensely. . . with symptoms, and like
everything . . . like my head is so clear.”

Being employed or continuing their education. A few participants
discussed the benefits of education or employment,
especially because of its absorbing and distracting nature but
also for providing a sense of belonging. One participant said,
“I work on the weekends too because it’s just distraction, it’s
good, it’s what I call the distraction factor.”


HighAchievingPeoplewithSchizophreniaManageSymptoms2016.pdf (461.9 KB)


Out of the nine highlighted things listed here, I currently only do two of them: taking medications and coping strategies.

I like the way things are now. Although social isolation, I admit, can have its emotional ups and downs, I still prefer it. I prefer insistence on sameness in my apartment where I live and being able to have daily routines. Being on disability (haven’t had a job in years) enables me to just have a sort of freedom to live at my own pace and then go from there. Without disability income, I would likely be homeless which would not be good as that would enact too many changes and I prefer daily sameness.

Being by myself 24/7 can have its advantages to try to have a sense of progress even after time being wasted on things like repetitive thinking habits or difficulty thinking and constantly losing trains of thought. Try to absorb inefficiencies that are just a sort of multi-product of my form of mental illness. Have few ways to cope with feeling the need to stay connected with reality in my mind which isn’t all there because of apparent mental disconnecting fluctuations.

I have no problem avoiding alcohol or illegal drugs or marijuana. I don’t do drugs. Never have, never will. I avoid alcohol at all costs. I never drink, ever. Never been drunk before and never will. I don’t have tolerance for that stuff anyway and could kill me.

I don’t utilize support from family members. I don’t really get along with them that well, anyway. I love them and all but I don’t connect with them. I’d rather just be self-sufficent or live in my own little world so they don’t have to worry about me. Don’t have any friends. I’ve been questioning my inability to make real friends or keep in touch (even in today’s social media world) and it just doesn’t work that way. It’s just not really possible in my case. If I did have friends, I wouldn’t go to them for support. I prefer to be alone and try to not have others worry about me.

I’ve never done this CBT thing, but I don’t think it would help me, if I did. Psychotherapy type of stuff doesn’t really affect someone like me, I don’t think.

It’s great to read about people with schizophrenia who have found ways to gain great success in school and employment. School and work just don’t apply to me, anymore. Never really did. Finding certain alternate ways to do that stuff, I found, isn’t really how it works in reality. Doesn’t last for me. Like one of the mental health professionals I’ve seen before, she said, “It’s like trying to fit a square peg in a round hole.”

There is a lot of scientific evidence that CBT works - its the dominant (i.e. about 98% of of medical and psychology schools) teach it because its the most effective thing out there.

Of course - if you don’t believe the evidence and science and take a negative view - then it won’t help. If you have a more open mind - it would likely help you (this is a message for everyone).

Anyone else have thoughts about how these strategies are used by you or might be used by you?

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I think work is beneficial for me. My first job after diagnosis was as a clerk in a hospital. It was part time sometimes working full time. Started at 7 and by 2 I was ready to go back home. Most days this wasn’t a problem to leave.

Now I work as a waitress on the day shift mostly by myself.

Both jobs are not my dream jobs but being home everyday alone without coping skills makes it worse for me.

Getting ready to start alcohol counseling in December. Hopefully some CBT too.

Stable for a couple of years but never really had any positive counseling. Plus I think I am just ready to move ahead with my goals and dreams.


Yeah, good point. I’ve just never heard of it until I came to this site. I’m guessing they (mental health professionals) never mentioned CBT to me before, probably because they don’t think it’ll affect me much.

Is CBT a “group therapy” type of thing? It could help me if it was more of a one-on-one type thing where mental deficits are directly addressed and understood to a point of finding ways of betterment. Something like that.

If my current pdoc ever mentions/suggests it, I’d be willing to give it a try. But you know, that’s not going to happen. You got to realize some of us with Sz are way off the grid. You know? :slight_smile:

CBT is certainly fashionable. Personally I am wary of anything that touts itself as a solution to a 101 different things, be it for psychiatric or non psychiatric purposes.

To me it smacks too much of a medicine man’s miracle cure all/elixir.

Some of my skills are just ingrained in me due to exposure to situations that are stressful for most people with SZ. For instance Mardi Gras has made me immune to large crowds. Childhood stress from the divorce and things allows me to bounce back pretty quickly from stressful situations. Also the flat affect keeps me from absorbing stress right away.

One of my friends from Face Book has been in the ICU for 2.5 months so he was delirious and posted that he was dying. The next day his sister shared that he was not, but I was torn up about it before her news. I even called the 700 Club which is the most embarrassing thing I’ve ever done that I can tell people about. :wink:

So, I’m spiritual. It helps. I get a doughnut and coffee before church (which I sometimes miss and am usually late for). I don’t force my religion on others, and I certainly don’t represent the fundamental elements of Christianity.

Now I’m trying to avoid politics, scary movies, and mom’s scary friend.

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I do some of those things. I’ve intentionally never smoked anything or drunk beer or take any other kinds of drugs. I was against doing drugs when I was young because I didn’t want to become an alcoholic. I didn’t smoke because I saw how it turned people’s lungs black, and I assumed when I was young that smokers died of suffocation for some reason when they got lung cancer. I don’t know if lung cancer actually causes suffocation or not though, but it still seems really painful. I take my meds every single day. I personally don’t think the antidepressants work very well, but they help me to not hear voices, to go to sleep and to eat less. I pray every night, but I have to admit that for the past couple of months I’ve spent more time looking at suicide watch on reddit and fantasizing about committing suicide than I have in reading the Bible. I don’t really have any coping strategies. I see a psychologist a couple of times a month though which I think counts as a coping strategy. I connect closely to my family. I talk to my relatives when I see them, well, I mostly listen. I listen to Christian music every day to calm my nerves. I’m always anxious, especially if I don’t listen to music. I focus on counting calories to maintain or lose weight, but I don’t really exercise that much. I’ve been working part time at my dad’s office and going to community college part time. I have a lot of nervous breakdowns though, but I manage overall to study enough for my classes. I’d say I follow most of what they say to do. I just applied to five four year state universities and the counselors seem to think I have a good shot of getting in to the local one. It’s been 4 years since I was diagnosed with schizophrenia and dropped out of the university I was going to, but it seems like taking my meds and trying hard at the community college are paying off. I might actually get in!


Good to see someone else like me. I’ve never smoked either. I’ve read there seems to be a high percentage of schizophrenics who do smoke. That percentage needs to come down.

IMO, there are plenty other ways to deal with stress or whatever besides smoking. Life can be tough on anybody and smoking just makes it worse.


Hey I want to apologize because I may have been wrong. I had to fill out this paperwork and it required me to look at my disorganized pieces of paper laying around. I was reminded I did have an appointment with a Psychologist in 2014. It is possible he mentioned something like CBT during that appointment. I simply don’t remember. I think he mentioned there being some kind of psychotherapy. I forgot. However, he just mentioned something; didn’t exactly suggest it. So I just turned it down opting to just see a Psychiatrist for meds.

However, after hearing more about CBT since coming to this site, I may change my mind if the opportunity presents itself. I just do not enjoy talking to people, and different types of psychotherapy appear to require a lot of conversation. I prefer to minimize verbal conversation as much as I can.

I hate paperwork. It said it would require about 60 minutes to complete. Ha, took me several hours to try to gather what I could from paperwork sitting around. Overloads me so much I wanted to just sleep after I submitted the paperwork. At least it’s something they don’t send often (Continuing Disability Report from the SSA).

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Great study! It was very interesting to read that sz’s use avoidance as a major coping strategy. I guess this should tell me to stop watching Homeland, Black List, and all those other spy tv series, as these television shows are pretty triggering to me. I just love the adrenaline rush and they have great plots.

I think that pdocs put too much emphasis on “rest” and not enough on “rest then return to your daily life.” It seems like sz is the end of the road to pdocs. They don’t encourage us very much to go back to work or school. My pdoc of many years told me to go on disability and quit my delivery job and my part-time schooling at the community college. It would have been nice to have someone who believed in my ability to heal and function, but in the end I graduated from the university with my BA and MA due to my stubborn refusal to accept that sz’s can’t have jobs or college degrees. That doctor doesn’t know how far I’ve come, since he was my in-hospital pdoc, but I’d like to show him sometime that I proved him wrong and tell him to quit telling people to just stop living and rest indefinitely. Rest is great, but many of us have all this spare energy with nothing to do with it. It’s mind numbing to just be an inert object at rest with no goals or ambitions. I think the main coping strategy I used was to create goals and ambitions and to not let people talk me out of them.

I think self-expression is a big coping tool for me, in particular. Like art or writing poetry. Painting got me through the worst times of my life, post-illness.


Wow, my doctors never told me to go on disability or things like that. I think one doc told mentioned “research scientist” but, okay, that’s a little unrealistic for my case. I just gravitated eventually towards going on disability.

Some doctors probably saw Sz but for certain reasons didn’t officially diagnose me with it, initially. They started with personality disorders and (I believe) labels that rhymed with schizophrenia, like social phobia. Something like that. Sometimes, I think doctors would rather avoid a Sz diagnosis, if they can and use it only when it becomes necessary. Well, that’s the impression I got with my case.

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my psychologist and psychiatrist are really supportive of me getting a job and going to school. One of them asked when I was planning on going back to the four year college that I dropped out that was really competitive, since I could appeal based on having schizophrenia. the other one has been encouraging me to go to school and graduate with a bachelor’s even though I originally after reading about schizophrenia asked about how to work at a sheltered workshop. they both helped me get on SSI the first time I applied and have been encouraging me to finish a bachelor’s degree and get a high paying job.

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