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…
Objective:
The study objective was to elucidate coping strategies utilized by individuals recovered from schizophrenia.
Methods:
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.
Results:
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.
Conclusions:
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
supplement.]
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.”
FULL RESEARCH PAPER:
HighAchievingPeoplewithSchizophreniaManageSymptoms2016.pdf (461.9 KB)
