Non-Pharmacologic Therapies in Schizophrenia

It is important to remember that psychotherapy is not an alternative to pharmacologic treatment, but rather is usually integrated with pharmacotherapy. Non-pharmacologic treatments for schizophrenia include psychosocial therapy and rehabilitation. The goal of psychosocial therapy is to help resolve social and psychological difficulties. This is also important for families, who are often confused by the person’s bizarre behavior and low motivation. Because the social and cognitive impairments seen in schizophrenia are often long-lasting, training in interpersonal skills can help patients cope with these problems. Psychosocial therapy can help patients in several specific ways; for example, by:

• improving medication adherence
• improving the capacity to handle stress
• identifying appropriate expectations for achievement
• providing support

What are the types of psychosocial therapy can be used to treat schizophrenia?

• Behavior Therapy: helps patients identify and change behaviors. Patients are motivated to modify their behavior through positive reinforcement (i.e., praise or tokens that can be redeemed for hospital privileges
• Family-oriented therapy: involves surrounding patients with a supportive environment so they are able to trust others. Family therapists can help the family and patient understand schizophrenia, encouraging them to discuss psychotic episodes.
• Group Therapy: focuses on real-life problems and relationships, easing patient feelings of isolation, and providing a basis for reality testing, and groups that focus on support, rather than interpretation, appear to be most helpful.
• Cognitive Therapy: teaches patients how thinking patterns can distort their view of the world. It helps patients avoid destructive ways of thinking by making them more aware of their cognitive distortions and errors in judgment.
• Individual Psychotherapy: often utilized for people with schizophrenia later in their disease course (e.g., decades rather than months or years of treatment). Therapists must focus on establishing a relationship that is reliable, genuine, and makes the patient feel safe.

In addition to psychosocial therapy, rehabilitation for people with schizophrenia includes services that help them improve specific areas of impaired functioning. These services may include supervised shelters, social and occupational skills training, and lessons in daily hygiene and food preparation.