Snoezelen Therapy in Adults With Alcohol Dependence and Adults With Schizophrenia

In all control groups, for ethical reasons, a standard therapy based on the principles of best clinical practice will be conducted.

There will be 3 control groups:

1. patients suffering from schizophrenia control group, N = 20, standard therapy based on the principles of best clinical practices will be conducted for 12 weeks.
2. patients suffering from schizophrenia control group requiring permanent institutional care, N = 20, standard therapy based on the principles of best clinical practices will be conducted for 12 weeks.
3. patients (women) treated for alcohol addiction, N = 30, standard therapy based on the principles of best clinical practices will be conducted for 6 weeks.

Adults suffering from schizophrenia requiring permanent institutional care, N= 20 Snoezelen® therapy will be conducted twice a week (for 30 minutes) for 12 weeks.

The goal of the therapy will be to improve cognitive functioning, organization in daily activities, mood, including reducing emotions such as anxiety and sadness, and to increase the patient's overall quality of life.

• Snoezelen®

Adults suffering from schizophrenia, N= 20 Snoezelen® therapy will be conducted twice a week (for 30 minutes) for 12 weeks.

The goal of the therapy will be to improve cognitive functioning, organization of daily activities, mood improvement, including reducing emotions such as anxiety and sadness, as well as increasing the patient's overall quality of life and emotional intelligence.

• Snoezelen®

Patients (women) treated for alcohol addiction, N= 30. Snoezelen ® therapy will be used twice a week (for 30 minutes) for 6 weeks. Then, 4 weeks after the end of therapy (so-called follow-up ), a telephone interview will be conducted to assess mood and the short Penn Alcohol Craving Scale.

The goal of the therapy will be to improve cognitive functioning, organization of daily activities, mood improvement, including reducing emotions such as anxiety and sadness, as well as increasing the patient's overall quality of life and emotional intelligence.

The each session of Snoezelen® therapy will last 30 minutes and will include:

1. preparation and adjustment of stimuli based on information regarding the assessment of the patient's condition and problems,
2. careful observation and appropriate care of the patient,
3. grading of stimuli and their appropriate stimulation,
4. experiencing therapeutic activities together with the patient,
5. recording the therapist's presence and comments on the therapy card.

• Snoezelen®

1. Cognitive function testing using the MOCA or ACE-III

• The Montreal Cognitive Assessment (MOCA) assesses cognitive function. The test consists of 30 tasks assessing language, memory, reasoning, orientation, visual reasoning, and spatial reasoning. The test takes approximately 10-15 minutes to complete. Maximum score: 30 points. One point is added for individuals with less than 12 years of education.
• The Addenbrooke's Cognitive Examination III (ACE-III) is an extended screening tool for cognitive function. The test assesses attention and orientation, memory, verbal fluency, language, and visuospatial functions. The test takes approximately 15 minutes. The maximum score is 100 points. A score below 88 suggests the presence of cognitive impairment and requires further medical evaluation.

Emotional state examination, which will be carried out by determining the degree of:

a. Severity of depressive symptoms using the BDI or GDS scale.

• The Beck Depression Inventory (BDI) measures the severity of depression symptoms, which includes questions about mood, guilt, and physical symptoms. A score of 0 to 10 indicates no depression, 11 to 27 indicates mild or moderate depression, and 28 or more indicates severe depression.
• The GDS-30 (Geriatric Depression Scale) is a screening tool used to assess the severity of depression symptoms in older adults. GDS-30 consists of 30 questions about well-being over the past week. 0-9 points: normal condition (no symptoms of depression); 10-19 points: suspicion of moderate depression; >20 points: suspicion of severe depression.

1. Cognitive function testing using the MOCA or ACE-III or the CSSS Scale. The MOCA or ACE-III scales are described above in the outcomes in patients suffering from schizophrenia requiring institutional care group.

The Cognitive Screening Scale for Schizophrenia (CSSS) is a brief diagnostic tool used to quickly detect cognitive deficits in people with schizophrenia. This scale assesses the patient's overall cognitive performance, is time-consuming, and aids in qualifying patients for rehabilitation. Higher scores indicate better cognitive functioning.

The intensity of positive or negative symptoms is assessed using the PSYRATS Psychotic Symptom Rating Scale and the BNSS (Brief Negative Syndrome Scale).

-The PSYRATS Scale (Psychotic Symptom Rating Scale) is a multidimensional tool for the assessment of auditory hallucinations and delusions, consisting of two subscales (for hallucinations and delusions) rated from 0 to 4. Scale Structure: Auditory Hallucinations Subscale (AHS): contains 11 questions, including questions about frequency, duration, loudness, content, degree of distress, and belief in the reality of voices. Delusions Subscale (DS): contains 6 questions, including questions about the degree of preoccupation, belief in reality, and anxiety. Assessment Method: Each symptom feature (dimension) is scored on a scale from 0 (no symptom) to 4 (maximum severity).

The intensity of positive or negative symptoms is assessed using the BNSS (Brief Negative Syndrome Scale).

-The Brief Negative Symptom Scale (BNSS) is a clinical tool used to assess the severity of symptoms in schizophrenia. Its basic information and structure consist of 13 questions divided into 6 main subscales. The test format: a semi-structured patient interview combined with clinical observation. Duration: approximately 15 minutes. Scoring range: 0 (no symptom) to 6 (extreme severity) for each item; the total score ranges from 0 to 78 points.

Emotional state examination, which will be carried out by determining the degree of:

• Severity of depressive symptoms using the BDI or GDS or CES-D
• Anxiety level using the Burns Anxiety Inventory or the STAI Anxiety Inventory.

• Satisfaction with life using the SWLS scale. STAI Scale The STAI (State-Trait Anxiety Inventory) measures two distinct types of anxiety: State Anxiety (the X-1 scale for temporary feelings) and Trait Anxiety (long-term feelings). The STAI is a tool for assessing anxiety, understood as a transient and situationally determined individual state, and anxiety, understood as a relatively stable personality trait. It is used for screening and individual assessment; the X-1 scale is also useful in experimental studies requiring the recording of changes in anxiety intensity.

  • The other mentioned scales are described above in the outcomes in patients suffering from schizophrenia requiring institutional care group.

Emotional intelligence testing with the INTE Emotional Intelligence Questionnaire.

The INTE questionnaire measures emotional intelligence, defined as the ability to recognize, understand, and control one's own and others' emotions, as well as the ability to effectively use emotions to guide one's own and others' actions. It is primarily used for research purposes. The survey lasts approximately 10 minutes. Sum of item values give a total emotional intelligence metric.

1. Cognitive function testing using the MOCA or ACE-III diagnostic tools The Montreal Cognitive Assessment (MOCA) and the Addenbrooke's Cognitive Examination-III (ACE-III) are key medical tests used to find cognitive impairment.

Cognitive function testing using the MOCA or ACE-III - The Montreal Cognitive Assessment (MOCA) assesses cognitive function. The test consists of 30 tasks assessing language, memory, reasoning, orientation, visual reasoning, and spatial reasoning. The test takes approximately 10-15 minutes to complete. Maximum score: 30 points. One point is added for individuals with less than 12 years of education. - The Addenbrooke's Cognitive Examination III (ACE-III) is an extended screening tool for cognitive function. The test assesses attention and orientation, memory, verbal fluency, language, and visuospatial functions. The test takes approximately 15 minutes. The maximum score is 100 points. A score below 88 suggests the presence of cognitive impairment.

Emotional state examination, which will be carried out by determining the degree of severity of depressive symptoms using the BDI or GDS or CES-D scale (The Center for Epidemiologic Studies Depression Scale).

The Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Geriatric Depression Scale (GDS) are three widely used self-report tools to screen for and measure the severity of depressive symptoms.

Emotional state examination, which will be carried out by determining the degree of:

b. Anxiety levels using the Burns Anxiety Inventory or STAI State-Trait Anxiety Inventory.

The STAI (State-Trait Anxiety Inventory) measures two distinct types of anxiety: State Anxiety (the X-1 scale for temporary feelings) and Trait Anxiety (long-term feelings). The STAI is a tool for assessing anxiety, understood as a transient and situationally determined individual state, and anxiety, understood as a relatively stable personality trait. It is used for screening and individual assessment; the X-1 scale is also useful in experimental studies requiring the recording of changes in anxiety intensity.

Emotional state examination, which will be carried out by determining the degree of CISS (Coping Inventory for Stressful Situations) Scale.

A questionnaire for diagnosing stress coping styles. It is used for research and practical purposes, for example, as a tool in qualification tests for specific job positions in certain professions (police, firefighters, drivers), or in testing individuals applying for firearms licenses. In our study, we aim to determine whether Snoezelen therapy can influence the stress coping style of women addicted to alcohol. Rating Scale: A 5-point frequency scale ranging from 1 ("not at all") to 5 ("very much").

Emotional state examination, which will be carried out by determining the degree of: - Satisfaction with life using the SWLS scale.

Life satisfaction using the SWLS scale The SWLS (Satisfaction with Life Scale) is a short psychological tool used to assess overall life satisfaction. It consists of five statements, which the respondent rates on a seven-point scale. It is intended for adults, both healthy and sick, and takes approximately two minutes to complete. The scasle contains five statements regarding satisfaction with one's overall life. Response Format: Seven-point Likert scale (from 1 - I completely disagree to 7 - I completely agree). Score: overall life satisfaction index = the higher the score, the greater the sense of satisfaction.

Emotional intelligence testing with the INTE Emotional Intelligence Questionnaire.

The INTE questionnaire measures emotional intelligence, defined as the ability to recognize, understand, and control one's own and others' emotions, as well as the ability to effectively use emotions to guide one's own and others' actions. It is primarily used for research purposes. The survey lasts approximately 10 minutes. Sum of item values give a total emotional intelligence metric.

* 4 weeks after the end of study (follow-up), a telephone interview will be conducted with the use of short Penn Alcohol Craving Scale (PACS).

The Scale is a self-assessment method, it comprises 5 statements, and is designed to assess alcohol craving experienced by a patient in a week prior to the examination. 0-3 points - low intensity of alcohol craving, 4-9 points - average intensity of alcohol craving, above 10 points - high intensity of alcohol craving.