Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Evidence-Based Practices: Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 9
Practitioner Guidelines for Handout #8:
Coping with Problems and Symptoms
Introduction

Coping with problems effectively can help people reduce stress and their susceptibility to relapses. This module helps people to identify problems they may be experiencing, including symptoms that are distressing. Two general approaches to dealing with problems are taught:

A step-by-step method for solving problems and achieving goals
Coping strategies for dealing with specific symptoms or problems.
People can choose strategies that seem most likely to address their problems. Practicing problem-solving and using coping strategies both in the sessions and as part of homework can help people learn how to reduce their stress and discomfort.

Goals

Convey confidence that people can deal with problems and symptoms effectively.
Help people identify problems and symptoms that they experience.
Introduce a step-by-step method of solving problems and achieving goals.
Help people select and practice strategies for coping with specific problems and symptoms.
Encourage people to include family members and other supportive people in their plans for coping with problems and symptoms.
Number and pacing of sessions

“Coping with Problems and Symptoms” can usually be covered in two to four sessions. Within each session, most people find that covering one or two topics and completing a questionnaire is a comfortable amount.

Structure of sessions

Informal socializing and identification of any major problems.
Review the previous session.
Discuss the homework from the previous session. Praise all efforts and problem-solve obstacles.
Follow-up on goals.
Set the agenda for the current session.
Teach new material (or review material from the previous session if necessary).
Summarize the progress made in the current session.
Agree on homework to be completed before the next session.
Strategies to be used in each session

Motivational strategies

Most people are motivated to solve and/or cope with problems and symptoms that cause them distress. In this module, the practitioner focuses on helping the person develop effective strategies for dealing with specific problems and symptoms that he or she is experiencing. For example, if someone is troubled by persistent auditory hallucinations, the practitioner could focus on identifying and practicing strategies for dealing with hearing voices. If someone has problems related to drug or alcohol use and is interested in reducing his or her substance use, the practitioner could focus on helping the person learn strategies for achieving this goal

The following suggestions may be helpful:

“The “Common Problem Checklist” helps people identify the specific areas in which they experience problems. The practitioner can then focus on the sections of the handout that provide strategies for dealing with these problems.
Practitioners should keep in mind the goals identified by people in previous sessions. Being able to solve problems (or cope with them more effectively) can help people overcome some of the obstacles they may have experienced in achieving some of their goals. For example, when someone has a goal of taking a class, having difficulty concentrating may interfere with his ability to study, which presents an obstacle to his goal of succeeding in school. Using the strategies of minimizing distractions and breaking down tasks into smaller parts might help him improve his concentration and ability to study for tests.
Practitioners can help people to make plans to achieve goals, using the Step-By-Step Problem-Solving and Goal Achievement worksheet.
Educational strategies

Educational strategies for this module focus on increasing people’s knowledge about two general approaches to dealing with problems: a step-by-step method for solving problems and achieving goals, and coping strategies for dealing with specific symptoms or problems.

The following educational strategies were discussed in detail in the Practitioner Guidelines for Educational Handout #1:

Review the contents of the handout by summarizing or taking turns reading paragraphs.
Pause at the end of each topic to check for understanding and to learn more about the person’s point-of-view.
Allow plenty of time for questions and interaction.
Pause to allow the person to complete the checklists and questionnaires.
Break down the content into manageable “pieces.”
Find a pace that is comfortable to the person.
Cognitive-behavioral strategies

Cognitive-behavioral strategies focus on helping people learn more effective strategies for solving and coping with problems.

During the sessions, practitioners can help people learn how to use the strategies of their choice by modeling and role-playing the skills.

The following examples may be helpful:

If someone who has problems with depression wanted to learn the strategy of scheduling something pleasant to do each day, the practitioner could help her set up a calendar of a week’s worth of pleasant activities. If one of the pleasant activities was going bowling with a friend, the practitioner could help her decide whom to invite and role-play a conversation making the invitation.
The practitioner should help people make plans for implementing the strategies and help them practice any aspect of the plan with which they feel uncomfortable. For example, if someone is having a problem getting along with a roommate who plays loud music late at night, he might decide to use the strategy of asking the roommate to use head phones after 11 PM. The practitioner could help him role-play how he might make the request.
Homework

Homework focuses on helping people put into action what they are learning about coping with problems and symptoms. During the session, people identify coping strategies that they would like to use in their own lives. The homework assignments follow up on this by making specific plans for people to try out the strategies on their own.

Practitioners should follow up on homework assignments in the next session by asking how it went. They should reinforce completed homework or the effort people have made to complete homework. If people are not able to complete the assignment, practitioners can explore the obstacles they encountered and help them come up with a solution for following through on the homework.

The following examples of homework may be helpful:

Working on solving a problem using the “Step-By-Step Problem-Solving and Goal Achievement” method. The person may benefit from asking family members or other supportive people to participate in helping to solve the problem.
Working on planning how to achieve a goal using the “Step-By-Step Problem-Solving and Goal Achievement” method.
Reviewing what helped and what did not help in dealing with specific problems in the past.
Using a particular coping strategy and evaluating its effectiveness. For example, someone could practice using reading to distract himself from voices.
Asking family members, friends and other supporters to participate in a coping strategy. For example, if someone plans to attend Alcoholics Anonymous (AA) as a strategy for stopping alcohol abuse, she could ask for a ride to a local AA meeting as part of a homework assignment.
Modifying coping strategies that are not effective and trying them again. For example, if someone was unsuccessful in using reading to distract himself from voices, he might try something else, like listening to music. If listening to music is not effective, he could try humming to himself to distract himself from voices.
Locating resources for implementing a coping strategy. For example, if someone wants to attend a support group as part of coping with the problem of isolation, she could call the local mental health center or look on the Internet for information about the location and times of local support groups.
Tips for common problems

People may prefer not to talk about problems.
The practitioner can help the person re-frame problems as goals, which sounds more positive. For example, “sleep problems” could be defined as “getting a good night’s sleep”; “depression” could be defined as “being in a more optimistic mood”; “lack of interest” could be defined as “developing more interests.”
The goals that were established previous sessions can also be worked on in this module. The Step-By-Step Problem-Solving and Goal Achievement method is helpful in this process.
People may find it difficult to identify a coping strategy that they want to try to deal with a problem.
Particularly when people are depressed or experience the negative symptoms of schizophrenia, they may find it hard to imagine that a coping strategy may be helpful. In such situations, the practitioner can encourage the person to keep an open mind and to “give it a try” to see what happens. For example, some people find it hard to believe that exercise can help to improve one’s mood. The practitioner can encourage someone to try a 10 to 15 minute walk, rating his mood before and after the walk.
Practitioners can also suggest that the person ask someone to join him or her in using a coping strategy. For example, as part of a coping strategy for developing interests, someone could ask a friend or relative to join her on a trip to the art museum.
Review Questions

At the end of this module, the practitioner can use either open-ended questions or multiple-choice questions to assess how well the person understands the main points.

Open-ended questions

What are some of the important steps in solving a problem?
What is a problem that you experience?
What strategy could you use to cope with the problem you identified in question #2?
Multiple choice and true/false questions

In solving problems, it is important to consider more than one possible solution. True or False

Which two of the following items are examples of common problems?

Feeling anxious

Trouble concentrating

Having too much money
Which of the following is an effective strategy for sleeping better?

Going to bed at different times every night

Doing something relaxing in the evening

Napping during the day
Which of the following is an effective strategy for coping with depression?

Set goals for daily activities

Keep your feelings inside

Remind yourself of your faults