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Section 8
Coping with Psychotic Symptoms of Schizophrenia

Question 8 | Test | Table of Contents

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In the last section, we related the implementation of Gary’s relapse prevention plan.  We also discussed three steps a single family member or close friend can take to make it easier to head off a relapse.  The three steps a single family member or close friend can take are finding help, developing stronger relationships with the treatment team, and joining a self help advocacy association.

If you recall from section one and our discussion regarding the diagnosis of schizophrenia, Tyler, age 28, was paranoid delusional and suffered from auditory hallucinations. 

In this section, we will resume our discussion of Tyler’s case.  We will examine coping with positive symptoms of schizophrenic psychosis.  To illustrate Tyler’s coping strategies, we will discuss three specific strategies that Tyler found productive.  These three coping strategies for positive symptoms of schizophrenic psychosis are reality testing, self talk, and coping when losing control.  As you listen to this section, consider your client.  Could he or she identify with Tyler?  Or could playing this section for your client or a family member provide them with useful coping tools for positive symptoms?

♦ Positive Symptoms
First, let’s look at Tyler’s positive symptoms.  As you know, positive symptoms of schizophrenia are often treated with medication.  After Tyler’s first episode of schizophrenia, however, he frequently avoided taking his medication.  Although Tyler understood that his psychotic episodes were much worse than the side effects of his medication, he stopped taking his medication shortly after it started working to make him feel better. 

Tyler stated, "As soon as I start thinking about the brain waves and people looking into my mind, I think, ‘Well, I’ve done it again.  I better take my meds.’  But then I have to wait for them to kick in, and that’s like a bad trip. The hallucinations continue, it starts feeling like people are talking about me, and I get these feelings like someone is going to hurt me. And I don’t know if it’s the medication or what, but I sometimes start feeling like something is wrong with my body.  Geez, I get so confused." 

Think about your Tyler. Does your client periodically stop taking his or her medication?  Does he or she experience relapse of positive symptoms? 

3 Coping Strategies for Positive Symptoms of Schizophrenia

♦ #1  Reality Testing
During the onset of Tyler’s positive symptoms, I found that he could sometimes benefit from reality testing.  While Tyler waited for positive symptoms of psychosis to diminish, he implemented several coping strategies that we had talked about. 

Two Coping Strategies Tyler Used:
a. First, Tyler was careful to take his medication as prescribed. 
b. Second, Tyler checked with a trusted friend to help him with reality testing. 

Tyler stated, "Sometimes it helps to call Harry.  He’s been a good friend of mine for a long time, and whenever I start thinking people are out to get me, Harry is the only person I feel is on my side."  Because Tyler’s bedroom was his comfort zone during relapse and positive symptom experience, Harry came to Tyler’s house. 

Once there, he and Tyler discussed Tyler’s psychosis in objective terms. Tyler stated to me, "Harry is a big help with reality testing.  He points out how my paranoia is unjustified.  He makes me consider that nobody has actually done anything to make me think they are out to get me. And he’s right!" 

Tyler was fortunate to have a friend like Harry who could help him with reality testing.  Does your client have a trusted friend or family member like Harry who he or she can call at the onset of positive symptoms?  If not, perhaps self talk can benefit your client.

♦ #2  Self Talk
Self Talk is another coping strategy that Tyler sometimes implemented to deal with positive symptoms of psychosis. 

Tyler’s self talk included:

Clearly, for Tyler to implement self talk, he first had to be aware of the onset of positive symptoms.  Think of your Tyler.  Does he or she use self talk in a productive way?

♦ #3  Coping When Losing Control
In addition to reality testing and self talk, the third coping strategy that we will discuss is coping when losing control.  On one occasion, Tyler began to think he was losing control.  He observed himself thoughtfully considering the advice of his auditory hallucinations. 

Tyler stated, "I was convinced that my medicine was partly responsible for the way I felt, so I flushed it.  Then I realized that I had started listening to the voices again.  I became certain that the FBI was coming, and that video cameras were everywhere.  I got so scared that I began to lock all the doors and windows.  I was considering boarding up my whole house, and maybe even getting a hostage, so I could negotiate for my life. That’s when I had a moment of clarity.  The voices stopped, and I had a chance to think straight.  I called 911, because my doctor wasn’t available.  When they asked what the problem was, I told them that I had schizophrenia, I was off my medication, and I needed help.  After that, it was a bad scene. By the time the ambulance and the police came, I was hearing the voices again.  The cops had to restrain me, but if they hadn’t come, it could’ve been a lot worse." 

Tyler knew he had lost control during the moment the voices stopped.  Had Tyler not become aware that he had lost control, he may not have had the presence of mind to get help immediately. Do you find it productive for clients to understand the importance of getting help when they lose control? 

Other strategies for coping when losing control may include calling a family member, or going to the hospital. Tyler agreed that getting help immediately was the best thing he could do?  Think of your Tyler. If your client experiences positive symptoms or relapse, could these coping strategies help your client reduce symptoms? 

In this section, we have discussed coping with positive symptoms of schizophrenic psychosis.  Three specific coping strategies for positive symptoms of schizophrenic psychosis we discussed are reality testing, self talk, and coping when losing control.

In the next section, we will discuss skills for communicating effectively.  The six skills for communicating effectively are getting to the point, directly expressing feelings, giving positive feedback, making positive requests, checking out feelings, and taking breaks.  

The Cognitive-Behavioral Treatment of Schizophrenia:
The State of the Art and the Evidence

- Gaudiano, B. A. (2006). The Cognitive-Behavioral Treatment of Schizophrenia: The State of the Art and the Evidence. International Journal of Behavioral Consultation and Therapy, 1(2). p. 1-11.
Reviewed 2023

Peer-Reviewed Journal Article References:
Barrios, M., Guilera, G., Hidalgo, M. D., Cheung, E. C. F., Chan, R. C. K., & Gómez-Benito, J. (2020). The most commonly used instruments in research on functioning in schizophrenia: What are they measuring? European Psychologist, 25(4), 283–292.

Bechi, M., Bosia, M., Agostoni, G., Spangaro, M., Buonocore, M., Bianchi, L., Cocchi, F., Guglielmino, C., Mastromatteo, A. R., & Cavallaro, R. (2018). Can patients with schizophrenia have good mentalizing skills? Disentangling heterogeneity of theory of mind. Neuropsychology, 32(6), 746–753.

Boschi, S., Adams, R. E., Bromet, E. J., Lavelle, J. E., Everett, E., & Galambos, N. (2000). Coping with psychotic symptoms in the early phases of schizophrenia. American Journal of Orthopsychiatry, 70(2), 242–252.

Mueser, K. T., Valentiner, D. P., & Agresta, J. (1997). Coping With Negative Symptoms of Schizophrenia: Patient and Family Perspectives. Schizophrenia Bulletin, 23(2), 329–339.

Riehle, M., & Lincoln, T. M. (2018). Investigating the social costs of schizophrenia: Facial expressions in dyadic interactions of people with and without schizophrenia. Journal of Abnormal Psychology, 127(2), 202–215. 

QUESTION 8
What are three specific coping strategies for positive symptoms of schizophrenic psychosis? To select and enter your answer go to Test.

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