A strengths-based cognitive approach to enhancing occupational performance and self-efficacy in individuals with Schizophrenia

OBJECTIVE: People with schizophrenia have functional challenges related to cognitive impairments and decreased self-efficacy. Strengths-based approaches to rehabilitation are recommended, but such approaches are not well-defined or widely researched. This dissertation study investigated a strengths-based cognitive prompting intervention to improve occupational performance and self-efficacy in people with schizophrenia. METHODOLOGY: Five members of a community-based psychiatric rehabilitation services (PRS) program participated in this mixed methods study. Their goals came from individual rehabilitation plans (IRPs). Strengths were gleaned from an assessment protocol guided by the cognitive functional evaluation (CFE) process. Tests included the BLERT, BRIEF-A, BPRS-E, CTMT, EFPT, GSE, HT, and SWL; results were analyzed using quantitative methods. Single-case design with multiple baselines used the MOHOST as the repeated measure of occupational performance. Qualitative methods included a focus group and individual interviews to understand participants’ lived experience of the intervention and assessment protocol. RESULTS: Single-case design showed an overall small intervention effect (d = .26) with varying results among individual participants and MOHOST domains. Analyses point toward relationships between variables of occupational performance, cognitive skills, and life satisfaction post-intervention. Participants reported a positive experience of the intervention and of the assessment protocol, improved self-confidence, and increased use of strengths for more successful occupational performance. CONCLUSION: Findings from this study showed initial support for the strengths-based cognitive prompting intervention. In addition, the study demonstrated that an assessment protocol that uses CFE guidelines and facilitates individuals’ understanding of the relationship between functioning and assessment results is meaningful to individuals. This study has implications for further development of the intervention and assessment protocol and for integrating the intervention into cognitive remediation for people with schizophrenia spectrum disorders.