CLINICAL HANDBOOK OF SCHIZOPHRENIA

258 IV. PSYCHOSOCIAL TREATMENTFIGURE 25.3. A model for cognitive remediation therapy.fer skills need to be reinforced further by integrating them into different rehabilitation orlife skills programs by other rehabilitation specialists. The general principles for successfulgeneralization need to be followed in a comprehensive rehabilitation service to enableclients to achieve their full potential. We can now be much more optimistic about realizingthis potential given the development of these new cognitive rehabilitation technologies.This type of therapy has been adopted in the cognitive enhancement models andseems to be of benefit.TREATMENT GUIDELINES1. Initial assessment. Investigate the range of severity of cognitive difficulties andstrengths.2. Identify personal goals. Cognitive rehabilitation needs to involve participantsand improve motivation by the incorporation of cognitive activities that lead directly tothe achievement of a personal goal.3. Therapeutic environment. Provide a structured environment initially that reducesdistraction.4. Therapeutic relationship. The therapeutic relationship reduces social demand, instillsa sense of being valued, and provides a forum to offer positive feedback abouthealthy cognitive behavior (thus promoting self-esteem).5. Individual tailoring of sessions. Tailor sessions to an appropriate length, dependingon mood, mental state, level of fatigue, and so forth, and include a variety of tasksthat make varying demands in terms of the types of skills required and the level of complexity.6. Learning. Learning should be constructive and reflective rather than passive, butbe guided by the therapist using modeling and shaping, Socratic questioning, andmultimodal practice.