or discharge from long-term hospitalization) that overwhelm the protective effects of medication, personal coping, and social support can also lead to symptomatic exacerbation. Even in the absence of a time-limited stressor, vulnerable individuals can succumb to ambient levels of challenge, tension, or conflict in their environment if they lack the protection conferred by medication, coping abilities, and social support. The vulnerability-stress-copingcompetence model highlights the role of specific psychosocial interventions in developing personal and familial Downloaded from by guest on 23 November 2021 VOL. 12, NO. 4, 1986 5*7 coping skills, and interpersonal and vocational competence as protective factors in the course of mental disorders. Psychosocial protective factors buffer the impact of potentiators and stressors, and thereby reduce the probability of symptomatic relapse. Socially learned coping helps individuals to obtain their instrumental and social-emotional needs by meeting the challenges and solving the problems of everyday life. Coping and competence protect an individual with a given level of vulnerability to schizophrenia from stressful life events and ambient levels of environmental tension. At any level of psychopathology, coping can reduce the social, occupational, and self-care impairments that are - 1. Vulnerability, stress, coping, and competence model of mental disorders Psychobiological vulnerability Socioenvironmental stressors Protective factors Social support Skill building Transitional programs Medication Impairments Rehabilitation outcomes Good Poor In this conceptual framework protective factors that facilitate coping and competence can modulate the deleterious affects of psychoblologlcal vulnerability and socloenvlronmental stressors. Coping and competence confer protection against Impairment, disability, and handicap. associated with the disorder. The model also encourages investigators to design optimal psychopharmacological interventions to modify the effect of psychobiological vulnerability factors. For example, antipsychotic medication serves as a personal protective factor against biological vulnerability; it thereby decreases relapse rates and improves the course of schizophrenic disorders. Antipsychotic medication also raises the threshold at which environmental potentiators and stressors precipitate psychotic symptoms in an individual with a given level of vulnerability to schizophrenic episodes (Leff et al. 1973; Vaughn and Leff 1976a, 1976b). However, the modulation of biological vulnerability by antipsychotic medication cannot fully remediate a vulnerable individual's susceptibility to relapse when faced with severe stressors, loss of social support, or diminution in personal problem-solving skills. Even with reliable ingestion of neuroleptics, for example, upwards of 30-40 percent of schizophrenic patients relapse within a year (Liberman 1984). In this vulnerability-stress-copingcompetence model, the appearance or exacerbation of characteristic schizophrenic symptoms and associated disabilities may occur in susceptible individuals when: • Underlying psychobiological vulnerability factors are triggered, which is more likely in the absence of optimal antipsychotic medication. • Stressful life events intervene that exceed the individual's coping skills and competencies in social and instrumental roles. • The social support network weakens or diminishes; • Coping and problem-solving skills atrophy as a result of disuse, reinforcement of the sick role, or loss of motivation. by guest on 23 November 2021 548 SCHIZOPHRENIA BULLETIN Psychiatric Impairment, Disability, and Handicap From the point of view of rehabilitation professionals, the psychobiological abnormalities in the nervous system that produce deficiencies in cognitive, attentional, and autonomic functions, and in regulation of arousal and information processing, represent the active pathology or disease state. The neurosciences are just beginning to develop instruments and techniques that can sensitively measure these abnormalities. However, they can be inferred through assessment of impairments that presumably index the more basic disturbances in brain