Getting through the stress of day-to-day living is hard for many of us.

Now imagine trying to do that when you hear voices telling you you're worthless, or believe that someone is out to destroy you.

That is the challenge faced by many people with schizophrenia, which affects an estimated 1 percent of the U.S. population. The disease enervates patients, and many of them sleep late, spend time watching TV or smoking and don't take their medications regularly.

That is the point where Dawn Velligan intersects with their lives.

Dr. Velligan, co-director of the schizophrenia division of the University of Texas Health Sciences Center in San Antonio, is the inventor of a system known as cognitive adaptation training, which looks for practical ways to help patients cope with the disordered thinking and lack of motivation that keep their lives in limbo.

She was in Pittsburgh Friday to attend the 26th annual Pittsburgh Schizophrenia Conference and receive the Gerald E. Hogarty Excellence in Schizophrenia Research Memorial Award.

Besides the hallucinations that people with schizophrenia often suffer, it's common for them to have thinking difficulties, especially in "executive control," which involves such activities as planning, problem-solving and following a routine, Dr. Velligan said in an interview last week.

If the patient doesn't take good care of his personal hygiene, her program will attach a toothbrush and toothpaste tube to the bathroom mirror with a reminder to brush his teeth.

If the patient puts on her winter coat before going out, even if it's roasting outside, the program will pack the coat up and put it under the bed.

If a patient signs up for outside activities but routinely fails to show up, the adaptation program will send an aide to the home to go with the person to his first appointment.

One problem for patients with schizophrenia is that they "don't plan to do things because they don't anticipate it will be that great, even though once they get involved in an event, they often enjoy it."

Much of the cognitive adaptation training approach is based on checklists. "We all use checklists at work and when we check something off, we feel really good," Dr. Velligan said. In a more basic way, the brightly colored checklists that her team puts up on the walls of patients' homes will ask whether they showered that day, called their sister, made their bed, or took their medications.

Studies of people with schizophrenia show that long before they develop symptoms, they have various developmental delays -- they walk later, talk later and do more poorly on standardized tests.

And when they have their first psychotic episodes -- often in their late teens -- it can cause an immediate drop in IQ of 10 points, she said.

People with the disease can still be very smart, she said, but probably not as sharp as they would have been without the disease. "You have cognitive deficits relative to what you would have had, given your socioeconomic status and your genetic endowment. If you were going to be a genius, you could still be a genius with schizophrenia."

For many patients, it's not just a matter of thinking less clearly, but a lack of impulse control. "So an example would be if you're balancing your checkbook, and you find a check for your dance class, you get up and start practicing your dancing."

The program she developed is aimed at strengthening four aspects of thinking: motivation, planning, persistence and focus. "You need to get an idea [about what you want to do], which doesn't happen a lot when you have apathy; you need to know what the sequence of events is, so what do you do first and second and third; you need to be able to persist even when there are distractions; and finally, you need to be able to inhibit anything irrelevant or inappropriate."

Controlled studies have shown that patients using the training method are much better at taking their vital medications -- 80 percent vs. a typical rate of 50-60 percent -- and exhibit better performance on the job and in social settings, she said.

The same system of posting reminders and prompting people with personal visits can be used with people with depression or memory loss, she added. "It works for husbands and children as well," she said with a laugh.

One of the challenges in implementing cognitive adaptation training, she said, is that health insurance often doesn't pay for it, or only pays for a limited time, even though the patients' needs persist.

"People don't say, 'Boy, this medication is working great; now we should take it away and see if it still works.' But with psychosocial treatment, they always say now we'll take it away and see if it still works."

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