The most rewarding part of my job as a psychiatrist is practicing psychotherapy, particularly when I’m able to help patients with severe mental health conditions like schizophrenia. I am disappointed when I hear people suggest that psychotherapy is really not the right treatment for patients with schizophrenia1. My goal in this article is to inform patients, their families and practitioners that psychotherapy can be a very important part of a patient’s recovery plan from schizophrenia. The list of possible therapies studied as a treatment for schizophrenia is vast, and choosing a type of therapy depends on you and your unique personal therapeutic goals.
Cognitive Behavioral Therapy (CBT) is the most widely studied therapy for schizophrenia, and involves first being more aware of your thoughts (cognitions), feelings and behaviors. You then work with your therapist to normalize and understand that some of your previous or current symptoms of schizophrenia (such as delusions, hallucinations or disorganized thinking) are part of your psychiatric condition. You can share these troubling experiences without being judged and use CBT to improve your understanding and coping skills. Published studies report that patients receiving CBT show improvements in positive (i.e.psychotic) symptoms (hallucinations, delusions), negative symptoms (lack of motivation, blunted facial expression, social withdrawal), functioning, mood, hopelessness, and social anxiety2.
Supportive therapy (ST) can provide you with a warm, supportive relationship where current problems can be discussed freely and worked on in partnership with your provider. It is generally less structured than other forms of therapy, and the scientific evidence for its effectiveness is not as strong as other treatments3.
Social Skills Training (SST) is a therapy focused on learning and practicing specific social skills in an effort to improve your life, and also involves making and achieving your individual goals towards recovery (i.e. getting a job, meeting new people, increasing enjoyable activities)4.
Cognitive Remediation (CR) works to improve or to find “workarounds” to the problems in thinking that often occur due to schizophrenia. Examples of CR goals could be improving concentration, memory, social awareness, or the ability to “think about your thinking” (metacognition)5.
Psychoeducation (PE) provides information to patients, and Family Intervention (FI) provides information to patients and their families about the diagnosis, realistic expectations and common issues or conflicts6.
Psychodynamic Psychotherapy involves exploring your past life experiences and increasing your understanding into how previous emotional conflicts may be (unconsciously) influencing your current behavior. Studies show psychodynamic psychotherapy can provide improvements in a “target problem,” symptom level, and social functioning7. However, it might not be suitable for all patients.
In my clinical practice I usually use CBT for many of my patients. I have studied and learned other forms of therapy, but have found CBT to be the most flexible and efficient way to help my patients thrive. One patient of mine with schizophrenia (“Jeff”) has offered some comments about how psychotherapy has helped in his recovery journey, and I will close this article with his comments. It’s been a pleasure working with Jeff and I am incredibly proud of his progress!
“Therapy has helped me understand myself and my symptoms much better. I used to see the world as a much scarier place and feel much more paranoid than I do now. I still hear voices every day, but thanks to therapy I understand them, I react to them in a totally different way, and they bother me much less. Once I’m able to use CBT to tackle an issue that’s bothering me I notice a significant drop in my stress level. I’m much better able to keep calm in situations where there are a lot of people, noises, and bright lights. In therapy I get a space to discuss things that are very difficult for me to talk about. Building trust was essential for me, and it gave me the opportunity to get these things off my chest. Finally, there have been times in my life where it would have been very easy to just “give up,” but doing this therapy has helped me maintain hope and motivation. I don’t feel like I’m “cured,” but I’m handling my life so much better than I used to!”
- Kuller, A. M., Ott, B. D., Goisman, R. M., Wainwright, L. D., & Rabin, R. J. (2010). Cognitive behavioral therapy and schizophrenia: A survey of clinical practices and views on efficacy in the United States and United Kingdom. Community mental health journal, 46(1), 2-9.
- Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia bulletin, 34(3), 523-537.
- Buckley, L. A., Maayan, N., Soares‐Weiser, K., & Adams, C. E. (2015). Supportive therapy for schizophrenia. Cochrane Database of Systematic Reviews, (4).
- Granholm, E., & Harvey, P. D. (2018). Social skills training for negative symptoms of schizophrenia. Schizophrenia bulletin, 44(3), 472-474.
- Barlati, S., Deste, G., De Peri, L., Ariu, C., & Vita, A. (2013). Cognitive remediation in schizophrenia: current status and future perspectives. Schizophrenia research and treatment, 2013.
- Girón, M., Nova-Fernández, F., Mañá-Alvarenga, S., Nolasco, A., Molina-Habas, A., Fernández-Yañez, A., … & Gómez-Beneyto, M. (2015). How does family intervention improve the outcome of people with schizophrenia?. Social psychiatry and psychiatric epidemiology, 50(3), 379-387.
- Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of general psychiatry, 61(12), 1208-1216.