While most treatment of schizophrenia involves one or more antipsychotic medications, other treatments have also proven effective and vital to helping a person with schizophrenia maintain their recovery. Medications seem to work best on certain symptoms of schizophrenia, such as hallucinations, delusions, and incoherence.
Even when people with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (their 20s), they are less likely to complete the training required for skilled work. As a result, many people with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.
We’ve also learned in recent years that early psychotherapy interventions — when a teenager is having early signs of possible schizophrenia — can help reduce the risk of later being diagnosed with schizophrenia, or reduce its severity.
It is with these psychological, social, and occupational problems that psychosocial and psychological treatments may help most. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they are beneficial for those whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient’s social functioning — whether in the hospital or community, at home, or on the job. Some of these approaches are described here. Unfortunately, the availability of different forms of treatment varies greatly from place to place.
Individual Psychotherapy for Schizophrenia
Psychotherapy or other forms of talk therapy may be offered, with cognitive behavioral therapy being the most frequently used. This may focus on the direct reduction of the symptoms, or on related aspects, such as issues of self-esteem, social functioning, and insight. Cognitive-behavioral therapy (CBT) has been found effective in helping treat schizophrenia, especially when used early on, before a full-blown psychotic episode takes place.
Individual psychotherapy involves regularly scheduled sessions between the person with schizophrenia and a mental health professional such as a psychologist or therapist. The sessions may focus on current or past problems, experiences, thoughts, feelings, and relationships. By talking about these issues with an experienced professional, individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted. Recent studies indicate that supportive, reality-oriented, individual psychotherapy, and cognitive-behavioral approaches that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia.
Rehabilitation for Schizophrenia
Broadly defined, rehabilitation includes a wide array of non-medical “coping with everyday living” interventions for those with schizophrenia. Rehabilitation programs emphasize social and job training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.
Very often, patients with schizophrenia are discharged from the hospital into the care of their family. Therefore, it is important that family members learn all they can about schizophrenia and understand the difficulties and problems associated with the illness.
It is also helpful for family members to learn ways to minimize the patient’s chance of relapse — for example, by using different treatment adherence strategies — and to be aware of the various kinds of outpatient and family services available in the period after hospitalization. Family psychoeducation, which includes teaching various coping strategies and problem-solving skills, may help families deal more effectively with their ill relative and may contribute to an improved outcome for the patient.
Self-help groups for people and families dealing with schizophrenia are becoming increasingly common. Although not led by a professional therapist, these groups may be therapeutic because members provide continuing mutual support as well as comfort in knowing that they are not alone in the problems they face. Self-help groups may also serve other important functions. Families working together can more effectively serve as advocates for needed research and hospital and community treatment programs. Patients acting as a group rather than individually may be better able to dispel stigma and draw public attention to such abuses as discrimination against the mentally ill.
Family and peer support and advocacy groups are very active and provide useful information and assistance for patients and families of patients with schizophrenia and other mental disorders. A list of some of these organizations is included at the end of this document.