We have observed that individuals react in a positive way to stimulating experiences. They become more animated, cheerful, and reasonable, when participating in stimulating activities, such as playing games, preparing meals, and engaging in group sports. In fact, they are indistinguishable from the line staff when they are engaged collaboratively in these endeavors. It seems to me that at a psychological level, the individuals (as well as the staff) experience activation of positive adaptive beliefs, such as “I can have a good time,” “I have control,” “I am as good as other people.”
As I have noted before, the individuals regress to the “default mode,” where they are no longer engaged in these activities. Over time, however, the activation of the adaptive mode (positive beliefs) becomes progressively more durable than the regressive mode (negative dysfunctional beliefs). Although the individuals have obviously shown improvement at the time of discharge or transfer to a step-down facility, I believe that they are still vulnerable to relapse. While the adaptive mode (positive beliefs) may help to sustain them through some of the stressors, they are still vulnerable to frustration, disappointment, and devaluation. Once these stressors take hold, the dysfunctional beliefs may become activated and the individual may relapse.
It is important to address the dysfunctional negative beliefs directly, during the hospital stay, even though the individual is improving. The dysfunctional beliefs lead to discouragement, control, and thwarting. Consequently, it is important to “work through” the defeatist, asocial, and other dysfunctional beliefs, before the individual moves out. This can be best accomplished through behavioral experiments. Often it is possible to role-play an upsetting incident that has occurred in the unit. The essence of this behavioral experiment may center on situations, such as being forced to take medication, having requests refused, being disparaged by another person. In the role-play, the individual is enabled to re-experience the same beliefs and emotions that he/she experienced in the real life situation, and is then, provided with an opportunity to reframe the conclusions. Since doing these behavioral experiments is time consuming, we should think of a group format for carrying them out. Also, for experimental purposes, we should develop a positive checklist. As I have noted above, seems to me that activation of the positive beliefs can lead to the patient getting better, and activation of the dysfunctional beliefs leads to their regression. Of course, the regressive mode is the default condition and will come to the fore until such time as the adaptive mode has been activated.
I would very much appreciate your comments. Even if you don’t have a comment, it would be helpful to know whether or not you have read this piece.