Abstract
Mental illnesses have a disabling impact on an individual and require individual biopsychosocial formulation for patients for a comprehensive management. Mental illnesses often take a chronic course and in certain conditions, stabilizing the patients from active and recurring symptoms itself becomes a challenging task. Stabilization process has been used in different context in different mental illness conditions like substance abuse, psychosis, and trauma. The process is vital for achieving optimum treatment outcome, especially in patients with traumatic stress. Negative experiences and emotions associated with the trauma have potential to facilitate brain inflammation in later stage, thus an important intervention target. Several approaches of psychosocial management of trauma are in use; however, the indication of cognitive skill training in stabilization of trauma patients needs further exploration and support. The chapter highlights the implication of cognitive skill training focusing on the underlying domains that aid in stabilization process in patients with traumatic stress.
TopIntroduction
The impact of mental illnesses on an individual is disabling, affecting psychological, social, and occupational functioning in addition to default symptoms of the illness. The impact is usually chronic in nature and recovery is often a time taking process depending on early preventive strategies adopted, timely consultation, appropriate therapeutic measures, and good psychosocial support. Stabilization is one of the most vital components in the recovery process. The term and concept of stabilization could be difficult to have a standard definition, as it has been used in a similar but slightly different context in different clinical conditions like psychosis, substance abuse, and trauma or post-traumatic stress. It roughly translates to reaching a phase of psychological equilibrium which suggests a minimal or symptom-free stage progressed after initial intervention and is deemed essential for carrying forward the interventions with more inputs for a better treatment outcome.
Stabilization thus is the first step in the treatment of mental illness and involves stabilizing the symptoms of the patient, both physical and psychological as well as achieving stability in mood and emotions. The period of stabilization is dedicated to having minimal or nil symptoms as well as developing adjustment and a better understanding of the treatment regime. The process normally takes a few months after symptom recovery; however, it may be up to a year or more for complicated cases.
The process of stabilization involves learning skills to cope with difficulties and distress and maintain emotional well-being and finally come back to normal life. The process includes different skills training that can be used to increase patients’ ability to face and control the situation when exposed to triggers, and to increase their capacity for stabilization or level of tolerance to handle unpleasant emotions and reminders.
Psychosocial management of trauma often takes a supportive and or supervisory approach focusing on safety and stabilization. Considering the emotional state of patients in trauma, cognitive skills training may appear trivial in the initial stages but is a vital component. The stabilization process and involvement in tolerance should include targeting cognitive processes which need to be identified and focused through cognitive skill training.
Mental Illness and Cognition
It is important to know why cognition is a vital treatment goal not only in trauma, but mental illnesses in general. Mental illnesses are known to cause impairments in psycho-social functioning; but impairments in cognitive functions are also evident, which are often in the backdrop of psychosocial and occupational functioning. Cognitive dysfunctions can be defined as a trans-nosological domain serving as an essential mediator of disparate mental disorders. Cognitive dysfunctions have previously been considered a secondary symptom of some diagnosed mental illnesses, and evidence indicates that it is a primary symptom or core feature of psychotic illnesses like schizophrenia and affective disorders. However, prolonged mental illness leads to underlying or prominent cognitive impairment in any condition, including daily life stress reactions. Cognitive deficits have been suggested to significantly contribute to poor functional outcomes. Difficulties in maintaining work and social connections, living independently, and acquiring skills are common manifestations of the disability experienced by people with mental illness and are associated with degrees of cognitive impairment. Social and occupational difficulties are widely recognized as core features of mental illness affecting social interaction, vocational functioning skills, recreation, and activities of daily living including self-care (Clements et al., 2015). This equally applies to patients suffering from traumatic stress. Further, poor performance on neurocognitive tasks has been observed to be associated with poor performance on measures of community functioning, psychosocial skill acquisition, and social problem-solving (Mohamed et al., 2018).
Additionally, depressive and negative symptoms have also been found associated with cognitive deficits (Glise et al., 2020). However, very few studies have tried to address these issues during symptomatic remission. Residual negative symptoms are known to mediate the relationship between diagnosis and cognitive function, particularly in the executive function domain. This implies that negative symptoms and cognitive symptoms share significant common variances. Thus, enhancement of cognitive performance or speeding up the learning process through a brain enhancement system is a tangible target of contemporary research focusing on the psychological management of trauma.
Key Terms in this Chapter
Cognition Skills Training: Improves cognitive abilities specific to domains of cognitive functioning. The main goal is to improve deficits and maintain the present skills of the individual.
Negative Emotions: These are derived from negative apprehensions regarding situations. It might cause negative thoughts and beliefs about self and others. It causes emotional distress among individuals.
Working Memory: A cognitive domain that has a limited capacity for information. It causes difficulties in reasoning and decision-making.
Emotional Regulation: The ability to control emotional state and determine the process of regulating expressive and suppressive emotional responses over situations.
Mental Illness: A wide range of psychological conditions which affect functioning in terms of cognition, emotion, and behavior. Genetic, biological, and psychosocial factors cause mental illness and disorders.
Cognitive Control: A process to direct behaviors and thoughts regarding a specific situation. Cognitive control plays important role in adaption to a constantly changing environment and influences adaptive behaviors.
Trauma: An emotional response that causes intense and distressing effects on psychological health. It leads to the inability to cope and helplessness which might have long-term adverse impacts on well-being.
Stabilization: Leads to resource intervention; it is an effective and efficient technique for treatment for PTSD survivors.