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Schizophrenia is a metal disorder that is characterized by the collapse of the thought processes and all overall lack of general emotional responses. This results in marked susceptibility to stress (Seidman, 1984; Zubin, 1986). Therefore, stress coping and the nature of the disorder complicates the severity of the condition.

Schizophrenia is characterized with relapses and there are premonitory symptoms and phases of decomposition that require effective stress management (Herz, 1989). Relapses are especially occur and are associated with stressful times and events (Leff and Vaugh, 1985). Stressful moments, interactions and the treatment environment necessitate possible relapses. Studies have suggested that identification of the premonitory symptom and early intervention can be effective reducing relapses (Herz et al, 1989).     

There are no known phases in the recovery process that needs to be spelt out in the treatment of schizophrenia. Such efforts will precipitate decomposition due to over aggressive rehabilitation procedures. Practitioners have reported that aggressive rehabilitation attempts have resulted in relapses during the early stages of the treatments (Drake & Sederrer, 1986).

It is known that treatment has generally focused on symptoms reduction in schizophrenia, little focus has been put on the subjective experiences of the individual suffering from schizophrenia (Strauss & Estroff, 1989). According to Strauss (1989) addressed the need to focus on the interaction between the individual and his disorder. Goals, feeling and management were some of the questions addresses using this line of treatment.  Estroff (1989) focused on the impact of the self of the individual suffering from the disorder. Unlike, assessment and treatment focus which primary focused on symptoms reduction it ignored the psychosocial functioning which forms a core component in the treatment of schizophrenia. Rather as stated by (Strauss, 1989) “attention to life trajectories, personal goals, characteristic approaches to regulating one's life... is essential."

The use of CBT can be used in a residential and impatient setup

According Kingdom and Turkington (1991, 1994) results the use of CBT resulted in reduced levels of symptoms, hospitalization and improved psychosocial functioning. Another study done Perris (1992) reported successful use of CBT with patients living at home in Sweden.

A research study design of CBT with four schizophrenic persons who participated in an outpatient treatment, the persons has significant reductions in symptoms, re-hospitalization, improved social adjustment and treatment goals were achieved even after one year.

Problem Behavior & Baseline Data

I am a youthful female of 26 years in age. I have gone through education in high school and 1 year in college. I grew up in middle class family that cherished accomplishment in education and career just as their Christian faith. I am the third born in a family of five. I was excellent in class and at home, which gave me all that I was doing and quite focused. My social life was characterized by shyness though with a number of friends and dated in fewer times.

After graduating from high school education, I joined a college that was outside the state. My success shown once again in my first year, however I started to undergo hallucinations and delusions. My behavior was out of the normal and I separated myself from others. Due to this condition, I was in no position to work and got support from SSI. The illness was bizarre as it had not risen from my family past. My family on the other hand gave all the support that I needed be it financially or emotionally.

I was released from the psychiatric hospital two months later from inpatient treatment. My diagnosis was schizophrenia, undistinguishable type, chronic. My Global Assessment of Functioning (GAF) when I was being discharged was 30. I stayed with my parents and was placed on the support of SSI. My daily dose comprised of 500 mg of thorazine and was medication bound.

On my release from the psychiatric hospital, I was supposed to undergo a continued psychotherapy so as to enable me to get used to the needs of staying with the community and handle the illness. Cognitively I underwent auditory persecutory hallucinations and delusions in addition to perceptions that were negative that were negative of my condition. Emotionally I experienced a flat emotional impact and nervousness that were connected to inner conditions, duties and the composition of hallucinations and delusions. Internally I was alone and kept a distant from the social setting. My character was dormant; I could not do anything or live without the support from anyone.

My psychosocial aspect was in a big way harmed by the connection with the illness and my mode of handling it. The hallucinations, delusions and perceptions of my condition affected my daily life. My way of handling it was through evading duties and inner conditions and the rise in negative signs to manage stress on the other hand elevated anxiety, negative cognitions and psychotic conditions. 

Treatment and Intervention

The treatment rationale was within the CBT model. Cognition, mood, physiology and behavior were all important. CBT helps in all levels. It intervenes in restructuring for maladaptive thoughts, better management of negative emotion, imagery mediation and relaxations clams the body and also centers their attention towards the treatment goals. The therapeutic relations were collaborative. It used logic and empiricism as form of homework. It also emphasized on guide discovery to help me identify cognitive errors. To overcome various obstacles to treatment such as non compliance, I was accessed as to the actual cause of noncompliance through asking questions, use of guided discovery to confirm the problem. Therapy secession were friendly, non hostile or impatient. I also educated myself about the CBT model and persistent non compliance is an indicator of a negative outcome. The treatments were divided into monthly sessions. The sessions begun by setting the agenda for the session, review homework assignment completed since the last session, assigning new homework and lastly asked about outcome of the sessions. Behavioral treatments focused on assertive training, anger management, relaxation, improvement productivity and managing schizophrenia. 

The treatments were divided into phases: early phase treatment and middle phase. Early phase of treatment, focused on activities and my difficult to manage stress and anxiety. In order to help me cope, a weekly schedule of activities was structured. A calendar was used to record my activities and was divided into three: morning, afternoon and evening. These activities were reviewed by therapist and I in order to give a picture of areas of improvement or activities that worsen my condition. Also, it helped me understand my reaction to different events in my life. The tasks using a graded hierarchy were used starting with small task to increase my level of activity.

Middle treatment was estimated to take approximately 16 months. It stresses on identification of habitual stressful situations and cognitive strategies to cope. Social situations impact of schizophrenia self and fear of relapse. Role-play with the therapist was used to improve my social skills. Social skills training were used to nature coping in interpersonal situations. Two social skills were addressed. This included feelings and assertiveness. Specific stressful situations were indentified and plans were made by the therapist to make them positive in coping with stress. In addition, cognitive skills were developed guide discovery, modeling, rehearsal, role-play and assignments. I enrolled in a community college, began going out with friends and volunteered in a hotel.  With the increase interactions and interpersonal communication I begun to experience heightened anxiety. Therefore, I was required to create a balance between social interaction and my time alone to prevent a possible relapse. The fears of relapses were dealt in a number of ways. First: education about my condition and subsequent interpretation of my experiences to help normalize my condition. Second, preventive actions such as medication, reviewing my stress thermometer, activities, exercise and proper diet to protect against possible relapses. Lastly, fears were examined through a questionnaire to determine countermeasures.

Discussion and Results

The study made use of four resultant variables: symptomatology, active psychosocial, acquisition of treatment objectives and hospitalizations. Symptomatology was estimated through Global Pathology Index (GPI) that applied the Psychiatric Rating Scale from Hopkins (Derogatis, 1974). The GPI is a scale that is used to measure the behaviour of a patient by describing a number of symptoms. Psychosocial aspect was measured through Role Functioning Scale (RFS) (McPheeters, 1988). The scale is comprised of four sections: work, social, family and autonomous living. Every section is a composed of a 7-point behaviorally based scale. Both the RFS and GPI are scales that with regard to the rater. Hospitalization was estimated by the frequency a patient is hospitalized and sum of days they were in the hospital.

Meeting of the treatment objectives was estimated using the Goals Attainment Scaling (GAS) (Kiresuk & Sherman, 1968). In this form of scaling, the behaviorally attributes of the operation are acquired by the number of sections of goal successes and the ones met by the client. A score that varies from -2 (regression in objectives met) through 0 (meeting of goal) to +2 (surpassing the standards) is allocated for every goal with regard to the client’s accomplishment.

Results

I underwent advancement in psychosocial operation, success of objectives; a drop in symptomatology and several hospitalizations kept at 6 months and 1 year follow up (cf. Table 1). Based on psychosocial operation I advanced in work, autonomous living and social connection. The general score showed the psychosocial functioning score. My score was 27 at the end of the study showing development in social connection. Symptomatology was low. My score was 7 showing severe reading of the condition; hallucinations and delusions, error in judgment, inability to handle myself among others.

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