Schizophrenic Therapy: Schizophrenia Treatment Options

Schizophrenia is a chronic, serious mental illness that affects over 24 million people worldwide. Those living with schizophrenia may experience significant difficulties maintaining quality of life. In addition, they may face stigma and discrimination due to their condition. However, with appropriate treatment, it may be possible to manage the symptoms of schizophrenia and achieve positive outcomes. 

Schizophrenia often requires a holistic treatment approach that includes medication management, education, family interventions, cognitive-behavioral therapy (CBT), and other forms of talk therapy. Psychotherapy can help people with schizophrenia cope with their symptoms, develop useful skills, and receive valuable support. However, the thought of therapy can be daunting for those unfamiliar with the process. It can be helpful to know the various types of treatment available for schizophrenia, the goals of treatment, and what people with schizophrenia can expect in a therapy session. 

Goals of treatment for schizophrenia

The treatment process may be multifaceted and could involve the assistance of multiple mental health professionals. An individual’s care team may suggest various treatment methods to help limit the negative effects of psychotic episodes, including therapy. Goals might include reducing the frequency and severity of symptoms and improving quality of life. Below are other breakdowns of the goals of psychotherapy for schizophrenia. 

Symptom reduction 

Schizophrenia is characterized by several distressing symptoms, including the following: 

• Positive symptoms involving excess or distorted functioning, such as hallucinations and delusions

• Negative symptoms that involve a deficit or loss of normal functioning, such as apathy, social withdrawal, loss of interest in previously enjoyed activities, and cognitive impairment

• Disorganized symptoms that might include confusion, cognitive impairment, and abnormal motor behavior

In the context of symptoms, "positive" means symptoms that add to one's state, and negative symptoms involve traits that are taken away or no longer present from an individual's previous state when the condition develops. Diagnosed individuals may work closely with a treatment team to manage these symptoms via medication and talk therapies (sometimes called talking therapies). They may also learn coping skills to help them manage distressing situations.

Improved social and occupational functioning

Treatment may seek to improve a person's social and occupational functioning. Symptoms of the disorder can make it difficult to maintain employment, form and maintain relationships, and engage in social activities. Through cognitive-behavioral therapy (CBT), cognitive remediation therapy (CRT), and psychosocial therapy, occupational specialists and other professionals can help clients integrate with their communities through employment and social support systems.

Improved insight and coping skills

It can be challenging for those with schizophrenia to understand their experiences and effectively manage symptoms. Treatments like CBT and CRT can help those with schizophrenia develop insight into their mental illness. They may also learn coping skills and self-management strategies to help them live independently.

Improved quality of life

Improved quality of life is often a primary goal of treatment for individuals. Medication may help clients manage acute symptoms of schizophrenia, while psychotherapy and psychosocial interventions may empower individuals to engage in meaningful activities, form relationships, and enjoy a more significant sense of well-being.

Types of therapy for people with schizophrenia

Treatment may include several solutions to manage symptoms and improve quality of life. Each approach may have unique benefits and can be tailored to meet individual needs. Therapy for schizophrenia can occur in various formats, including individual psychotherapy, community care (e.g., assertive community treatment, self-help groups), and group psychotherapy (e.g., family therapy). In addition to the below modalities, mental health professionals may utilize elements from a variety of other methods, such as arts psychotherapies. The following are examinations of techniques that might be used in some methods.  

Cognitive behavioral therapy (CBT)

Cognitive behavior therapy, also referred to as cognitive behavioral therapy, is a widely utilized treatment option for various mental health disorders. According to NHS, “Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave”.

Research has shown that CBT can be an effective way to treat schizophrenia. CBT focuses on the interdependent relationship between a person's thoughts, feelings, and behaviors. For those living with schizophrenia, CBT may look at identifying and challenging maladaptive thoughts and beliefs that may contribute to psychotic symptoms, including hallucinations and delusions.

In treatment, CBT may involve different techniques, including but not limited to the following: 

• Reality testing to help the client differentiate between real and false 

• Cognitive restructuring to challenge and change beliefs or distorted perceptions that may be contributing to psychotic symptoms

• Coping skills training to help clients manage difficult symptoms like psychosis and paranoia

• Depression and anxiety treatment for clients who experience other mental health conditions alongside schizophrenia

Cognitive remediation

Cognitive remediation therapy (CRT), often called cognitive enhancement therapy (CET), is a form of psychotherapy that focuses on improving cognitive functioning. It is often used to treat the cognitive deficits associated with this disorder, such as attention, memory, and problem-solving difficulties. In CRT, individuals may work with a counselor or team of psychotherapists who guide them through exercises and activities designed to enhance their cognitive skills. 

Research has shown that CRT can be effective in improving cognitive functioning in individuals with schizophrenia and can lead to improvements in daily functioning, vocational outcomes, and quality of life. It can be used in conjunction with other treatments like medication and CBT to provide a comprehensive treatment approach for individuals with schizophrenia. 

Interventions with family members

Family therapy is a type of psychotherapy that focuses on improving family dynamics. Family therapy can be beneficial for those living with this disorder, as symptoms may impact not only the individual but their family members. For example, in family education interventions, the psychotherapist teaches the family member with schizophrenia and their caregivers, siblings, etc., how to communicate, cope with unwanted feelings, and provide support to one another. Because symptoms often lead to withdrawal, it can be difficult to maintain a support system for some people with schizophrenia. 

A licensed family psychotherapist can help families learn communication strategies and conflict management skills. In addition, research has proven this method effective in strengthening family relationships and overall outcomes for individuals with schizophrenia.

Psychoeducation programs

Psychoeducation programs aim to educate individuals and their families about mental health conditions to improve treatment outcomes. Education programs can help those with schizophrenia and their families better understand the condition, its impact on daily functioning, and potential benefits of medication and other treatments.

These programs can also provide practical strategies for managing symptoms, improving communication, and enhancing coping skills. Psychoeducation programs can be effective in reducing symptom severity and improving overall outcomes for individuals with schizophrenia.

Social skills training programs

Social skills training programs help individuals develop and improve social skills such as communication, assertiveness, and problem-solving. It may be helpful for those with difficulty establishing and maintaining relationships, fostering healthy social interactions, and participating in social activities.

Social skills training may also involve group sessions that focus on specific social skills and provide opportunities for individuals to practice these skills in a supportive environment. This training may also include role-playing exercises, feedback, and coaching to help clients develop and refine social skills.

Research has proven social skills training is an effective way for those with this disorder to reduce social isolation, increase the likelihood of community integration, and improve overall quality of life. According to the National Institute of Mental Health, individuals who participate in psychosocial therapy interventions like social skills training “are less likely to have symptoms reoccur or to be hospitalized”.

Medication

Medication is a common and often effective approach for managing the symptoms of this disorder. Antipsychotic medications—the primary class of medication used to treat schizophrenia—can reduce the severity of a psychotic episode. These can include first-generation antipsychotics (also called typical antipsychotics) and second-generation antipsychotics (also called atypical antipsychotics), which are more commonly prescribed now. These medications work by blocking dopamine receptors in the brain. This process might reduce hallucinations, delusions, and other symptoms. 

Medication is often managed by a psychiatrist and is closely monitored for side effects. Common side effects of schizophrenia medications include dry mouth, constipation, weight gain, and tardive dyskinesia (a condition that can cause unwanted, involuntary movements). It often takes several weeks for the effects of a medication to become noticeable. Additionally, clients may experience changes in symptoms when switching medications or dosages. Aside from adjusting medications, practitioners can help these individuals learn appropriate medication management skills, which may significantly improve treatment outcomes. For individuals who do not respond to medication, providers may recommend electroconvulsive treatment. 

Consult your primary care physician or psychiatrist before starting, changing, or stopping a medication. 

What to expect in a schizophrenia treatment session

Mental health professionals are trained to offer personalized, evidence-based treatments to address the specific needs of each client. Thus, treatment may look different for the individual. Still, a few common steps might be expected in a therapeutic environment, including the following. 

Establishing rapport 

A therapist may work with the client to develop a positive, trusting relationship when psychotherapy begins. When a person begins attending therapy, a therapist may start by getting to know the client by asking about hobbies, interests, and other light topics of conversation before moving on to more in-depth topics about symptoms and past experiences. 

Intake 

A psychotherapist may go through an intake process with new clients to gain an understanding of their client's symptoms before beginning treatment. They may do this to ensure they're an effective option for the client's treatment. 

Discussing symptoms and progress

In treatment sessions, a therapist may ask about any changes in symptoms, medication side effects, or challenges the individual has faced. These check-ins can help therapists track their client's progress and adjust the treatment plan as necessary.

Coping skills training 

During treatment, a therapist may help clients learn techniques for managing their disorders. These techniques may include relaxation, mindfulness, or cognitive-behavioral strategies to manage symptoms and reduce stress.

Setting goals regarding mental illness

Goal setting can help individuals focus on specific areas for improvement and work toward tangible outcomes. Goals may include improving social skills, managing symptoms, or achieving independence, for example.

Medication management

Medication management may be addressed in psychiatric care environments or by a doctor. However, counselors, therapists, and social workers do not provide this service in the US. Management may involve reviewing the individual's medication regimen, discussing any side effects, and adjusting dosages as necessary to optimize treatment effectiveness.

Seeking treatment for schizophrenia

Schizophrenia is considered a severe mental illness. If you are experiencing symptoms of schizophrenia, seek treatment from a mental health professional as soon as possible. Because it is often treated with medication, consider contacting your primary care provider for a referral to a psychiatrist alongside psychotherapy. 

In addition to the support of a psychiatrist, you may also benefit from CBT. Research suggests that CBT can treat some symptoms of schizophrenia and other concurrent mental health conditions. Additionally, studies suggest that online CBT may be as effective as in-person treatment.

Effectiveness of online therapy for treating mental illness

Internet-based platforms like BetterHelp could be helpful for those whose symptoms make it difficult to attend in-person appointments. For example, some people with this disorder may be hesitant to attend a session in person because they fear they may have a hallucination in public. Others might lack reliable transportation or prefer to receive treatment in the comfort of their homes. Additionally, online therapy can be more affordable than traditional in-person psychotherapy.