Speech and language disturbances have been recognized as core components of schizophrenia since the early days of modern psychiatry. In his description of “dementia praecox,” which is often credited as the first modern characterization of schizophrenia, German psychiatrist Emil Kraepelin described both positive (e.g. incoherence, derailment, stereotypy, neologisms) and negative symptoms (e.g. mutism) associated with speech.

Another psychiatry pioneer, Eugen Bleuler, noted that the primary symptoms of schizophrenia “find their expression in language,” but “here the abnormality lies not in language itself, but in what it has to say.” 

“The words, phrases, sentences, and dialogues from our patients say so much,”  wrote Sunny Tang, assistant professor of psychiatry at the Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in a recent article on Psychiatric Times. “So does their breaths in between, and their voice and its dynamics, and the cadence and tonality used. These are the building blocks and foundations of our work as psychiatrists, whether we are an analyst in an armchair, dissecting and reconstructing a patient’s narrative, or a biological psychiatrist with pen in hand, translating the patient’s report into scales and delving for correlates in the brain.” 

Even the most innovative methods of biological psychiatry—from neuroimaging to magnetoencephalography—cannot replace patient reports. “Syllable and sound are still the primary means for taking the measure of thoughts and emotions,” according to Tang.

Since the 1980s, researchers have been able to quantify speech disturbance in patients. They found that many features were shared with speech from patients in manic episodes, although mania was associated with greater positive thought disorder and schizophrenia with greater negative thought disorder.

“Through advancements of machine learning and artificial intelligence, we have new tools for taking the measure of speech and thought disturbance,” explained Dr. Tang. “Methods for extracting information from speech can be roughly divided into two areas. First, acoustics analysis extracts and quantifies information on pitch, amplitude, and vocal qualities on a millisecond-by-millisecond scale. Second, lexical analysis focuses on the content of speech, including word choice, grammar, the ideas being represented, and the relationship between words and ideas.”

Recently, Tang and her colleagues compared traditional clinical rating scales with “natural language processing” (NLP) methods for differentiating speech in individuals with schizophrenia spectrum disorders from that of comparison participants without schizophrenia. “When classifying participants into either the schizophrenia or health comparison group, we found machine learning algorithms performed significantly better using NLP-derived features (87 percent accuracy) than clinical ratings (68 percent accuracy), suggesting that important information is being captured by NLP.”

Perhaps, with additional research, it will soon be possible to link specific speech markers to changes in specific brain circuits. However, speech disturbance in schizophrenia is likely multifaceted and should not be treated as a single uniform entity.

“It is important to remember that our mission is the healing and well-being of individuals and families,” wrote Dr. Tang. “This is not technology for the sake of novelty, no matter how nifty the gadget. Finally, the availability of brain measures should not mandate reliance on pharmacology over psychosocial interventions—quite the opposite. Automated language processing can be harnessed to measure changes in thought and brain structure on a personalized level. This layer of technology should not occlude the individual but rather allow clinicians to delve deeper into each unique case.”

Psychosocial interventions are central to the Warner treatment model at Colorado Recovery which emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

People with schizophrenia can be treated effectively in a variety of settings with hospitalization mostly reserved for acute cases. Outside of a hospital environment, treatment should include social rehabilitation. People with schizophrenia typically need help to improve their functioning in the community. This can include training in basic living skills, assistance with a host of day-to-day tasks, job training, job placement, and work support.

Sadly this aspect of treatment is frequently missing. “Lacking a useful social role, many people with mental illness face lives of profound purposelessness,” wrote the late Colorado Recovery founder Richard Warner, MD, in The Environment of Schizophrenia (2000).   

This situation leads to severe functional deficits in schizophrenia, In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, in a recent presentation for Psych Congress Network about he importance of psychological rehabilitation, such as cognitive remediation and vocational rehabilitation in the treatment of schizophrenia. 

The numbers are quite shocking. “Only 10 percent of all patients with schizophrenia work full-time. Only one-third ever worked part-time,” said Citrome. “Fewer than 10 percent of male patients with schizophrenia have a child, and the self-care deficit is reflected in high rates of medical comorbidity.”

These deficits are a big problem but there are things that can be done to change the situation. “Cognitive behavioral therapy or CBT, although it’s labor-intensive, can be helpful, even in patients considered treatment-refractory, and has been evaluated in controlled clinical trials in patients with treatment-resistant schizophrenia,” explained Dr. Citrome. 

“Cognitive remediation is a very specific type of treatment. It’s a set of drills or interventions designed to enhance cognitive functioning. It’s a therapy that engages the patient in learning activities that enhance neurocognitive skills relevant to their chosen recovery goals. It’s very personalized.”

Ultimately, psychosocial rehabilitation includes improving functional and subjective outcomes. It consists of is a range of techniques, including CBT and cognition remediation, as well as addressing patient employment.

Meaningful employment is an important aspect of the treatment model originated by Dr. Warner. Clinical research shows that “patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” as Dr. Warner wrote The Environment of Schizophrenia. 

Dr. Citrome agreed. “One of the key goals in psychosocial rehabilitation is helping patients live independently and be employed. Employment is identified as a goal for most of our patients. They’ll tell us on many occasions, ‘Yes, I’d like to have a job.’”

There are multiple barriers to employment that need to be addressed starting with the psychiatric symptoms. In addition, there may be substance misuse, non-psychiatric medical conditions, stigma from employers, internalized stigma, and low self-confidence—even the fear of losing disability benefits.

“Vocational rehabilitation addresses these barriers by providing skill training, sheltered workshops, transitional employment, and supported employment, as well as the maintenance of benefits,” said Citrome.

Finding appropriate employment for patients is an important part of the treatment plan at Colorado Recovery. Employment support includes helping clients find a job, go back to school, or find volunteer work in the community. 

“Patients who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over three months than those who received vocational rehab alone and had better work outcomes over the two-year follow-up period,” explained Citrome. “A comprehensive approach is better, and for those community settings that can offer this, their patients are better off. With employment, one may expect increased self-esteem, reduction in symptoms and hospitalizations, enhanced social functioning, and improvement in overall quality of life.”

Empowerment and vocational rehabilitation are crucial elements of the Warner model. “Work helps people recover from schizophrenia. Productive activity is basic to a person’s sense of identity and worth,” Dr. Warner wrote. “Given training and support, most people with schizophrenia can work.”

The Colorado Recovery program approaches mental healthcare with a focus on self-reliance through developed practiced skills. Our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. Those in our care go to school, volunteer, or are employed in the beautiful surrounding Boulder area where they regularly take advantage of all it has to offer recreationally.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

“Since first being diagnosed with depression and generalized anxiety in my early 20s, I felt the stigma of being considered ‘abnormal,’” remembered journalist and author Steven Petrow in a recent article in the Washington Post. Petrow often used to hear friends use pejorative words like “nuts,” “psycho,” “schizo,” “insane” and “looney tune” as general insults to anyone for any transgression. The not-so-subtle message he perceived: It’s okay to mock those with mental health issues—that “we are somehow weird, stupid, scary, or dangerous.”

Sadly, the stigmatization of people with mental health issues has a long history.

“Research on the stigma of mental illness has been fueled by interest in labeling theory. Once a deviant person has been labeled ‘mentally ill,’ argues sociologist Thomas Scheff, society responds in accordance with a pre-determined stereotype, and the individual is launched on a career of chronic mental illness from which there is little opportunity for escape.” wrote Colorado Recovery founder Richard Warner in his 1985 book Recovery from Schizophrenia.

Those stereotypes are largely still with us. And they are still exacerbating the mental health issues of many Americans. 

“Stigmatizing language can become a stumbling block to treatment and support and increases the likelihood of these problems worsening before treatment is instituted,” Petrow wrote in the Washington Post. “According to the American Psychiatric Association, more than half of people with mental illness don’t get help for their disorders because they fear being treated differently or losing their jobs.”

When the Warner model of treating mental illness is all about empowerment, stigmatization is all about discrimination and disenfranchisement. Recovery from mental illness is about more than just controlling symptoms and staying out of psychiatric hospitals. It is about regaining a sense of identity, belonging, and purpose in life.

Empowerment is essential if people with mental health issues are to overcome the prejudices that many Americans still carry with them: the stereotype that makes them believe a person with a mental illness is incapable, unpredictable, even violent, and worthless. 

Before his death in 2015, the late Dr. Warner noted that “popular television programs often depict people with mental illness as dangerously violent.” A 1992 study found that an astonishing 58 percent of respondents considered “lack of discipline” a cause for mental illness.  Almost three decades later, Petrow makes a similar point, noting how Piers Morgan, a British television personality, criticized tennis player Naomi Osaka after she quit the French Open for mental health reasons as “an arrogant spoiled brat” who was “weaponizing mental health to justify her boycott.” 

Gymnast Simone Biles didn’t fare much better after citing mental health concerns as her reason for pulling out of several Olympic competitions in Tokyo. “Media representation of the mentally ill have shown little improvement since the Second World War,” wrote Dr. Warner in The Environment of Schizophrenia (2000).

It may slowly be changing for the better now. Petrow’s niece, “a 21-year-old college senior, lives with generalized anxiety disorder, adjustment disorder, and attention-deficit/hyperactivity disorder but has made clear she does not feel stigmatized. Her grandmother, my mom, would be proud of her openness and that she has sought treatment at a relatively early age.”

When Petrow asked her about the mean-spirited words some directed at Biles, she replied: “The language of belittling it, just putting ‘mental health issues’ in quotes, that’s super problematic because it’s making a serious issue. You just can’t do that anymore. That’s not where we’re at as a society, at least not in my generation.”

Our modern, non-institutional approach to living with mental health disorders is focused on individual empowerment and provides the services needed to address schizophrenia, bipolar disorder, and other serious conditions. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

Colorado Recovery is now expanding services outside our signature continuum of care. We are admitting directly into our intensive outpatient program (IOP) clients who may be ready to begin their recovery at the IOP level of care, or for those in the process of stepping down from another program. One of the offerings now available at the IOP level is our movement therapy group.

Dance/movement therapy (DMT) is defined by the American Dance Therapy Association (ADTA) as “the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the individual, for the purpose of improving health and well-being.”

“The basic tenet is that emotions live in the body,” says Colorado Recovery’s movement therapist Elise Alvarez. “It’s about creating awareness around clients, and then use movement to process those emotions. In case of anger management issues, we could ask ‘Is there a specific part of your body that you feel anger in?’ Anxiety might manifest as feeling a weight in the chest.” 

By expanding the awareness of such feelings, people are better able to recognize what’s happening in each present moment and then make more informed decisions about their feelings instead of simply reacting to them impulsively.

Even without verbal information, movement therapists are able to work with their clients. According to the ADTA movement is everybody’s first language. Without using words, just moving the body “can be functional, communicative, developmental, and expressive. Dance/movement therapists observe, assess, and intervene by looking at movement, through these lenses, as it emerges in the therapeutic relationship in the therapeutic session.” 

Alvarez goes into each session with a couple of specific ideas to be able to address the needs of individual clients in each particular group. In one recent session, she had clients toss a ball to each other in a pattern – a kind of group juggling. The purpose of the little game was to make people “wake up a little bit and become alert to what’s happening right now,” says Alvarez. 

Movement therapy has also physical benefits like improving reflexes and coordination. Group games strengthen cohesive teamwork, connecting people to each other as they work as a unit. 

“Sometimes we just throw a frisbee around—just having the movement aspect makes it feel more natural and fluid. People may open up a bit more because they’re moving and not just sitting in a circle, talking.” There is also walking meditation: “Everybody is paying attention to bodily sensations while walking, catching the mind should it start to wandering off,” says Alvarez. “At the end of a session we typically share our experience with the group. Our checkout question is often ‘How we are feeling right now?’”

For more information about direct admission to our intensive outpatient program or our other services, connect with a specialist who can answer your questions at (720) 218-4068.