Cognitive Behavioral Therapy for Schizophrenia
Cognitive behavioral therapy, also known as CBT, may be a treatment option for people with schizophrenia. CBT teaches a person to modify beliefs or behaviors that may be leading to negative emotions. The therapy has two main parts: a cognitive component, which helps a person to change his or her thinking about a situation, and a behavioral component, which helps a person to change his or her reactions.
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Cognitive behavioral therapy is a short-term, problem-focused approach with the goal of teaching people who have schizophrenia a variety of coping skills to help them manage difficult situations. This type of therapy is typically given for one hour a week during the course of 12 to 16 weeks.
During cognitive behavioral therapy sessions, a person works with a therapist to learn how his or her thoughts, feelings, and behaviors influence each other. In order to change unwanted feelings or problematic behaviors, the therapist teaches strategies to modify negative thoughts and respond to them differently. The therapist teaches the person how to test the reality of his or her thoughts and perceptions, ignore any voices, and manage symptoms.
Cognitive behavioral therapy can also help people with schizophrenia to develop better social and problem-solving skills, reduce the severity of symptoms, and lower the risk of relapse, a period of time when schizophrenia symptoms return.
Schizophrenia is a serious mental illness that affects your thinking, emotions, relationships, and decision making. And because there’s no cure, getting the proper treatment early is the best way to improve chances of managing the illness.
Schizophrenia treatment will center on managing your symptoms. You may need to stay on medication for a long time, possibly even for life. Psychotherapy, a kind of talk therapy, will likely also be a big part of the plan to help you understand and manage your symptoms. The right treatments, along with practical and emotional support from your loved ones, will go a long ways to help you navigate your life.
Types of Psychotherapy
Individual psychotherapy. During sessions, a therapist or psychiatrist can teach the person how to deal with their thoughts and behaviors. They’ll learn more about their illness and its effects, as well as how to tell the difference between what’s real and what’s not. It also can help them manage everyday life. Learn more about the different types of psychotherapy.
Cognitive behavior therapy (CBT). This can help the person change their thinking and behavior. A therapist will show them ways to deal with voices and hallucinations. With a combination of CBT sessions and medication, they can eventually tell what triggers their psychotic episodes (times when hallucinations or delusions flare up) and how to reduce or stop them. Read more on how cognitive behaioral therapy can help thinking patterns.
Cognitive enhancement therapy (CET). This type of therapy is also called cognitive remediation. It teaches people how to better recognize social cues, or triggers, and improve their attention, memory, and ability to organize their thoughts. It combines computer-based brain training and group sessions.
Types of Psychosocial Therapy
If a person with schizophrenia sees improvement during psychotherapy sessions, it’s likely they’ll need more help learning how to become part of a community. That’s where psychosocial therapy comes in.
Social skills training. This type of instruction focuses on improving communication and social interactions.
Rehabilitation. Schizophrenia usually develops during the years we are building our careers. So rehabilitation may include job counseling, problem-solving support, and education in money management.
Successful treatment for schizophrenia involves a mix of medication and therapy. People who do both are less likely to have a relapse or wind up in the hospital. Studies show this treatment pairing also improves their social skills and quality of life.
The most common types of therapy for schizophrenia include:
Cognitive behavior therapy (CBT). This treatment helps you change how you think and react to things. It also teaches you to deal with negative feelings by thinking about them in a different way so you feel good instead. To do this, you’ll need to identify patterns that make your life difficult. When you change those patterns, your symptoms can change. Your life becomes more manageable. CBT can help you learn to:
- Solve problems
- Understand others’ behavior
- Face your fears
- Find new ways to relax
The goal is for you take to control of your emotions. In this therapy, you learn skills that you can use for the rest of your life. Your therapist teaches you how to ignore thoughts and voices in your head. You’ll gain a new understanding of your reality. Here’s how it helps:
- Improves social skills
- Lowers relapse
- Lessens symptoms
- Builds confidence
Schizophrenia is usually treated with an individually tailored combination of talking therapy and medicine.
Most people with schizophrenia are treated by community mental health teams (CMHTs).
The goal of the CMHT is to provide day-to-day support and treatment while ensuring you have as much independence as possible.
A CMHT can be made up of and provide access to:
- social workers
- community mental health nurses – who have specialist training in mental health conditions
- occupational therapists
- pharmacists
- counsellors and psychotherapists
- psychologists and psychiatrists – the psychiatrist is usually the senior clinician in the team
After your first episode of schizophrenia, you should initially be referred to an early intervention team.
These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers.
Care programme approach (CPA)
People with complex mental health conditions are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs.
There are 4 stages to a CPA:
- assessment – your health and social needs are assessed
- care plan – a care plan is created to meet your health and social needs
- key worker appointed – a key worker, usually a social worker or nurse, is your first point of contact with other members of the CMHT
- reviews – your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed
Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist.
You’ll work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency.
Your care plan should include a combined healthy eating and physical activity programme and support for giving up smoking, if you smoke.
Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan.
Further information
- Rethink Mental Illness: Care programme approach
Acute episodes
People who have serious psychotic symptoms as the result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide.
These episodes are usually dealt with by antipsychotic medication and special care.
Crisis resolution teams (CRT)
A treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis.
Without the involvement of the CRT, these people would require treatment in hospital.
The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre.
CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis occurring.
Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis.
Voluntary and compulsory detention
More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it’s necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act (2007), but this is rare.
It’s only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder and if detention is necessary:
- in the interests of the person’s own health and safety
- to protect others
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you’re no longer a danger to yourself and others, you’ll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
Advance statements
If it’s felt there’s a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement.
An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to include contact details for your care co-ordinator.
If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP.
Further information
- Mind: Health and social care rights
Antipsychotics
Antipsychotics are usually recommended as the initial treatment for the symptoms of an acute schizophrenic episode. They work by blocking the effect of the chemical dopamine on the brain.
Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.
It’s important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you.
Antipsychotics can be taken orally as a pill, or be given as an injection known as a depot. Several slow-release antipsychotics are available. These require you to have one injection every 2 to 4 weeks.
You may only need antipsychotics until your acute schizophrenic episode has passed.
However, most people take medication for 1 or 2 years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent.
There are 2 main types of antipsychotics:
- typical antipsychotics – the first generation of antipsychotics developed in the 1950s
- atypical antipsychotics – newer-generation antipsychotics developed in the 1990s
The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects.
Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person.
The side effects of typical antipsychotics include:
- shaking
- trembling
- muscle twitches
- muscle spasms
Side effects of both typical and atypical antipsychotics include:
- drowsiness
- weight gain, particularly with some atypical antipsychotics
- blurred vision
- constipation
- lack of sex drive
- dry mouth
Tell your care co-ordinator, psychiatrist or GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicines that will help you deal with the side effects.
If you do not benefit from your antipsychotic medicine after taking it regularly for several weeks, an alternative can be tried. It’s important to work with your treatment team to find the right medicine for you.
Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP. If you stop taking them, you could have a relapse of symptoms.
Your medicine should be reviewed at least once a year.
Further information
- Mind: Antipsychotics
- Royal College of Psychiatrists: Depot medication
Talking therapies
Talking therapies can help people with schizophrenia cope with the symptoms of hallucinations or delusions better.
They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment and interest in things you used to enjoy.
Talking therapies for schizophrenia work best when they’re combined with antipsychotic medication.
Common talking therapies for schizophrenia include:
- cognitive behavioural therapy (CBT)
- family therapy
- arts therapy
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to change this thinking with more realistic and useful thoughts.
For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts.
Most people require a series of CBT sessions over the course of a number of months. CBT sessions usually last for about an hour.
Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist.
Family therapy
Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family.
Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetings over a period of around 6 months.
Meetings may include:
- discussing information about schizophrenia
- exploring ways of supporting somebody with schizophrenia
- deciding how to solve practical problems that can be caused by the symptoms of schizophrenia
If you think you and your family could benefit from family therapy, speak to your care co-ordinator or GP.
Arts therapy
Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia.
Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others.
Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people.
The National Institute for Health and Care Excellence (NICE) recommends that arts therapies are provided by an arts therapist registered with the Health and Care Professions Council who has experience of working with people with schizophrenia.
Want to know more?
- Mental Health Foundation: talking therapies
- Mind: talking therapy and counselling
