CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 27ILLNESS SELF-MANAGEMENT TRAININGKIM T. MUESERSUSAN GINGERICHIllness self-management is a broad set of strategies aimed at teaching people with schizophreniahow better to manage their illness in active collaboration with professionals,family members, and other supporters. The short-term goals of teaching illness selfmanagementare to reduce relapses and rehospitalizations, and to improve coping withpersistent symptoms to maximize functioning and subjective well-being. The long-termgoals of teaching illness self-management are to promote greater independence, betterrole functioning (e.g., work, school, parenting), more rewarding social relationships, anda stronger sense of purpose and self-confidence. These long-term goals are often referredto as recovery, even when they occur in the context of persistent symptoms.PRINCIPLES OF ILLNESS SELF-MANAGEMENTThe principles of illness self-management are derived from the stress–vulnerability modelof schizophrenia. According to this model, the origins and course of schizophrenia aredetermined by the dynamic interplay among biological factors, the environment, and personalcoping efforts. Specifically, the symptoms and associated impairments of schizophreniaare assumed to have a biological basis, determined by genetic and other biologicalfactors (e.g., obstetric complications), that may interact with social–environmentalstress (e.g., life events such as the death of a loved one or being the victim of a crime;living in a hostile, critical social environment). If sufficient biological vulnerability exists,schizophrenia will develop regardless of the extent of exposure to environmental stress,whereas, in other cases, stress may trigger the disorder in vulnerable individuals. Onceschizophrenia has developed, symptoms, relapses, and functioning are influenced by biological,environmental, and psychological factors.In terms of biological factors, medication can reduce the biological vulnerability thatunderlies the disorder. Drugs and alcohol, on the other hand, can increase biological vul-268