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Evidence-Based Practices: Shaping Mental Health Services Toward Recovery

Illness Management and Recovery Workbook

Chapter 4
Practitioner Guidelines for Handout #3:
Stress-Vulnerability Model and Treatment Strategies

Introduction

This module helps people understand the stress-vulnerability model of mental illness. It explains what causes mental illness and what factors affect its course. Based on the stress-vulnerability model, several different treatment options are available to help people manage their mental illness and achieve recovery goals. Being knowledgeable about the causes and treatments for mental illness helps people to make informed decisions and engages them actively in the treatment process.

Goals

1. Explain how stress and biological vulnerability play a role in causing symptoms.
2. Convey the message that treatment can help people reduce their symptoms and achieve their goals.
3. Help people become familiar with different treatment options.
4. Help people decide which treatment options they want.

Number and pacing of sessions

The “Stress-Vulnerability Model and Treatment Strategies” module can usually be covered in two to four sessions. Within each session, most people find that covering one or two topics and completing a questionnaire is a comfortable amount.

Structure of sessions

1. Informal socializing and identification of any major problems.
2. Review the previous session.
3. Discuss the homework from the previous session. Praise all efforts and problem-solve obstacles.
4. Follow-up on goals.
5. Set the agenda for the current session.
6. Teach new material (or review materials from a previous session if necessary).
7. Summarize progress made in the current session.
8. Agree on homework to be completed before the next session.

Strategies to be used in each session

Motivational strategies

Motivational strategies in this module focus on helping people see how treatment can improve their lives. The two major questions to keep in mind are:

“How can treatment decrease symptoms and distress for the person?”

“How could treatment help the person to accomplish his or her personal goals?”

The following suggestions may be helpful:

• Keep in mind that common motivations for treatment include decreasing symptoms, relapses and rehospitalizations, increasing independent living, and improving relationships.
• For each major topic covered in the handout, help the person to identify at least one way that information about that subject might be helpful to him or her. For example, when reading about the topic “Coping with stress,” you might ask a general question, such as “How could it be helpful to you to learn effective ways of coping with stress?” If the person has difficulty answering, you might try one of the following probe questions, “Have there been times when you’ve been under stress? What happened?” “Did you ever think that stress might be connected to having more symptoms?”
• Show an appreciation for the person’s experience and knowledge. Thank the person for his or her comments and clarifications. Recognizing the person’s expertise makes the relationship with the practitioner collaborative, reinforcing,
  and motivating.
• Keep in mind the goals that the person identified in the first module (Recovery Strategies). Continue to help him or her identify goals as an ongoing process. In this module, the practitioner can also help the person identify information about treatment that might help him or her achieve a personal goal.

Educational strategies

Educational strategies for this module focus on helping people understand the stress-vulnerability model. According to the stress-vulnerability model, effective treatments must address both stress factors and biological factors.

It is helpful to relate the information in the handout to the person’s own situation. For example, learning more about the stress-vulnerability model might help someone recognize that stress contributed to an increase in symptoms or a rehospitalization in the past.

The following strategies were discussed in detail in Module 1.

• Review the contents of the handout by summarizing or taking turns reading paragraphs.
• Pause at the end of each topic to check for understanding and to learn more about the person’s point-of-view.
• Allow plenty of time for questions and interaction.
• Pause to allow the person to complete the checklists and questionnaires.
• Break down the content into manageable “pieces.”
• Find a pace that is comfortable for the person.

Cognitive-behavioral strategies

Cognitive-behavioral strategies focus on helping people decide how to use information from this module to think differently or behave differently regarding treatment. It is especially helpful for people to think of how they can use treatment to improve some aspect of their own lives.

• At the end of each session of this module, help the person think of ways that he or she might apply the information covered in the session. For example, after reading “What kinds of treatment options are there to choose from?” some people may say that they have been interested in finding a job, but did not know about supported employment programs.
• In the session the person could determine the steps for enrolling in a local supported employment program. The person could practice how to talk with his or her case manager about a program, or make a phone call to get information. Making the phone call before the next session could be part of homework.
• In completing the “Coping with Stress Checklist,” the person might choose the strategy of engaging in a hobby as a way of dealing with stress. The practitioner could help the person choose a hobby, ensure that he or she has the necessary equipment, and help him or her plan when to engage in the hobby. If the hobby is something that requires another person, such as a card game, the practitioner could help the person pick someone to ask. The practitioner could then role-play with the person how he or she could make the request. Homework could involve making the actual request.

Homework

• Help the person plan to do something outside of the sessions that will put into action what he or she is learning. For example, if the person is interested in writing in a journal to relax, the practitioner could help the person decide where to buy a journal and how many entries to write before the next session.
• Follow up on the homework by asking how it went. For example, the practitioner could ask, “Were you able to locate a notebook for your journal? Were you able to write an entry in the journal? How did it go?”
• If people do not complete the homework, the practitioner can gently ask what got in the way. The practitioner can then develop (and sometimes practice) ways of overcoming obstacles to completing the homework. For example, if someone was unable to write in the journal because of a lack of privacy, the practitioner could explore alternative locations that might be available. If someone had difficulty thinking of topics to write about, the practitioner could help identify possible topics.
• Encourage homework that involves family members and supporters.

Tips for common problems

• People may say that they do not have a mental illness and believe that they do not need treatment.
• Even when people do not believe they have an illness, they may recognize the negative effects of stress in their lives. They are often receptive to talking about treatment options as a way of reducing stress or coping with life problems.
• Many people who do not think they have a mental illness are comfortable talking about problems they are experiencing, and are interested in hearing ideas about how they might solve those problems. For example, if a person reports feeling isolated, he or she might want to hear about local support groups, consumer-operated clubhouse programs, or peer support centers. People who express an interest in working might be interested in hearing about supported employment programs.
• Some people say they don’t want to make decisions about their treatment. They prefer practitioners to make the decisions for them.
• Many people have had prior experience in which they were discouraged from expressing their opinions and were not consulted about their preferences. It is very important to ask people questions and elicit their opinions and comments about treatment. Practitioners should show they value what people have to say, and emphasize the importance of people making decisions in active collaboration with others.
• Some people have had negative experiences with treatment in the past. Allow people time to talk about their experiences, but do not devote an entire session to dwelling on the past. Let people know that there are more treatment options available than there were before. For example, several more effective medications have recently been developed and new psychosocial programs are available.
• Do not pressure people to accept specific treatments, but actively encourage them to become aware of their options and to get involved in making their own choices. Practitioners should emphasize that they would like to work with people to help them make treatment decisions that will help them achieve their goals, get on with life, and avoid previous negative experiences.

Review Questions

At the end of this module, practitioners can use either open-ended questions or multiple choice questions to assess knowledge of the main points. Practitioners can use either of the following types of questions (open-ended or multiple choice).

Open-ended questions

• According to the stress-vulnerability model of psychiatric disorders, what are the main factors that contribute to symptoms?
  
• How can people reduce their biological vulnerability?
  
• How can people cope with stress?
  
• What are some examples of treatments that help people recover?
  
• What treatment options have helped you?

Multiple choice and true/false questions

1. Scientists believe that biology and stress both play a part in causing symptoms. True or False
   
2. One way people can reduce their biological vulnerability to symptoms is:
   
   Drink alcohol and take street drugs
   
   Take medications prescribed by the psychiatrist
   
   Read about the symptoms
   
3. Two effective ways to cope with stress are:
   
   Exercise regularly
   
   Put pressure on yourself
   
   Drink a six pack of beer
   
   Talking with friends or family members
   
4. Which of the following is NOT an example of a treatment option for mental illness?
   
   Medications
   
   X-rays
   
   Supported employment programs
   
   Social skills training groups
   
5. Everyone with mental illness benefits from exactly the same treatment. True or False

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