CLINICAL HANDBOOK OF SCHIZOPHRENIA

210 IV. PSYCHOSOCIAL TREATMENTFIGURE 21.1. Examples of three CAT interventions, one for each behavioral type—apathetic (A),disinhibited (B), and mixed (C)—for someone with poorer executive functioning.skills. For example, for someone with poor attention, the color of signs can be changedregularly or fluorescent colors can be used to capture attention. For someone with memoryproblems (particularly those with good auditory attention) audiotapes can be used tosequence behavior.CAT interventions are established and maintained in the home by weekly visits froma CAT therapist/trainer. Individuals with bachelor’s and master’s degrees have beentrained to do CAT. Fidelity to the model has been high. Intervention in studies publishedto date has lasted for 9 months. Studies of the effect of fading visits from weekly tomonthly following 9 months are currently under way. During fading, we work to trainthe individual to set up the supports on his or her own (e.g., filling his or her own pillcontainer weekly) and provide a month’s worth of supports where possible (e.g., checkliststhat cover 5 weeks). Treatment typically begins by targeting client-identified goals,safety issues, and medication adherence. Over time, treatment targets a broad range offunctional behaviors that include finding employment and engaging in leisure activities.Patients who participated in a 9-month CAT treatment program were found to havelower levels of symptomatology and fewer relapses than those in standard treatment andcontrol conditions. In addition, CAT has been found to improve adaptive functioning andcommunity adjustment compared to standard and control treatments. Moreover, CAThas been found to improve adherence to medication regimens, as assessed by unannouncedin-home pill counts. In summary, CAT strategies can improve a broad range ofoutcomes for individuals with schizophrenia.OTHER WAYS TO USE ENVIRONMENTAL SUPPORTSGeneric Environmental SupportsFull CAT treatment is somewhat labor intensive and requires individualized treatmentplans and home visits. As an alternative to CAT, it might be possible to provide importantenvironmental supports, such as medication containers, calendars, watches, remindersigns, and hygiene checklists and supplies to patients when they come in for routine medi-