TV Therapy for Schizophrenia
People skills can break a vicious cycle.
by Sheila Read
Right: A painting by Ramell Moore, who studied abstract visual art at Carolina. “This painting shows a woman who was blinded by gases released at her workplace,” Moore said. “It represents the danger people are exposed to working in hazardous conditions for low wages. It also conveys the onset of psychosis.” See more art by Moore and other patients from the Schizophrenia Treatment and Evaluation Program at brushesWithLife.org.
If you e-mail some friends and they don’t respond immediately, do you assume they are very angry with you, or that there’s a conspiracy of people who have decided not to pay attention to you? Do you withdraw or lash out? You might, if you have schizophrenia.
Social problems such as these matter because they can interfere with recovery, says David Penn, professor of psychology. Penn says that people who have good relationships with family and friends have less trouble living with schizophrenia.
Most public attention on treatment of schizophrenia focuses on antipsychotic medications and the problems with cost, side effects, and many patients’ refusals to keep taking them. Even though medications do lessen some of schizophrenia’s worst symptoms, there’s little evidence that meds help people with the disease to develop better relationships, Penn says.
At John Umstead Hospital in Butner, North Carolina, graduate student David Roberts had been struggling to figure out how to engage people with schizophrenia in treatment groups that taught basic social skills. There were problems. It is notoriously difficult to capture the attention of someone who is hallucinating, as many patients are when they arrive at psychiatric hospitals. And group leaders found that the standard curriculum on social skills was falling flat. That curriculum assumed people had profound deficits in social skills, Roberts says.
One day when Roberts was watching the comedy Friends with patients, something clicked. He noticed that they were laughing at the same scenes he was. Maybe, he thought, the patients understood more about social situations than clinicians had thought. After trial and error, Roberts and Penn hit on a creative prescription for the treatment groups: Turn on the HBO hit Curb Your Enthusiasm. Watch Larry David bumble his way through embarrassing social encounters. Laugh. Discuss.
“A lot of the episodes show people getting social cues wrong,” Penn says. “These are problems all of us can relate to. All of us jump to conclusions. All of us at one point or another will misread a social cue.”
But schizophrenia often magnifies small miscommunications.
People with schizophrenia tend to have difficulty identifying other people’s emotions and reading between the lines to infer what someone means, Penn says.
Schizophrenia has a wide range of symptoms and severity, but it is characterized by profound alteration of thinking, feeling, and ability to communicate. At its worst, it may involve symptoms such as auditory and visual hallucinations, delusions, and disorganized behavior.
A vicious circle often occurs in which someone with schizophrenia withdraws from an awkward situation, Roberts says. Then others respond by avoiding them. “They think, ‘That’s a weird person,’ and they don’t engage with him or her anymore,” Roberts says. That leads to fewer social opportunities for the person with schizophrenia, and social skills deteriorate further.
Penn and Roberts have high hopes for the Social Cognition and Interaction Training program. They initially showed episodes of Curb Your Enthusiasm and Monk to spark discussion about sticky social situations, but Penn and Roberts eventually produced their own videos, using their own scripts and UNC actors.
The six-month program aims to improve the ability of people with schizophrenia to identify others’ emotions, develop reasonable explanations for other people’s behavior, and — most importantly — apply these skills to their lives.
Roberts and his colleagues have completed a clinical trial of about forty out-patients at the Schizophrenia Treatment and Evaluation Program at UNC Hospitals and Caramore, a structured residential program in Carrboro, North Carolina, for adults with mental illnesses.
After participants completed the training program, independent raters judged how well the participants handled situations such as making a request of a landlord or meeting a new neighbor. Roberts says the researchers did see a significant difference in the people who received the training compared to those who received standard treatment.
After an article on the program appeared in The New Yorker in October 2007, clinicians and community organizations from around the world expressed interest in it, Penn says.
Sheila Read is a master’s student in journalism at Carolina.
David Penn is a professor of psychology and associate director of clinical training at Carolina. David Roberts is a graduate student in psychology at Carolina.
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