CLINICAL HANDBOOK OF SCHIZOPHRENIA

27. Illness Self-Management Training 269nerability, either by affecting the brain directly, or by lessening the protective effects ofmedication. Environmental stress can trigger symptom relapses and impair functioning.On the other hand, coping efforts (e.g., skills for reducing anxiety, solving problems, anddecreasing tension) can reduce the effects of stress, thus protecting individuals against relapses.Finally, social support can also reduce the effects of stress by either removingstressors or helping individuals cope with them more effectively.Based on the stress–vulnerability model, teaching illness self-management skills topeople with schizophrenia is guided by several overarching goals:• Increase medication adherence to reduce biological vulnerability.• Reduce substance use.• Reduce stress through stress management and involvement in meaningful activities.• Improve coping skills.• Improve social support.RESEARCH EVIDENCE FOR SPECIFICILLNESS SELF-MANAGEMENT PRACTICESReviews of research on teaching illness self-management skills have identified five specificpractices that improve the course of schizophrenia: psychoeducation, behavioral tailoring,a relapse prevention plan, and coping and social skills training.Psychoeducation involves providing factual information about the nature of schizophreniaand the principles of its treatment, using a combination of teaching strategies,such as didactic presentations and review of educational materials. Research on psychoeducationindicates that clients acquire and retain critical information about their illnessand its treatment. Although such information alone tends to have a limited impact on thecourse of illness, it is an important ingredient for clients’ informed decision making abouttheir treatment.Research on improving adherence to antipsychotic medication regimens has evaluateda variety of different strategies. The strongest empirical support is for behavioral tailoring,which has been shown to help people take their medication more regularly. Thisstrategy involves teaching clients how to incorporate taking medications into their dailyroutines to minimize the common problem of forgetting to take them.Developing a relapse prevention plan includes working with the client (and significantothers, when available) to identify the early warning signs of relapse, and devising aplan to monitor and to respond to those signs. Implementing relapse prevention plans iseffective at preventing relapses and rehospitalizations. Relapse prevention is frequentlyemployed in individual and family interventions for schizophrenia.Coping skills training involves teaching clients how to use coping strategies to minimizethe effects of persistent symptoms. Such training uses the principles of social learningtheory, including modeling, rehearsal, feedback, and home practice. For example, aclinician might model using “positive self-talk” to respond to negative voices, then askthe client to practice it. Research indicates that coping skills training reduces the severityand distress of persistent symptoms, such as auditory hallucinations, and improves people’sability to function in spite of the symptoms.Social skills training involves teaching interpersonal skills using the same sociallearning principles we just described. Research indicates that skills training effectively improvesthe quality of social relationships, especially when there are concerted efforts to