Schizophrenia: Practical Strategies for Relapses & Reducing Symptoms

In the last section, we discussed three of five common negative symptoms of schizophrenia.  The three negative symptoms that we discussed were apathy, incongruous emotional responses and reductions in speech. 

In this section, we will discuss the remaining two common negative symptoms of schizophrenia.  The remaining two negative symptoms that we will examine are social withdrawal and reduced social performance.  As with the last section, the focus of this section is to provide examples of negative symptoms and applicable techniques that schizophrenic clients can use to cope with or reduce those symptoms.  While listening to this section, you might consider how to implement the techniques with your client.

5 Negative Symptoms of Schizophrenia (#4 & #5)

♦ Sympton #4 - Social Withdrawal
First, let’s examine social withdrawal.   Remember Gloria from the last section?  Gloria used the Communication Skills Building technique to cope with reductions in speech.  However, Gloria retained a tendency to cut herself off from people socially.  Gloria’s social withdrawal was characterized by difficulty making eye contact and a general uncomfortable feeling when she was in social situations. 

Gloria stated, "It’s so hard to look at people.  Sometimes I get the feeling that if I don’t look at them, they lose their ability to know what I’m thinking."  Think of your client.  Does he or she experience social withdrawal as aresult of paranoid symptoms?  If so, then perhaps the "Look at Me When You Talk" technique can benefit your client.

♦ "Look at Me When You Talk" Technique, 4 Steps
To help Gloria avoid social withdrawal and to foster an acceptance of eye contact, I asked her to try the "Look at Me When You Talk" technique.  As I describe the "Look at Me When You Talk" technique, consider how you can best implement the technique with your client. 

--Step 1: First, I explained the importance of eye contact to Gloria.  I stated, "Eye contact is part of how we communicate.  It is almost as important as our words.  It lets people know we are interested in what they are saying.  Eye contact helps build trust, and that can be important in both work and social situations.  Do you agree?"  Gloria stated that she agreed, so I moved to the second step in the "Look at Me When You Talk" technique. 

--Step 2: The second step was to talk with Gloria about what bothered her when she looked at someone.  As I described earlier, Gloria’s uneasiness was the result of paranoid delusions that eye contact made it easier for others to read her thoughts. 

--Step 3: In addition to explaining the importance of eye contact and discussing the client’s uneasiness regarding eye contact, the third step in the "Look at Me When You Talk" technique was for Gloria to practice making eye contact.  I had previously noticed that Gloria avoided eye contact during our sessions, so I asked her to practice looking at me when she was talking. 

--Step 4: In the fourth step, I began pointing out when Gloria didn’t make eye contact.  I worked with Gloria to help her become aware of lapses in her eye contact.

When she felt comfortable with looking at me, I asked her if she could start looking at others when she talked to them as well.  Gloria later stated, "I’m starting to think that maybe people can’t tell what I’m thinking after all.  Because when I talk to some people, they don’t have a clue what I mean.  But if I make eye contact and have a little patience when explaining myself, most people usually catch on." 

Think of your Gloria.  If your client began to feel comfortable around others in a social setting, could his or her symptoms decrease?  Could the "Look at Me When You Talk" technique benefit your client?
 
♦ Symptom #5 - Reduced Social Performance
In addition to social withdrawal, the second negative symptom we I will describe is reduced social performance.  You have probably found that reduced social performance can sometimes be a result of reductions in speech.  Also, reduced social performance can lead to social withdrawal.  Therefore, previously described techniques may benefit your client if he or she suffers reduced social performance. 

However, I have found that some clients experience reduced social performance as a result of the way they feel.  You are well aware that schizophrenia isn’t typified by self-confidence or feelings of well-being. Peter was no different. Peter, age 32, stated, "I didn’t used to dress like such a slob. Before I became ill, I had good hygiene and took care of myself. But now I feel like shit all the time because I hear this running commentary in my head about myself, what I’m thinking, even what I’m doing." 

Do you agree that when clients feel ill, they sometimes don’t dress well or take care of their hygiene?  I stated to Peter, "Your hygiene and appearance might cause problems, because if you don’t look well, people might think something is wrong with you."  I gave Peter a list of things he could do to improve on his reduced social performance. 

Peter's List to Improve his Reduced Social Performance
1.   Shower daily.
2.   Use deodorant.
3.   Keep your hair clean.
4.   Stay clean shaven.
5.   Brush your teeth daily.
6.   Wear clean clothes.
7.   Take off your coat whenever you are in a heated room.

Think of your Peter.  Could a similar list help foster increased hygiene for your client?  If so, you might consider what items to include on your list and appropriate wording so that your client will accept the list. 

In this section, we have discussed the remaining two common negative symptoms of schizophrenia.  The remaining two negative symptoms that we examinee were social withdrawal and reduced social performance

In the next section, we will discuss the stigma of schizophrenia.  Three topics we will examine are prejudice, stereotypes, and who to tell.  We will also discuss how clients can deal with prejudice and stereotypes.

Peer-Reviewed Journal Article References:
Diamond, D. (2018). Changes in object relations in psychotherapy with schizophrenic patients: Commentary on Carsky and Rand (2018). Psychoanalytic Psychology, 35(4), 410–413.

Holzman, M. S., & Forman, V. P. (1966). A multidimensional content-analysis system applied to the analysis of therapeutic technique in psychotherapy with schizophrenic patients. Psychological Bulletin, 66(4), 263–281. 

Leventhal, D. B., & Shemberg, K. M. (1977). Treatment failures and technique modifications in the out-patient psychotherapy of schizophrenic college students. Psychotherapy: Theory, Research & Practice, 14(1), 49–51.

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 3
What are two of five common negative symptoms of schizophrenia? To select and enter your answer go to Test.