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Psychosocial Interventions

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Antipsychotic drugs are the first line of treatment for schizophrenia. But psychotherapy and other social treatment options can make a big difference in outcomes and quality of life, too. These resources can come in many forms, including individual or group therapy. There are many potential options in person or online.1,2

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is one of the most commonly used therapy options for people with schizophrenia. A psychologist, psychiatrist, or other professional trained in CBT leads these sessions. The goal is to change and reduce unwanted thoughts and feelings. These thoughts and feelings may relate to insecurities, fears, or general stressors. They are then reframed into more productive ideas and actions.1-4

In people with schizophrenia, CBT may involve identifying strong false beliefs (delusions) and learning why they may be unhelpful or untrue. These ideas can then be challenged and reframed into something that is less disruptive to the person.3,4

This process can be tricky during some stages of schizophrenia. For example, a common feature of schizophrenia is anosognosia. This term refers to being unable to identify that you have untrue or problematic beliefs. This can make readjusting and reframing thoughts difficult. But CBT can help most people with schizophrenia who are not in the active psychosis phase.1,4

CBT is thought to be most helpful for people with long-term management of schizophrenia. It is ideally used alongside antipsychotic drug treatment. It can be done 1-on-1 or in groups. Outside of CBT, there are other cognitive therapy options, too. These focus on improving memory and information processing.1

Family therapy

In family therapy, you and your family members attend therapy sessions together. Family therapy can help those closest to you better understand what you are going through. It can also help loved ones answer questions and learn about schizophrenia. Family therapy is a great source of validation and support for caregivers as well.1,2,5-7

Family therapy is a good setting to make game plans for treatment, whether for the long term or crisis situations. Starting family therapy as soon as possible after a schizophrenia diagnosis can get everyone on the same page quickly. It can also help reduce the risk of severe symptom relapse.1,2,5-7

Family therapy does not always include your family of origin. You can decide who attends these sessions based on what makes the most sense for you. The people you are closest to or those you want to improve relationships with are ideal to include no matter your relationship.1,2,6,7

Other forms of therapy

CBT is not the only form of 1-on-1 therapy used in schizophrenia. General talk therapy can be helpful for processing emotions. It can be helpful for caregivers, too. A talk therapist should have a mental health certification of some kind. Ask your therapist what type of certification they have and what kind of therapy they provide before you start treatment.2,8

Group talk therapy also has benefits. In group therapy, you can learn from people with similar mental health conditions or going through similar situations. This allows everyone participating to navigate problems together. A group therapy session is led by a trained professional. These sessions can be in a healthcare setting or in the community. There are online group therapy options, too.2,5

Trauma therapy also may be beneficial if the person has endured early life trauma. Mental health experts can be specifically trained in trauma therapy and support. They can help a person face their trauma, understand it, cope with it, and overcome it through various therapy techniques.9

Other forms of therapy that may help include art therapy and music therapy. These options allow participants to express complicated emotions or frustrations in a creative way.2

Peer counseling

Peer counseling can provide validation and hope for the future. In peer counseling, someone who has been living with schizophrenia or other mental illness leads 1-on-1 or group counseling sessions. Peer counselors may be older. But anyone who has a lot of personal experience managing the condition can make a great peer counselor.5

Social skills training

Over time, schizophrenia may impact your ability to carry out daily tasks. These tasks may include things like doing laundry, paying bills, making friends, and cooking. Social skills training focuses on learning and problem-solving tactics to reduce barriers experienced.1,2,5

Sessions can take place in formal healthcare settings, in the community, or at home. You may have sessions multiple times a week for a few months at a time. The focus of social skills training can also change based on what you need at that moment. Each person’s goals and experiences will be different.1,2

Supported employment and education

Schizophrenia symptoms can make it challenging to do well at work or school. But there are programs to help you be the best version of yourself in these settings. Case managers and social workers can connect you to these resources. This type of assistance is called supported employment or vocational rehabilitation.2,5,10

If you are in school, you may need a special education plan or accommodations to succeed. If you are employed or unemployed and looking for work, these programs can help as well. They will provide support to help you prepare, secure, and maintain employment over time.2,5,10

Coordinated specialty care and assertive community treatment

Coordinated specialty care (CSC) focuses on helping people who are having their first episode of psychosis. Psychosis refers to losing connection with reality. CSC brings a team of experts together from different backgrounds to provide intensive care as soon as possible. These teams are often specialized to help young people.4

A CSC team will have doctors, pharmacists, case managers, therapists, and more to help with any and all needs. Researchers have found that earlier and more aggressive support for people having their first episode of psychosis leads to better overall outcomes.4

Assertive community treatment (ACT) is also a team-based approach to caring for people with schizophrenia. It includes many of the same team members but is focused on long-term care rather than the first episode of psychosis. Both CSC and ACT can be accessed any time, day or night. They are also both helpful in crisis management.4,11

A well-rounded treatment plan includes multiple psychosocial options, often at once. Talk with your support system and healthcare team about the support you need. You can work together to set goals and decide what resources might be best for you.

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