Mind Stimulation Therapy for Persons with Schizophrenia

Before getting into the meat of this post, I feel like I need to touch base briefly on Schizophrenia.  Schizophrenia is a mental illness that I think most people are familiar with, but know little about.  Our stereotypes of people with Schizophrenia are largely shaped by the interactions we have with people affected by the illness.  In the general public this may be limited to encounters we have with people in public forums – parks, malls, on buses or trains – and often are marked by their brevity.  I remember the first time I ever encountered someone with Schizophrenia.  I was taking the commuter rail back from an evening in Boston and a disheveled looking man entered the car I was on.  He was exuberant, slightly raucous, and yelling at one of his pointer fingers because he thought it was talking to him.  As he engaged in this conversation it was apparent that, at least in his mind, the conversation was a two-way one (although on my end that pointer finger never did reply!)  In retrospect, there’s no way of knowing this man actually did have Schizophrenia.  Any number of things can account for hallucinations – medical issues, drug use, etc – but as a younger person with limited knowledge of this mental illness my brain immediately associated talking to oneself with Schizophrenia.

Despite this very limited interaction in my earlier life, I feel fortunate that I have encountered people who experience mental illness in real and tangible settings, though growing up they were few.  While many of us may know people who struggle with depression, anxiety, or substance abuse, Schizophrenia affects only 1% of the population.  This means that most people will never knowingly encounter a person with Schizophrenia.  Thus, many people’s understanding of this illness is based on fictional representations they see in movies or tv, characters they may read about in books, or the horror stories they occasionally hear via the news or internet.  In these instances, their mental illness often becomes the headline and inevitably Schizophrenia is paired in people’s minds with violence.  If you don’t believe this, do a Google image search for Schizophrenia and see what comes up. 

I bring this up now because since starting work in a community mental health agency I have encountered people with Schizophrenia regularly.  Currently I work with a number in personal therapy.  And guess what?  They’re actually very interesting, resilient people who happen to struggle with mental illness on a regular basis.  As such, I have begun researching treatment approaches to use with these clients that don’t forcefully challenge their beliefs, reduce the likelihood they will engage in therapy, or cause greater stress than what they are already experiencing.  For a long time treatment for Schizophrenia has been primarily focused on medicating the client and changing their beliefs.  For example, trying to convince your client that his or her next-door neighbor ISN’T controlling his mind.  However, as a longtime yoga practitioner I’ve always felt a little bit unnerved with approach, which I believe lacked some of the core components of my daily yoga practice: acceptance & non-judgement.  Thankfully while completing my master’s degree I was introduced to a way of working with clients diagnosed with Schizophrenia steeped in a positive psychology framework.  And that way now has a name: Multimodal Integrative Cognitive Stimulation Therapy (MICST).

MICST is an approach steeped in learning theory and positive psychology that emphasizes the role that our environment and interactions have in shaping who we are.  With Schizophrenia, the creators of MICST (Ahmed & Boisvert, 2013) argue that portions of symptomology may actually be reinforced unintentionally by a person’s environment (friends, family, therapists, community interactions).  So what does this mean?  Basically, that Schizophrenia is an illness that can manifest itself in a number of symptoms.  But by constantly pointing these symptoms out to clients and arguing against them (i.e. “These things aren’t real.” “You’re just sick.” “No your neighbor isn’t spying on you!) we may actually be reinforcing these symptoms and further entrenching them within our clients.  Thus, MICST encourages practitioners to to emphasize reality-based behaviors and beliefs, and to focus on on what client’s do well rather than reinforcing their deficits.

Instead, the authors emphasize using a positive psychology framework “to enhance self-esteem and well-being,” by focusing on client strengths rather than their weaknesses and utilizing cognitive stimulation “to access areas of intact cognitive and memory functioning.”  The authors who created MICST suggest three basic ways of doing this:

1. Body movement-Mindfulness-Relaxation (BMR) exercises
2. Group Discussions
3. Paper & Pencil exercises

As I read through this treatment approach, I can’t help but notice the similarities I see between the recommendations set forth in the MICST manual and components I find in a really great yoga class:

• Acceptance: Encouraging your students to accept themselves where they are at rather than emphasizing failures or unmet wants & desires
• Non-judgement:  Role modeling your own personal acceptance as a teacher for your students and encouraging your students to engage in personal growth without harsh criticisms against themselves or others
• Asana: Engaging in physical exercise to provide a point of focus or “moving meditation”
• Mindfulness:  Reminding your students over and over again to be in the present moment (often I hear this with a phrase like “be on your mat,” or “Notice what’s going on with you on your mat today.)
• Relaxation: Taking Savasana at the end of class to integrate everything that you experienced during class
• Cognitive Stimulation:  I would argue that through the joint practice of mindfulness and movement, with the added component of education on yoga principles or mental health topics at the beginning of class that yoga is an excellent cognitive stimulation exercise
• Group Discussion: Who hasn’t gone to a yoga class and either engaged in conversation with their yoga buddy or with classmates? But I’d argue a really great class includes some discussion about the class theme, or a check-in with students, at the beginning of class (and is a two-way conversation)

Looking at that list and reflecting on the philosophy of MICST, it’s no question that components of yoga can be beneficial for patients with Schizophrenia (or that practicing yoga can help therapists acquire the skills necessary to serve their clients in the most effective way possible).  Next week I’d like to follow-up on these similarities further, focusing specifically on the BMR component of MICST and how yoga can help to play this role in clients affected by Schizophrenia.

For more information on MICST, check out the treatment manual on Amazon.