Behavioral rehabilitation for chronic mental patients.

A three-component program drawn from the vulnerability-stress paradigm of major mental disorders has shown promise in rehabilitating patients with chronic schizophrenia. In the first part of the program, patients are prepared for independent living by training in social skills. Ten "modules" have been devised, each addressing a category of social skills that falls within a given life area (for example, conversational skills or vocational rehabilitation). Each module consists of a set of sequential exercises and videotaped demonstrations. Intensive training with the modules is followed by "booster" exercises and maintenance services for an indefinite period. The second technique is medication self-management, because it is now recognized that neuroleptic drug therapy offers the stabilization of symptoms requisite for effecting behavioral change with psychosocial interventions. Compliance with a medication program must be learned; in this rehabilitation program, both patient and family are educated about drug actions and side effects, and negative attitudes toward taking drugs are examined. The last part of the program is behavioral family management. Numerous reports in the literature indicate that relapse rates are higher in patients who return to families with high expressed emotion. Training procedures are therefore aimed at creating a more congenial family milieu. Patients and family are educated about the nature and management of schizophrenia, trained in effective communication, and taught problem-solving skills. The modern treatment of schizophrenia is overriding the earlier dichotomy between drugs and psychotherapy. The combination of three treatment modalities--skills training, medication self-management, and behavioral family management--offers new hope in rehabilitating the chronically mentally ill.