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On the last track we discussed five strategies for managing conflict. These five strategies for managing conflict are avoiding blame, speaking calmly, being concise, discovering points of view, and focusing on the present.
On this track we will discuss anger due to schizophrenia. Our discussion will be include three main topics. These three topics are anger related to delusions, strategies for coping with anger, and problem solving strategies for clients with schizophrenia. As you listen to this track, consider your client. Could hearing this track benefit your client or his or her family member?
#1 Anger Related to Delusions
Samantha, age 32, also experienced paranoid delusions in which supernatural forces worked together with the FBI in a conspiracy with the cable company to spread false rumors about her sexual thoughts. Samantha often became angry during our sessions when her delusions were active. Samantha once stated, "I’m being watched! They’re reading my thoughts and there’s nothing I can do about it!" Think of your Samantha. How would you have responded to this outburst?
#2 Strategies For Coping With Anger
For example, to validate Samantha’s anger, I stated, "That must be upsetting. It must be hard to feel like you can’t have private thoughts." Samantha stated, "It is! I get so mad sometimes! That’s why I break things!" Further validating Samantha’s anger, I stated, "I can understand. It sounds very frustrating." Samantha responded by stating, "Yeah. Sometimes I feel like giving up." I stated, "I’m glad you haven’t given up yet. Maybe we could figure out ways of helping you get more control over your life."
Samantha stated that she would like to get more control over her life. This redirection of her focus from anger to hope made it possible for her to begin reducing symptoms. Think of your Samantha. Does frustration over psychotic symptoms anger your client? Would your client benefit from validation or considering alternative explanations for psychotic symptoms like delusions or hallucinations?
#3 Problem Solving Strategies for Clients with Schizophrenia
To help Brianna’s father cope with his daughter’s anger, I asked him to use a six step problem solving formula. The six steps in the problem solving formula were identifying the problem, brainstorming solutions, discussing each solution, choosing the best solution, planning how to implement the solution, and setting a solution review date.
Brianna’s father stated, "Once she calmed down, I approached her and we agreed to meet and solve the problem together. Brianna told me that she was upset and annoyed that I kept reminding her to take her medication. She said it made her feel as though I was treating her like a child." Clearly, Brianna felt responsible enough to take her medication on her own. However, Brianna’s father expressed concern because Brianna had stopped taking her medication before. He stated, "She’s gone off her meds before, and it’s never good. Brianna relapses quickly, and she’s been re-hospitalized twice. But, I agreed to work on the problem of her taking her meds without my reminders."
Brianna and her father sat down to have a problem-solving meeting. They brainstormed possible solutions. Brianna’s father stated, "We decided to figure out a strategy that would help Brianna remember to take her meds before she went to bed. Brianna had the idea of getting a pill box to put her pills into the week before. She kept the pill box next to her toothbrush."
Brianna and her father also agreed to have a follow-up meeting each week for a month to decide if any changes needed to be made. At a later session, Brianna’s father stated, "The strategy was effective. Brianna takes her medication on her own, and I learned to trust her to do it on her own." Could a problem solving formula benefit your client?
On this track we have discussed anger in schizophrenia. Our discussion will be include three main topics. These three topics are anger related to delusions, strategies for coping with anger, and problem solving strategies for clients with schizophrenia.
On the next track we will discuss cognitive difficulties. We will examine five basic cognitive skills. Our discussion will focus on how schizophrenia affects each basic cognitive skill and ways to cope with the resulting cognitive difficulties. The five basic cognitive skills we will examine are attention and concentration, information processing speed, memory and learning, executive functions, and social cognition.
Peer-Reviewed Journal Article References:
Batscha, C. (1996). Review of Letting go of anger, Angry all the time, Mind over mood, The clinician’s guide to mind over mood and Coping with schizophrenia [Review of the books Letting go of anger, , Angry all the time, , Mind over mood, , The clinician’s guide to mind over mood, , & Coping with schizophrenia, by R. Potter-Efron, P. Potter-Efron, R. Potter-Efron, D. Greenberger, C. A. Padesky, C. A. Padesky, D. Greenberger, K. T. Mueser & S. Gingerich]. Psychiatric Rehabilitation Journal, 20(1), 74–77.
Lysaker, P. H., Bryson, G. J., Marks, K., Greig, T. C., & Bell, M. D. (2004). Coping style in schizophrenia: Associations with neurocognitive deficits and personality. Schizophrenia Bulletin, 30(1), 113–121.
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