560 CHAPTER 12
is designed to strengthen cognitive abilities through extensive and focused practice
(Wexler et al., 1997). Researchers have reported that such practice enhances the abili-
ties to shift attention voluntarily, to sustain attention, and to reason, and increases
mental fl exibility (Krabbendam & Aleman, 2003; McGurk et al., 2007; Penadés et
al., 2006; Wexler & Bell, 2005; Wykes et al., 2003). However, this treatment is expen-
sive, and some studies fi nd that its effects do not generalize beyond the specifi c tasks
that are practiced (Silverstein et al., 2005). If in fact such practice does not generalize,
then this treatment will have only minimal effects on the patient’s functioning in the
real world. Research efforts are under way to determine which specifi c rehabilitation
techniques work to improve the general life skills of people with schizophrenia.Treating Comorbid Substance Abuse: Motivational Enhancement
Because many people with schizophrenia also abuse drugs or alcohol, recent re-
search has focused on developing treatments for people with both schizophrenia and
substance-related disorders; motivational enhancement is one facet of such treat-
ment. As we discussed in Chapter 9, patients who receive motivational enhancement
therapy develop their own goals, and then clinicians help them meet those goals.
For people who have both schizophrenia and substance-related disorders, one goal
might be to take medication regularly (Lehman et al., 1998). For people who have
two disorders, treatment that targets both of them appears to be more effective than
treatment that targets one or the other alone (Barrowclough et al., 2001).Targeting Social Factors in Treating Schizophrenia
Treatments that target social factors address three of the four general treat-
ment steps: They identify early warning signs of positive and negative symptoms
through family education and therapy; when necessary, such treatments involve
hospitalizing people whose symptoms make them unable to care for themselves or
whose symptoms put themselves or others at high risk of harm. These treatments
also reduce certain negative symptoms through social skills training and improve
overall functioning and quality of life through community-based interventions.
Community-based interventions include work-related and residential programs
(Tarrier & Bobes, 2000).Family Education and Therapy
By the time a person is diagnosed with schizophrenia, family members typically
have struggled for months—or even years—to understand and help their loved
one. Psychoeducation for family members can provide practical information about
the illness and its consequences, how to recognize early signs of relapse, how to
recognize side effects of medications, and how to manage crises that may arise.
Sucheducation can decrease relapse rates (Pfammatter, Junghan, & Brenner, 2006;
Pilling et al., 2002; Pitschel-Walz et al., 2001). In addition, family-based treatments
may provide emotional support for family members (Dixon, Adams, & Luckstead,
2000). Moreover, family therapy, as noted in Chapter 4, can create more adaptive
family interaction patterns:
In 1989, my older sister and I joined Mom in her attempts to learn more about manag-
ing symptoms of her illness. Mom’s caseworkers met with us every 6 to 8 weeks for
over 8 years. Mom, who had never been able to admit she had an illness, now told us
that she did not want to die a psychotic. This was one of the many positive steps that
we observed in her recovery. Over the years, other family members have joined our
group.... With the help of the treatment team, we can now respond effectivelyto
Mom’s symptoms and identify stress-producing situations that, if left unaddressed, can
lead to episodes of hospitalization. With Mom’s help we have identifi ed the different
stages of her illness. In the fi rst stage, we listed withdrawal, confusions, depression,
and sleeping disorder. Fifteen years ago when mom reported her symptoms to me, I just
told her everything would be okay. Today we respond immediately. For 8 years she has
maintained a low dosage of medications, with increases during times of stress.
(Sundquist, 1999, p. 620)