Module 1, « cognitive differentiation », is intended to exercise basic cognitive functions (attention/concentration, memory, and the creation/manipulation of concepts) through abstract exercises in the form of learning games. These exercises solicit and improve patients’ existing cognitive functions and permit the acquisition of compensatory strategies to reduce residual cognitive deficits. Module 1 not only stimulates cognitive functions, it also establishes the kind of safe learning environment that is essential for effective group processes, enabling participants to have successful experiences (Kielhofner, 2002).
Module 2, « social perception », consists of participants working together to analyze images (slides or video sequences) that represent a variety of social situations. Initially, simple cognitive content and emotionally neutral situations give way to progressively more complex content in more emotionally charged situations. Participants are asked to describe objective aspects of the images and to interpret their content. The aims are to avoid inappropriate interpretations, focus on the objective aspects of the image, and correct mistaken cognitive schemata that often occur in patients with schizophrenia. Module 2 also allows facilitators to make an initial assessment of the cognitive schemata of participants that will have an impact on the way they manage their emotions and solve everyday problems (covered in modules 5 and 6).
Module 3, « verbal communication », addresses patients’ basic communication skills through learning games or role-playing. Participants acquire listening skills, develop understanding, and learn appropriate responses. Clinicians work with participants on the various communication deficits that are frequently observed in patients with schizophrenia (eg, poor language, loss of content, circumstantial language, perseveration). This is a key module in which greater demand is placed on individual participants, but in which progress is made toward establishing a cohesive spirit within the group. Thus, this module is well suited for exercises on acquiring new adjustment strategies proposed by clinicians.
Module 4, « social skills », is a logical follow-up to the preceding module. It aims to develop an appropriate range of social skills in a variety of specific social situations. Participants are encouraged, according to their capacities and needs, to work through different social situations they encounter in their everyday lives using cognitive-behavioral techniques (eg, instructions, role playing, modeling, repetition, reinforcement). This module is largely based on classic approaches to developing social skills (Bellack et al., 2004; Liberman et al., 1993).
Module 5, « emotional management », helps patients develop the best strategies for managing emotions. The depiction of an emotion presented in a given situation (in a slide or short video sequence) allows participants to do a detailed analysis of their emotional reactions, question the appropriateness of the strategies they have adopted, search for better-alternative strategies, and then experiment with the strategies they have selected. Module 5 is demanding in that it requires clinicians to possess a solid mastery of group facilitation skills. The challenge is to maintain the established theoretical framework while increasing the complexity (cognitive, perceptual, and social) of the situations presented.
Module 6, « problem solving », involves analyzing problems experienced by the participants. These situations are examined according to the following steps of problem solving: identify and analyze the problem, engage in the cognitive conceptualization of the problem, search for alternative solutions, discuss the solutions, select a solution, implement the solution, and evaluate the solution’s effectiveness. This module requires participants to use the skills they have acquired in the preceding modules and proposes real-life situations and exercises that facilitate the transfer of learning skills.