We have found that we can restore individuals, to a large degree, to their previous lives. However, as our fellows have pointed out, what is to prevent them from relapsing after they are subjected to the stresses and strains of living in the community? We know from their past histories that they did have a great deal of trauma and can expect some degree of trauma in their future lives. However, over the decades, we have learned that a stress reaction depends, not only on trauma but is related to the meanings and significances of the trauma. We have demonstrated, for example, that traumatic experience, such as the killing at the Boston Marathon a few years ago, produces PTSD only in those individuals who had previously been shown to be catastrophizers. As the fellows pointed out, our individuals may be quite liable to relapse, unless they are taught preventative skills—in other words, old fashioned cognitive therapy, such as de-catastrophizing. To get started on this, we might begin with first-episode patients and train them in these cognitive skills to prevent a second episode. We can also incorporate this into the resilience program at the facilities.
Since most of the relapses involve exacerbation of negative symptoms, it is important to deal with “regressive/avoidance beliefs” and these include ideas about the value of withdrawal after an unpleasant experience (rejection or failure), the importance of avoidance beliefs, exacerbation of beliefs in one’s weakness, undesirability, etc. These negative beliefs can be ascertained following rejection or failure, even better, they can be brought out in roleplays.
I would appreciate receiving your feedback on the above formulations and your opinions regarding restoration vs. relapse prevention.