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Section 11
Angry - Coping with Schizophrenia

Question 11 | Test | Table of Contents

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In the last section we discussed  five strategies for managing conflict.  These five strategies for managing conflict are avoiding blame, speaking calmly, being concise, discovering points of view, and focusing on the present.

In this section we will discuss anger due to schizophrenia.  Our discussion will be include three main topics.  These three topics are anger related to delusions, strategies for coping with anger, and problem solving strategies for clients with schizophrenia.  As you listen to this section, consider your client.  Could hearing this section benefit your client or his or her family member?

Anger due to Schizophrenia - 3 Considerations

♦ #1  Anger Related to Delusions
First, let’s discuss anger related to delusions. As you are well aware, delusional beliefs and other psychotic symptoms can lead to anger. For example, if your client has delusions of reference, he or she may believe that people are saying negative things about them. Or if you have a client like Samantha who has delusions of control, your client may believe supernatural forces are taking thoughts out of her head and inserting others. 

Samantha, age 32, also experienced paranoid delusions in which supernatural forces worked together with the FBI in a conspiracy with the cable company to spread false rumors about her sexual thoughts. Samantha often became angry during our sessions when her delusions were active. Samantha once stated, "I’m being watched!  They’re reading my thoughts and there’s nothing I can do about it!" Think of your Samantha. How would you have responded to this outburst?

♦ #2  Strategies For Coping With Anger
I have found that there are a number of strategies for coping with anger related to delusions.  One strategy is to gently help the client consider alternative explanations for the delusions. When helping your clients consider alternative explanations for delusions do you avoid direct confrontation with the client’s beliefs? Another strategy for coping with anger related to delusions is validation. Clearly, we don’t want to validate or evaluate the delusions, but rather the anger and the feelings involved. 

For example, to validate Samantha’s anger, I stated, "That must be upsetting.  It must be hard to feel like you can’t have private thoughts."  Samantha stated, "It is!  I get so mad sometimes!  That’s why I break things!"  Further validating Samantha’s anger, I stated, "I can understand.  It sounds very frustrating."  Samantha responded by stating, "Yeah.  Sometimes I feel like giving up."  I stated, "I’m glad you haven’t given up yet.  Maybe we could figure out ways of helping you get more control over your life." 

Samantha stated that she would like to get more control over her life. This redirection of her focus from anger to hope made it possible for her to begin reducing symptoms. Think of your Samantha. Does frustration over psychotic symptoms anger your client? Would your client benefit from validation or considering alternative explanations for psychotic symptoms like delusions or hallucinations?

♦ #3  Problem Solving Strategies for Clients with Schizophrenia
Problem solving is one strategy for coping with anger that has multiple benefits for the client diagnosed with schizophrenia. Take Brianna for example.  Brianna, age 27, was angry with her father, who kept pestering her about taking her medication. Brianna’s father stated, "One night, when I reminded her to take her medication, she just blew up at me!  She accused me of trying to run her life, and then she stormed out of the room!" 

To help Brianna’s father cope with his daughter’s anger, I asked him to use a six step problem solving formula. The six steps in the problem solving formula were identifying the problem, brainstorming solutions, discussing each solution, choosing the best solution, planning how to implement the solution, and setting a solution review date. 

Brianna’s father stated, "Once she calmed down, I approached her and we agreed to meet and solve the problem together. Brianna told me that she was upset and annoyed that I kept reminding her to take her medication. She said it made her feel as though I was treating her like a child." Clearly, Brianna felt responsible enough to take her medication on her own. However, Brianna’s father expressed concern because Brianna had stopped taking her medication before.  He stated, "She’s gone off her meds before, and it’s never good.  Brianna relapses quickly, and she’s been re-hospitalized twice. But, I agreed to work on the problem of her taking her meds without my reminders." 

Brianna and her father sat down to have a problem-solving meeting.  They brainstormed possible solutions. Brianna’s father stated, "We decided to figure out a strategy that would help Brianna remember to take her meds before she went to bed.  Brianna had the idea of getting a pill box to put her pills into the week before.  She kept the pill box next to her toothbrush." 

Brianna and her father also agreed to have a follow-up meeting each week for a month to decide if any changes needed to be made.  At a later session, Brianna’s father stated, "The strategy was effective.  Brianna takes her medication on her own, and I learned to trust her to do it on her own."  Could a problem solving formula benefit your client?

In this section we have discussed anger in schizophrenia.  Our discussion will be include three main topics.  These three topics are anger related to delusions, strategies for coping with anger, and problem solving strategies for clients with schizophrenia. 

In the next section we will discuss cognitive difficulties.  We will examine five basic cognitive skills.  Our discussion will focus on how schizophrenia affects each basic cognitive skill and ways to cope with the resulting cognitive difficulties.  The five basic cognitive skills we will examine are attention and concentration, information processing speed, memory and learning, executive functions, and social cognition. 
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.

Batscha, C. (1996). Review of Letting go of anger, Angry all the time, Mind over mood, The clinician’s guide to mind over mood and Coping with schizophrenia [Review of the books Letting go of anger, , Angry all the time, , Mind over mood, , The clinician’s guide to mind over mood, , & Coping with schizophrenia, by R. Potter-Efron, P. Potter-Efron, R. Potter-Efron, D. Greenberger, C. A. Padesky, C. A. Padesky, D. Greenberger, K. T. Mueser & S. Gingerich]. Psychiatric Rehabilitation Journal, 20(1), 74–77.

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.

Diamond, D. (2018). Changes in object relations in psychotherapy with schizophrenic patients: Commentary on Carsky and Rand (2018). Psychoanalytic Psychology, 35(4), 410–413.

Lysaker, P. H., Bryson, G. J., Marks, K., Greig, T. C., & Bell, M. D. (2004). Coping style in schizophrenia: Associations with neurocognitive deficits and personality. Schizophrenia Bulletin, 30(1), 113–121.

QUESTION 11
What are three topics regarding anger in schizophrenia? To select and enter your answer go to Test.

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