Beyond Stable

A student does computer exercises as part of a brain-training program, called Cognitive Enhancement Therapy.
A student does computer exercises as part of a brain-training program, called Cognitive Enhancement Therapy.

Megan Michaels and I met up in Richmond Heights, to take Buddy for a walk. Michaels is a professional dog-walker. She has been for six years.

Michaels has schizophrenia. That’s not how she’d normally introduce herself—nor could you tell when you meet her—but she agreed to talk with me about her illness and what helped her.

MICHAELS: This way Buddy. Come on, come on.

Michaels loves her job. She’s stable. When she has bad days, feeling low or isolated, she knows how to handle it.

MICHAELS: I have to essentially pull myself out of my skin and realize that everybody has these kinds of days. The only difference is that I have a few more of these days.

But it hasn’t always been like this. When she was first diagnosed with schizophrenia in college, she says it was terrifying and traumatic. It required hospitalization.

MICHAELS: When you first get the illness you have no insight onto what is happening to you. And you’re scared.

She was stabilized with anti-psychotic meds but had trouble keeping on track, making plans, and thinking clearly. Ten years ago, Michaels—who is now 41—enrolled in a new program developed to help people like her. It’s called Cognitive Enhancement Therapy, or CET.

CET aims to “train” areas of the brain thought to be impaired in people with schizophrenia. People in the program do extensive drills on the computer that target memory, attention, and problem-solving. The one-year intensive program also has group sessions which teach social skills, like how to interact with co-workers.

I visited a recent CET class run by the Jewish Family Service Association in Cleveland. Students were at computers, doing exercises that honestly were making my head spin. Like, you’d see the word RED printed in yellow lettering. First round you had to match the word color; second round you had to match the word meaning. The exercises get progressively harder and you’re trying for speed as well.

This is all part of the plan to help students adapt to different situations and develop so-called “cognitive flexibility.”

Recent studies show CET resulted in lasting improvements in memory, attention and social skills for people with schizophrenia.

Dr. Sophia Vinogradov is a psychiatrist at the University of California San Francisco and studies brain-training programs like CET.

VINOGRADOV: Right now the standard of care for people with schizophrenia is—in this country anyway—is abysmally unambitious, I guess you could say.

People are stabilized with meds and sometimes counseling,

VINOGRADOV: But they really don’t do anything in terms of helping people get back integrated into their community, able to work.

This is the aim of CET, and Vinogradov says its dual emphasis on cognitive and social skills means it’s an approach with a lot of promise.

Megan Michaels says her most important takeaway from the program is the impact it has had on her interactions with family, friends, co-workers, even strangers like me.

MICHAELS: It’s helped me accomplish better relationships.

She’s held down her job; she’s been married for 9 years; and she agreed to do a radio interview about a stigmatized illness.

This is the kind of outcome that developers of CET hope for.

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