Schizophrenia: Practical Strategies for Relapses & Reducing Symptoms

In the last section, we 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. 

In this section, we will discuss a model for helping clients understand the experience of enjoyment.  As you probably know, Dr. Fred Bryant has studied the factors involved in people’s experience of enjoyment and pleasure.  Bryant indicated through his research that there are three stages of enjoyment.  These three stages of enjoyment are anticipation, savoring the experience, and reminiscing. 

We will examine these three stages of enjoyment through how Joann, the mother of a client, helped her schizophrenic son Hank increase his experience of enjoyment.  We will also discuss the six steps for improving leisure and recreation.  In applying these three stages of enjoyment to the treatment of schizophrenia, I have found that clients can experience longer periods of enjoyment and get the most out of leisure and recreational activities. Sound interesting? 

3 Stages of Enjoyment

♦ Stage #1 - Anticipation
First, let’s discuss anticipation.  Clearly, people look forward to activities that they enjoy.  However, clients with schizophrenia may have difficulty anticipating pleasant events.  I reviewed a model for understanding the experience of enjoyment with Joann.  Joann was the mother of a schizophrenic client of mine, Hank.  Hank had only recently been released from the hospital where he was diagnosed.  Hank, age 17, had difficulty anticipating pleasant events. 

I stated to Joann, Hank’s mother, "You can help Hank anticipate enjoyable activities by talking to him in a lighthearted way about an upcoming event."  Joann highlighted aspects of a museum visit that she expected to be positive.  Joann stated to Hank, "I’m really looking forward to visiting the museum again.  I just love the grand scale of the architecture."  By using ‘I’ statements, Joann displayed her own positive anticipation.  Joann then asked Hank what he enjoyed about the museum in order to prompt Hank to consider other pleasant elements of the experience.  Do you have a Hank who could benefit from increased anticipation of a pleasant event? 

♦ Stage #2 - Savoring the Experience
The second of the three stages of enjoyment is savoring the experience.  Due to cognitive difficulties, Hank had trouble paying attention to detail.  Joann, Hank’s mother, stated, "Hank has a hard time focusing on anything for very long.  So when he’s doing something he enjoys, it can be hard for him to really enjoy the moment."  I stated to Joann, "When you participate in an activity with Hank, it might benefit him for you to help him savor the experience. Talk out loud about what you are enjoying and encourage Hank to identify what he is enjoying in the moment." 

Joann later told me about her and Hank’s experience dining out after they had visited the museum.  Joann stated, "At the restaurant, while we were eating appetizers, I told Hank how  much I liked the décor of the restaurant and the ambience. When I asked Hank what he liked, he mentioned the unusual spices the chef used. Then he started talking about how nice the waiter was. Hank was really enjoying himself and said he really liked the dessert selection. So we saved room and ordered three desserts to share and talk about. Hank was really into it. We talked about the flavor, the texture, and the appearance of each dessert." 

Think of your Hank.  Could learning to savor the experience help your client to maximize the experience of enjoyment?

♦ Stage #3 - Reminiscing
In addition to anticipation and savoring the experience, the third stage of enjoyment is reminiscing.  After a pleasant event is over, can your client look back on it in ways that prolong or rekindle their enjoyment of the experience?  I have found that clients with schizophrenia like Hank have difficulty reminiscing.  Joann helped Hank with reminiscing by practicing recalling memories about the experience and focusing together on the most enjoyable parts.  To help Hank develop better memory recall, Joann started by asking him to recall memories soon after enjoyable experiences. 

Joann stated, "It’s much easier for Hank to remember things when they are fresh in his mind.  Then, later, it’s easier for him to remember again."  For example, Hank attended a Thursday night cooking class.  Joann recalled Hank returning from class.  Joann stated, "I asked him about what happened, who he talked to, what he made, how he made it, and what ingredients he used.  Then the following night, we prepared the same recipe together."  Does your Hank have trouble reminiscing?  Could the memory recall techniques that Joann used help your client?

Understanding and attending to the previous three stages of enjoyment can be a good foundation for fostering an enjoyment of leisure and recreation.  However, some clients with schizophrenia also benefit from help identifying and following through on developing new leisure and recreational activities.  Therefore, you may find the following steps for improving leisure and recreation useful.  As I read through these six steps, you might consider your client or a family member who could benefit from these steps.

♦ 6 Steps for Improving Leisure and Recreation
Step 1: Identify the benefits of leisure and recreation.
Step 2: Explore possible activities that the client may enjoy.
Step 3: Select an activity and develop a plan for the client to try it.
Step 4: Follow up on how the activity was enjoyed.
Step 5: Make another plan to try the activity or choose a new activity.
Step 6: When an enjoyable activity has been found, develop a regular routine.

Would you agree that for the client or for his or her family member, these six steps for improving leisure and recreation could be productive when implemented with respect to the three stages of enjoyment?  Could playing this section for a family member of your client be a good idea?

In this section, we have discussed a model for helping clients understand the experience of enjoyment.  This discussion was based on Bryant’s three stages of enjoyment.  These three stages of enjoyment are anticipation, savoring the experience, and reminiscing.  We also discussed six steps for improving leisure and recreation.

In the next section we will discuss independent living and self-care.   Seven basic guidelines can assist either the therapist or a family member in improving independent living and self-care.  The seven guidelines for improving independent living and self-care that we will discuss in the next section are discussing the reasons a specific skill area is important, agreeing on specific steps of the skill to work on, setting goals, demonstrating skills, practicing the skill, agreeing on a plan for the client to try the skill on his or her own, and planning follow-up.

Peer-Reviewed Journal Article References:
Gard, D. E., Sanchez, A. H., Cooper, K., Fisher, M., Garrett, C., & Vinogradov, S. (2014). Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both? Journal of Abnormal Psychology, 123(4), 771–782.

Hallford, D. J., Farrell, H., & Lynch, E. (2020). Increasing anticipated and anticipatory pleasure through episodic thinking. Emotion. Advance online publication.

Painter, J. M., & Kring, A. M. (2016). Toward an understanding of anticipatory pleasure deficits in schizophrenia: Memory, prospection, and emotion experience. Journal of Abnormal Psychology, 125(3), 442–452. 

Riehle, M., & Lincoln, T. M. (2018). Investigating the social costs of schizophrenia: Facial expressions in dyadic interactions of people with and without schizophrenia. Journal of Abnormal Psychology, 127(2), 202–215.

Sum, M. Y., Chan, S. K. W., Tse, S., Bola, J. R., & Chen, E. Y. H. (2021). Internalized stigma as an independent predictor of employment status in patients with schizophrenia. Psychiatric Rehabilitation Journal, 44(3), 299–302.

QUESTION 13
What are the three stages of enjoyment? To select and enter your answer go to Test.