Recovery Interventions that Promote Productive Lives

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Tiffany Herlands, Psy.D.
Tiffany Herlands, Psy.D.

WOMEN’S MENTAL HEALTH CONFERENCE: THE ART & SCIENCE OF CARING

On September 14, 2012 the Brain & Behavior Research Foundation hosted a Women’s Mental Health Conference: The Art & Science of Caring in New York City. The event included a panel discussion on Early Intervention, Rehabilitation and Reintegration; small group discussions with leading researchers across mental illnesses; and a final panel discussion on overcoming stigma and the future of public policy and research. The following pages contain highlights of some of the presentations. Full transcripts of the talks and a highlight video are available at bbrfoundation.org/2012-WMHC.


Recovery Interventions that Promote Productive Lives
Tiffany Herlands, Psy.D.
Director of Rehabilitation Psychology, Department of Psychiatry,
Columbia Presbyterian Eastside
Assistant Professor of Psychiatry,
Columbia University Medical Center

Currently available medications can often provide relief from the so-called positive symptoms of schizophrenia—psychotic delusions and hallucinations —but they do not help much with the negative symptoms—decrease in motivation, lack of attention and affect, memory loss and social withdrawal. The so-called negative symptoms are often the most pervasive and ultimately destructive symptoms of the illness. Eighty-five percent of patients with schizophrenia also have some level of cognitive impairment, in verbal learning, problem-solving and the mental flexibility necessary for negotiating unpredictable circumstances.

In Columbia University’s Lieber Recovery Clinic, Dr. Herlands and colleagues use a variety of behavioral interventions to help people with schizophrenia improve their functioning in these critical areas of deficit. The interventions are intended to promote functional recovery and to provide patients with the skills to help them regain autonomy so that they believe they can live fulfilling, productive lives.

The clinic’s treatments are personalized to take into account each individual patient’s cognitive and social functioning, family history and living skills, and their ability to adhere to treatment and manage symptoms. A program is then customized to create the motivational context for learning, which is done through different approaches that present a variety of choices:

  • Computer-based software helps to train attentiveness. Through computer games, patients learn how to pay attention in such real-life situations as navigating city streets.
  • Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), both forms of ‘talk therapy’, are used to address negative thinking and counterproductive behavior patterns.
  • Patients may also be helped by a recovery coach, someone who goes out into the world with them to help them practice the skills they are learning.

Providing multiple contexts helps patients to generalize outcomes to everyday situations. For example, someone who is learning with CBT to mitigate anxiety may do fine in the clinic, but not so well when out alone in the subway. The concept of generalization refers to the ability to transfer clinical learning to everyday needs. As patients start to achieve their goals, they reduce their time at the clinic. Dr. Herlands reported that to date the clinic has had a high rate of success with almost all patients achieving, partially if not completely, the goals they have set for themselves.

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Please note that researchers cannot give specific recommendations or advice about treatment; diagnosis and treatment are complex and highly individualized processes that require comprehensive face-to- face assessment. Please visit our "Ask an Expert" section to see a list of Q & A with NARSAD Grantees.
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