CLINICAL HANDBOOK OF SCHIZOPHRENIA

37. Treatment of the Schizophrenia Prodrome 385• Identification of cognitions associated with subjective feelings of stress or heightenedanxiety, which may include the completion of relevant inventories.• Cognitive restructuring of dysfunctional thoughts that may be maintaining anxiety/stress are countered with a more functional cognitive style (e.g., more positive copingstatements, positive reframing, and challenging).Other strategies include goal-setting and time management, assertiveness training, andproblem solving.Positive SymptomsThe strategies incorporated within this module are primarily drawn from cognitiveapproaches to managing full-blown positive symptoms. The goal of this module is toenhance strategies for coping with positive symptoms when they occur, to recognizeearly warning signs of these symptoms, and to prevent their exacerbation through theimplementation of preventive strategies. The fact that the experience of positive symptomsby UHR individuals is less intense and/or less frequent than that of individualswith frank psychosis can assist in guiding UHR individuals to recognize and managethese symptoms. For example, unusual perceptual experiences may be more easily recognizedas anomalous, and attenuated delusional thoughts may be more easily dismissedor challenged than more entrenched delusional thoughts. Strategies include thefollowing:• Psychoeducation about symptoms, including a biopsychosocial account of the originsof unusual experiences tailored to the individual patient. This can serve both to“normalize” these experiences and enhance motivation for treatment. It is important thatthe therapist’s language be modified appropriately for this population. For instance, becausethese individuals have not been diagnosed with a psychotic disorder, it may not behelpful to use the term psychosis. Use of this term may depend on the individual’s level ofanxiety about the possibility of developing a psychotic disorder and his or her generalcognitive level. Generally, it is most useful to adopt the language that patients use to referto their unusual experiences. Focusing discussion on dealing with current symptoms is oftenmore productive than concentrating on the potential negative outcomes.• Verbal challenge and reality testing of delusional thoughts and hallucinations. Anindividualized, multidimensional model of beliefs relating to delusional thinking or perceptualabnormalities is developed. This model is based on issues such as the meaningthat the individual attributes to the experiences, the conclusions that he or she drawsfrom the experiences and how he or she explains them. This model is then challenged byexamining its supporting evidence and generating and empirically testing alternative interpretationsof experiences.• Coping enhancement techniques, such as distraction, withdrawal, elimination ofmaladaptive coping strategies, and stress reduction techniques.• Normalizing psychotic experiences. Suggesting to patients that their attenuatedpsychotic symptoms are not discontinuous from normality or unique to them can serve todecrease some of the associated anxiety and self-stigma.• Self-monitoring of symptoms to enhance the client’s understanding of the relationshipof his or her symptoms to other factors, such as environmental events and emotionalstates. An important component of self-monitoring is for the patient to be alert to anyworsening of symptoms, which might indicate the onset of acute psychosis.