An App to Navigate Daily Life with Schizophrenia, and Modern Therapy Built on Storytelling Traditions

For decades, Comprehensive Healthcare has fostered a close partnership with the University of Washington to engage clients and community members in innovative research projects to advance behavioral health care in our region, state, and nationwide.

Two of our current initiatives, Healing Seasons and FOCUS, are designed to uncover new, evidence-based approaches to helping clients build skills for processing and effectively managing challenges. The benefits extend beyond individual participants and providers, according to Ron Gengler, chief clinical officer and a leader of advanced research at Comprehensive Healthcare.

“Introducing new ways of looking at longtime issues such as mental health, trauma, and substance use disorders has a broader impact on our communities,” Gengler said. “We find these projects are enabling clients and their support networks to gain a better understanding of underlying causes and potential solutions, and to reduce stigma overall.”

The Quest for Culturally Adaptive Evidence-Based Practices in Native American Communities

Traditional therapy for healing trauma or addressing substance use disorders often focuses on processes that are anchored in structured goal-setting and skill-building activities, along with the written word. While we’ve found these approaches effective overall, researchers and providers are continually searching for strategies that may be a better fit for all individuals in the communities we serve.

In 2017, we began partnering with the University of Washington and the Yakama Nation to understand whether a culturally adaptive, story-based model called Narrative Exposure Therapy (NET) would more effectively build on Native American communities’ rich cultural traditions of oral storytelling, and possibly offer improved behavioral health treatment outcomes.

The project, called Healing Seasons, recognizes that indigenous populations often face high levels of institutional and generational trauma that traditional therapy models, like the Motivational Interviewing with Skills Training (MIST) model, may not fully address.

With NET, participants work with a therapist to use objects, such as feathers, rocks, photographs and other items to help paint a physical timeline of abuse and trauma while also anchoring the participant in their positive memories. This model allows a client to view the trauma as one event in their life, instead of feeling like it controls their identity. In this way, NET and Healing Seasons is intended to help participants better understand the seasons of their own lives in which they can find more freedom from trauma experienced individually, and often compounded generationally.

“Creating culturally adaptive practices can really help people move on through trauma and live full, healthy lives,” Gengler said. “We can help restructure negative, unhelpful thoughts and help clients look at life in a positive and helpful manner, in spite of how the trauma has impacted them. It helps people reclaim their identities and realize, ‘I am not my trauma, the trauma does not define who I am. I am in a difficult season of trauma recovery that may have existed for generations, but I am more than that, too.’”

Nearly 400 tribal members have participated in Healing Seasons, receiving care at Comprehensive Healthcare or Yakama Nation behavioral health clinics, and about 85 individuals are currently enrolled.

Apps for Skill-Building and Mental Health Support for Individuals with Schizophrenia

While many people used telehealth and mobile health technologies for the first time in 2020, Comprehensive Healthcare has been working with UW researchers for the last two years to test the effectiveness of FOCUS, an Android health app and intervention program for individuals experiencing psychosis.

In conjunction with counseling services, the app allows users to build and practice emotional, behavioral, and social skills at the click of a button. Participants can learn emotional regulation practices, receive notifications and reminders to take medicine, tips for understanding social cues, sleep improvement techniques, and more. The idea, Gengler said, is to help clients manage their illness much like other chronic conditions, such as diabetes or high blood pressure.

“We know for diabetes, if you don’t take your prescribed medication, you’ll have a problem,” he said. “Nobody stigmatizes reminders for treating diabetes… we shouldn’t stigmatize reminders for psychosis medication.”
While the app is designed to support individuals who have experienced psychosis for years, many people with schizophrenia experience a first psychotic break as a teenager or young adult between the ages of 16 and 26. The age group is generally comfortable with using apps throughout daily life – and most likely to benefit from early intervention.

“A decade ago, a schizophrenia diagnosis may have meant a lifetime of case management. Now, with early intervention programs such as our own New Journeys program, people experiencing psychosis are learning to adjust, and remain in school or work,” Gengler said. “This app can be another
helpful tool for managing the symptoms of the diagnosis.”

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