Cognitive Skills

Most people with psychosis experience some degree of cognitive problems. For some, changes in cognitive functioning may be one of the earliest signs of the illness (occurring even before psychotic symptoms begin). Research has shown that the parts of the brain responsible for specific cognitive abilities often do not function the same way for people with psychosis.

Not everyone with psychosis is affected by cognitive difficulties in the same way. Some experience more problems with a certain aspect of cognition, such as attention or memory. Cognitive problems may come and go for some people. For example, cognitive problems may be most noticeable during episodes of illness. For others, the cognitive problems continue even when other symptoms go away. Certain types of cognition are particularly likely to be affected in people with psychosis. These areas include:

1. Attention
2. Learning and memory
3. Critical-thinking skills (e.g., planning, organizing, problem solving, abstract thinking)
4. Social cognition

Here are some strategies that might help with focusing your attention.

• Don’t put too much demand on your attention span: Keep things simple, direct, and to the point. Limit the time spent on any given task. For example, you may only be able to spend ten minutes on a task at a time.
• Focus on one thing at a time: Don’t try to divide your attention among different tasks. Focusing on more than one thing can become overwhelming.
• Take breaks: It is important to rest and take breaks to prevent yourself from becoming overwhelmed by challenging tasks.
• Limit distractions: Simplify the environment by removing distractors such as background noises, multiple speakers in a conversation, and/or disorganized surroundings. Having something to fiddle with, such as a squishy ball, can help keep restless hands busy while you focus on the task.
• Use cues and reminders: Cues such as self-talk, a touch or look from someone, or a visual reminder can help you focus and bring back your attention when it goes off-track.
• Mix it up: Vary the content or setting of the information or task. You might try alternating between different tasks to keep yourself interested and engaged.

Here are some strategies that often help decrease problems with memory.

• Avoid distractions: When trying to remember something, it is important that you pay attention to the source of the information. Strategies such as making sure you are in a quiet environment, focusing on one thing at a time, and minimizing the number of people in a conversation can help.
• Make use of repetition: It can help to have important information or instructions repeated. For example, during conversations you may ask people to repeat themselves or you could try saying what you heard out loud using your own words to make sure you understood it. When reading, you may need to re-read important parts several times. Developing habits/routines can also help you remember. For example, keeping your keys in the same location at home lessens the chances of misplacing them.
• Use memory aids: It can be helpful to have a way of recording important information so you can refer back to it. This will help you if you forget it. When possible, write down important information. For example, keeping a diary of important ideas, a day planner for appointments/contact information, or lists of things to do or buy are common memory aids used by many people. Electronic devices (e.g., cell phones) are great memory aids since they have calendars, take voice memos, and can even remind you about events.
• Cue your memory: There are a number of ways you can cue your memory to help you remember something.
• Mnemonics are groups of words or letters that help you remember more detailed information. For example, students use the first letters of the mnemonic “Never Eat Shredded Wheat” to remember the order of directions on a compass: North, East, West, and South.
• Alarms can also be helpful in cueing one’s memory, for example, to take medication at a certain time.
• Strategically placed sticky notes with reminders (“turn off the stove”) can also be helpful.
• Try multiple ways of remembering: For some people, simply listening to information isn’t enough to learn something new. Instead, it may be easier if important information is also presented visually. Similarly, when trying to remember something visual (e.g., where you parked the car), it may help to make an effort to think about the location using words as well: “The car is parked on the 3rd floor to the right of the mall entrance.”

Here are some strategies that often help with critical-thinking skills.

• Come up with routines: Having routines (e.g., schedules, doing things the same way over and over) can help with organization and planning. For example, certain tasks such as doing the laundry could be scheduled for the same day and time each week.
• Plan your day: Use a planning tool such as a day planner to help you organize your time. (Your mobile phone probably has a great calendar built into it.) Because it can be hard to remember to use a planner in the first place, you may want to come up with a daily routine (e.g., use the day planner every morning with your first coffee of the day) or use a memory cue (e.g., an alarm) to remind you.
• Break down tasks: Complex tasks with many steps can be overwhelming for people who struggle with critical-thinking skills. It can help to talk to a family member, friend, or health professional about ways to break down a large task into smaller components that are easier to tackle.
• Make lists: Try keeping ongoing lists (e.g., of supplies such as groceries) and bringing these lists along whenever you go shopping or do other errands.
• Set priorities: One way to set priorities is to re-write lists with the most important items at the top, or to group items in some way. For example, you might group all errands that need to be done on the same day, or group those that are in the same geographical area.
• Try playing games: Engaging your mind in solving puzzles or playing games can help to train your critical-thinking skills. There are many popular games that encourage players to plan ahead, develop strategies, and adapt to changing circumstances (e.g., chess, Sudoku puzzles, and card games such as Solitaire).

Here are some strategies that often help with social-cognition skills.

• Get clarification in the moment: Ask the person you are speaking with what he/she meant (“What do you mean by that?”). Or use your own words to restate what you believe the other person has said so that he/she can correct you if needed (“So what you are saying is …”).
• Ask others for their opinions: Ask a friend or someone you trust to give you a second opinion about a confusing situation. People you trust might also be helpful in suggesting ways to deal with situations in which a misunderstanding has occurred.
• Keep track of problem situations: Keep track of the kinds of social situations in which you experience problems or misunderstandings. You may be able to find out if you are consistently misinterpreting certain types of situations or behaviors. Again, others may be able to help you plan ways to deal with these types of situations before they occur again.
• Give the other person the benefit of the doubt: Most people are not intentionally mean, even if they do end up hurting our feelings from time to time. Try not to overreact to situations that you experience for the first time. If a social problem occurs over and over, then you can try some of the problem-solving techniques to see what is contributing to the problem and come up with ways to handle it in an open and respectful manner.

Here are some general tips for making use of cognitive strategies.

• Take time to think about and identify your problem areas.
• Try to make use of your areas of strength. Many of the checklists in this section can also point out things that are easier for you. Try to build on these strengths when you come up with plans to tackle problem areas.
• Don’t try to work on too many cognitive problems at one time. Start by focusing on one or two areas that cause the most difficulty in your day-to-day life.
• Don’t be afraid to tell others about the cognitive difficulties that you are struggling with. Unfortunately, individuals with cognitive problems can be mistakenly judged as being “lazy” or “unmotivated” when, in fact, it is their cognitive weaknesses that make it difficult for them to perform tasks effectively. Other people are more likely to try to help if they understand what is going on. Remember that your general health and emotional well-being can also impact your cognitive abilities. Most people think best (e.g., pay attention, remember things better) when they are rested and not emotionally stressed.

Fraser Health and British Columbia, Dealing with Psychosis Workbook (Page 50-58), 2012