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Hearing or seeing things that no one else seems to notice can be unsettling. Living with schizophrenia — a mental health condition that can alter how you experience reality (affects how you think, feel, and see things) — may have you feeling unsettled often. Managing the condition usually involves long-term treatment. Cognitive behavioral therapy (CBT) — a type of talk therapy — can play an important role in the treatment of schizophrenia.
CBT is commonly used alongside antipsychotic medications in order to better manage symptoms of schizophrenia. Mental health professionals usually refer to it as an adjunctive (add-on) treatment. A useful tool for managing many mental health disorders, CBT focuses on evaluating thought processes and teaching coping tools. These strategies can help reduce the distress caused by schizophrenia symptoms, improving daily functioning.
Here we’ll explore how CBT works for schizophrenia, what therapy sessions may look like, and how this approach can help support recovery.
CBT is one of the most commonly used types of psychotherapy (talk therapy). It centers on four principles, including:
In CBT, a mental health provider such as a psychologist or therapist works with you to help you understand how your thoughts, feelings, and actions interact. Your provider helps you identify unhelpful patterns and teaches you gentle coping strategies. These tools aid you in adjusting negative thought and behavior patterns.
Cognitive behavioral therapy for schizophrenia is called CBT for psychosis (CBTp) or cognitive behavioral therapy for psychotic disorders. CBTp is an evidence-based talk therapy used as an adjunct treatment for schizophrenia. Many mental health organizations, including the American Psychiatric Association (APA), recommend CBTp for people with schizophrenia.
CBTp focuses on managing symptoms of psychosis, such as hallucinations and delusions, that affect people with schizophrenia. CBTp can also help you navigate daily challenges, such as:
CBTp aims to help reduce psychosis symptoms and the distress they cause. It can also provide support for negative symptoms, such as lack of motivation. This sets the stage for better functioning and quality of life with schizophrenia.
Hallucinations — sensing things around you that aren’t there — are a common symptom of schizophrenia. Auditory hallucinations (hearing voices) are reported in 70 percent of people with the condition. People with this mental health condition are also more likely to interpret voices as malicious, or meaning them harm.
One goal of CBTp is to help people understand what their hallucinations are so that they don’t trigger as much distress. During a CBT session, a mental health provider will aim to find out how someone feels about voices they hear, such as whether a voice feels dangerous. Then they can teach coping strategies, like grounding, to help lessen distress. A recent review of 26 studies found that CBT appeared to modestly improve hallucinations, delusions, and overall distress in people with schizophrenia spectrum disorders.
Delusions — belief in things that aren’t true or real — may also be helped by CBTp. Therapy focuses on understanding how thought patterns are contributing to these false beliefs. For example, patterns may include jumping to conclusions or continuing to hold beliefs despite strong contradictory evidence.
The point of CBTp isn’t to argue with someone’s beliefs. Instead, a therapist will look at how a belief formed and how it affects someone’s emotions and actions. This approach can provide insight and encourage alternative ways of thinking. This collaborative process — often called cognitive restructuring — can help people relate to their thoughts in a flexible way. One review found that the addition of CBTp to usual treatment appeared to help reduce delusions and distress, especially in more recent studies.
Schizophrenia often involves a mix of positive symptoms and negative symptoms. Positive symptoms refer to symptoms that are present in people with the condition but not others, such as hallucinations. On the other hand, negative symptoms are those that are unusually absent, such as lack of pleasure or motivation.
Negative symptoms can be hard to treat because of the underlying beliefs linked to them and are not fully understood. For example, someone may choose not to participate in an activity because they already know they won’t enjoy it. CBT interventions for negative symptoms borrow from therapies used to treat anxiety and depression — conditions common among people with schizophrenia.
Through “behavioral activation,” therapists help people with these symptoms plan small, achievable activities. Doing these activities allows the person to rate their enjoyment, track their successes, and build their confidence. Over time, this can help break patterns of avoidance and improve well-being. One recent review found that CBT helped reduce negative symptoms in people with schizophrenia compared to other single treatments.
By helping people realize how their thoughts, feelings, and actions interact, CBTp can help them manage challenging parts of daily life. Learned coping mechanisms can enable people to better manage stress, social situations, and everyday tasks. Several reviews have shown that short-term CBT can help improve daily functioning and overall quality of life.
CBT sessions usually involve a weekly meeting with a therapist. Meetings are often one-on-one and may be done in person or via telemedicine. Family members are often encouraged to be involved.
When you start CBT, your provider will evaluate your symptoms and the distress they’re causing. This allows them to set treatment targets for you. After this, they’ll come up with a treatment plan that’s individualized to your needs. Then you’ll work together to achieve your treatment goals using CBT techniques.
Each CBT session will likely follow the same structure. First, you’ll review what happened during the last week. Next, you and your therapist will decide what you’d like to focus on during your session. You may also review any homework from the previous week and work on new skills to help manage your symptoms. Your provider will likely assign homework at the end of a session so you can work on your new skills on your own.
CBTp is typically a long-term treatment and usually lasts for several months. Often therapy takes place over a period of six months or longer for a total of 16 or more sessions. The total length of therapy will vary depending on your symptoms, treatment progress, and other needs.
If you’ve never had therapy before, the idea of finding a CBT therapist may seem daunting. Here are some factors to consider as you explore your options.
Several types of health professionals can function as cognitive behavioral therapists. Options may include:
Look for a therapist who is licensed, is state-certified, and has a background in CBTp. Cognitive behavioral therapists should have qualifications or additional training that shows they specialize in CBTp.
One way to connect with a therapist is to ask someone in your life for a referral. Your primary healthcare provider, loved ones, or others you trust may know of a cognitive behavioral therapist. There are also organizations that can help you find a therapist, such as:
In some cases, finding a therapist may not be the only thing standing in your way. Providers may have long waitlists due to limited availability. One way to get around this is to check out online therapy options, such as those given via telehealth or mobile phone apps. Online options often have a large network of therapists, some of which may be able to see you sooner.
Therapy can also come with a hefty price tag. If you have insurance, take a look at the type of coverage your plan offers for talk therapy. In some cases, insurance plans may only pay for a limited number of CBT sessions. You should also find out what payment options or plans your chosen therapist offers. Try looking for a provider in your insurance plan’s network, which can reduce any out-of-pocket costs.
It can also be hard to arrange CBT for someone who doesn’t believe they have schizophrenia. Many people with the condition don’t know they have it. This denial can result in a resistance to trying CBT or other therapies. If a loved one with schizophrenia refuses therapy, try to be understanding and listen to their point of view without judgment. Tell them your concerns, and ask what you can do to help them. Patient, ongoing support can show them that you’re there to help them whenever they’re ready.
You can’t force someone to get treatment. But, in certain instances, urgent care may be necessary. If someone is a danger to others or themselves, call 988, the Suicide and Crisis hotline. Help is available for free, at any time of day.
An inability to care for basic needs also requires evaluation. If someone with schizophrenia lacks clothing, food, or shelter, contact emergency services.
On MyDepressionTeam, people share their experiences with depression and related conditions, get advice, and find support from others who understand.
Have you tried cognitive behavioral therapy for schizophrenia? Let others know in the comments below.
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