Therapy for Schizophrenia: What Options Are Available?

Schizophrenia is a complex and chronic mental illness estimated to affect under 1% of the United States population. Schizophrenia cannot be cured, but treatment is available, and people can manage their symptoms and live productive lives with support. Understanding the treatment options available for this mental health condition can help you make an informed decision on the best type of care for you.

What is schizophrenia, and what are its symptoms? 

Schizophrenia is listed in the DSM-5 under mental health conditions known as the schizophrenia spectrum and other psychotic disorders. Two or more markers below must be present for a notable amount of time over a month. There's an exception if symptoms dissipate in less than a month due to successful treatment).

There are circumstances where criterion symptoms involving hallucinations or delusions must be present. For example, if an individual experiences delusions or hallucinations involving a voice consistently providing commentary on the individual's thoughts or behavior or if multiple voices are conversing with one another, this can indicate schizophrenia. 

The DSM-5 criteria for a schizophrenia diagnosis include the following. 

Loss of function 

People with schizophrenia may experience a lessened ability to function in one or more significant areas of life, including work, school, interpersonal relationships, or self-care activities, from the onset of disturbance for a notable portion of time since the start of symptoms. Alternatively, suppose individuals have an onset of schizophrenia during childhood or adolescence. In that case, a failure to present the anticipated level of functioning in school, interpersonal relationships, or occupational areas is present.

Prolonged symptom duration 

Symptoms of the disturbance may be persistent and continue for at least six months. During this period, the individual must experience a month or more (less if treated) of active phase symptoms listed in Criterion A and include periods of prodromal or residual symptoms. During these prodromal or residual periods, signs of disturbance might be displayed solely through more than two markers listed in Criterion A present in an attenuated form, such as unusual beliefs and abnormal perceptual experiences.

Ruled out other diagnoses 

Schizophrenia may be diagnosed if schizoaffective disorder, depression, or bipolar disorder with psychotic features have been ruled out. Or, if the individual has other conditions, they must be proven to be occurring outside of the schizophrenia symptoms. A psychologist may see if episodes of mania or depression have coincided with the active-phase symptoms or if periods of mood disturbance have co-occurred as active-phase symptoms. For example, a diagnostic provider may check to ensure the symptoms are not attributed to using substances such as drugs, alcohol, or medication.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

What treatment options are available for schizophrenia? 

The symptoms of schizophrenia may be manageable through different means, and various therapeutic options can significantly improve the quality of life and mental health for someone living with this condition, including the following. 

Pharmacological therapy options

Medical therapy for schizophrenia is often effective, as the condition has primarily biological causes, such as abnormalities in dopamine neurotransmission. However, medication prescribed by a psychiatrist may allow individuals to explore other therapies for schizophrenia in tandem with medical intervention. 

Second-generation antipsychotic medications (SGA) are often recommended as the course of treatment because they have fewer and less severe side effects than first-generation options. These classes of medications address the psychotic symptoms that characterize the condition, such as auditory and visual hallucinations, delusional thoughts and behaviors, and paranoia.

Antipsychotics may effectively treat conditions like schizoaffective disorder, delusional disorder, and bipolar disorder. These conditions can also display psychotic symptoms. In an acute psychotic episode, it is advised that medication therapy for schizophrenia is given as soon as possible to allow the client to regain basic functioning. 

Following this, there may be a maintenance phase, which aims to increase socialization and improve self-care and mood. This phase can be essential to prevent relapses, and those who commit to it have an 18% to 32% chance of relapsing, whereas those who do not stick with the maintenance phase have a 60% to 80% chance of having a relapse. 

Talk to a medical doctor, such as a psychiatrist or primary care physician, before starting, changing, or stopping a medication. Schizophrenic medications may cause side-effects, but these effects may lessen as the body adjusts to long-term use. Note that therapists, psychologists, counselors, and social workers cannot prescribe or offer medication management. In addition, Regain and its affiliates do not offer medication management or prescription services. 

Non-pharmacological therapy options

In addition to medication, various psychotherapy options are available to support those experiencing schizophrenia. Often, these options are used alongside medication. A therapist and a psychiatrist can work together to develop a comprehensive treatment plan for the client. 

Psychotherapy can be beneficial in helping clients stick with their treatment plans and provide them with skills so they can feel integrated into the community. Clients may find several types of therapies helpful, and they can be divided into three categories: individual, group, and cognitive-behavioral therapy.

Individual therapy aims to provide individual skills to the client. Some forms of psychotherapy included in this group are social skill therapies, vocational sheltered rehabilitation therapies, and counseling support.

While individual therapy for schizophrenia can improve social skills, group therapy often provides social interaction for each client. It allows them to give life experiences with others with a similar diagnosis. In contrast, individual therapy is one-on-one, which can be limiting socially. 

The cognitive-behavioral category includes cognitive-behavioral therapy (CBT) and other forms of cognitive therapy like dialectical behavior therapy (DBT). These types of treatment can help clients change their thought processes. For example, if a client denies that they are struggling or start to experience delusions, a therapist may help them challenge these beliefs in a safe and non-judgmental way. 

Assistance from family and friends can also be beneficial. In some cases, family therapy may be recommended. Support from these individuals provides another avenue for social interaction and may help those experiencing schizophrenia feel less alone in their symptoms. 

Counseling options 

Through a combination of medication and psychotherapy, clients living with schizophrenia can significantly improve their long-term outcomes. If you are looking for a therapist for schizophrenia, it may be beneficial to reach out to a mental health clinic or primary care doctor for a referral, as specialized therapy may be necessary. 

One study found that those with schizophrenia may also benefit from online treatment. The study reported that those with schizophrenia and psychotic symptoms could increase social functioning and knowledge of cognitive-behavioral therapy through the online program at a greater rate than those who used an in-person option. 

Platforms like BetterHelp for individuals or Regain for couples offer online services from licensed professionals who can help individuals cope with distressing symptoms. Therapy can also benefit those with a loved one struggling with schizophrenia. In addition, clients can choose between phone, video, or live chat sessions depending on their needs, allowing online therapy to be more flexible than some in-person options.