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On the last track we discussed anger due to schizophrenia. Our discussion included three main topics. These three topics were anger related to delusions, strategies for coping with anger, and problem solving strategies for clients with schizophrenia.
On this 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. As you listen to this track, you may consider evaluating my methods of coping with cognitive difficulties. You are encouraged to adapt these techniques for your own use, or integrate them directly into your sessions. Also, you may consider playing this track for the caregiver of your client for implementation of these techniques at home.
#1 Attention and Concentration
--a. First, I worked with Joseph to determine how long he could focus on a specific task. Prior to becoming ill, Joseph liked to play computer games. Therefore, I monitored Joseph as he attempted to play a simple game on my office computer. Because Joseph’s concentration was affected by noise, I made sure that possible distractions, such as fans, air conditioners, or telephones, were eliminated. Joseph was able to maintain his focus for about three minutes before he lost track of what he was doing.
--b. Second, I asked Joseph to work out a schedule of breaks with respect to his current attention span. Joseph decided to play the computer game for two and a half minutes, take a short break, and then continue. In addition to determining the Joseph’s attention span and scheduling appropriate breaks, the final step in the Attention Span Shape Up technique was to gradually increase Joseph’s duration of focus.
Over the next few weeks, I worked with Joseph to increase his attention span from three minutes to seven minutes. During this time, I was careful not to overtax Joseph by increasing his attention goals to much. Would you agree that higher expectations for clients like Joseph can lead to discouragement?
#2 Information Processing Speed
For example, if your client has trouble unlocking the front door when she comes home, perhaps she could label her keys and practice unlocking the door three times. When her time improves, she could start practicing unlocking the door five times. Would you agree that for client’s with decreased information processing speed, practice can help with certain tasks?
#3 Memory and Learning
Also, psychotic symptoms can distract a client from learning. Long term memory problems can occur when the client fails to view particular information as personally relevant or important. Think of your client who has memory and learning problems. Consider the benefits of identifying which other cognitive difficulties affect your client’s memory and learning abilities. Could identification of other cognitive difficulties help you resolve your client’s memory and learning problems?
#4 Executive Functions
Therefore, identifying other cognitive difficulties which affect executive functions can be a productive way to help a client begin to overcome cognitive difficulties. Problems in executive functions can lead to a variety of different life challenges, such as poor money management, inability to identify and take steps toward personal goals, and failure to anticipate certain consequences of certain actions. Could your client’s difficulty with executive functions be related to other cognitive difficulties?
#5 Social Cognition
Mick, age 37, had difficulty understanding common social rules, and had trouble ‘taking a hint’ or ‘getting a clue’ in certain situations. Mick stated, "I guess my problem is that I don’t know when to talk or what not to say. Sometimes I’m unsure of what people mean when they tell me things." Mick’s sister, Jean, clarified. She stated, "If I tell Mick he smells bad, I’m not trying to put him down. I’m just trying to let him know he needs to shower, but he doesn’t get it. It’s like he can’t read between the lines. And he’ll strike up a conversation with a perfect stranger like it’s no big deal. Even if it’s obvious the stranger doesn’t want to talk, Mick will start jabbering about his bowel problems, or something ridiculous like that."
Consider your client’s social behavior. Is his or her social cognition affected by schizophrenia? If so, then perhaps the coping strategies in the Social Awareness technique could benefit your client.
Step 1: I stated, "First, consider using explicit feeling statements. Instead of telling Mick that he smells bad, you could be direct by telling him he needs to shower and use deodorant."
Step 2: The second step Jean used in the Name That Emotion technique, was discussing social norms with Mick. Jean stated, "Maybe it would help if I talked to Mick about what to say and what not to say when he talks to people he doesn’t know very well." Jean matter-of-factly informed Mick about how much to reveal about himself to people he is meeting for the first time.
Step 3: In addition to using explicit feeling statements and discussing social norms, the third step in the Name That Emotion technique was for Mick to practice recognizing facial expressions. Jean implemented the third step by playing "Name That Emotion" with Mick. First, Jean wrote down the names of different emotions, and put them into a hat.
Then Jean and Mick took turns pulling out an emotion and displaying that emotion through facial expressions. Mick and Jean attempted to guess the emotion the other person was displaying. What about your Mick? Could the Social Awareness technique help him increase his social cognition?
On this track we have discussed cognitive difficulties. We examined five basic cognitive skills. The five basic cognitive skills we will examined are attention and concentration, information processing speed, memory and learning, executive functions, and social cognition.
Schizophrenia in Children and Adolescents
- Freed, C., Rando-Smelcer, C., McNabb, H. R., Stotts, J., and Wood, W. G. (2013). Schizophrenia in Children and Adolescents. TDMHSAS Best Practice Guidelines. p. 232-261.
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