CBT is the leading psychotherapy treatment for schizophrenia. It may be particularly effective combined with antipsychotic medication and psychosocial support.

If you’ve been diagnosed with schizophrenia, you’re definitely not alone.

Schizophrenia is a serious mental illness that affects about 1% of the American population. That may sound like a small number until you realize it amounts to about 3.32 million people.

The condition usually begins during adolescence or early adulthood, and it affects your thinking processes. You may have auditory and visual hallucinations, meaning you hear and see things that others do not.

You may have episodes of psychosis, in which you experience a complete break with reality. You may experience and believe things that are not real, although they seem very real to you. These are called delusions. For example, you may begin to think people are controlling you or plotting against you.

You may also lose interest in people and activities that you used to enjoy. You may find it difficult to organize your thoughts and actions, and say or do things that others find disturbing. Additionally, you may find it difficult to express emotion or initiate and continue projects.

The good news is that schizophrenia is treatable. The most effective schizophrenia treatment combines medication, psychotherapy, and psychosocial support, according to the American Psychiatric Association. This type of combined treatment is sometimes called coordinated specialty care (CSC).

Cognitive behavioral therapy (CBT) is a type of talk therapy in which you work with a therapist to learn how to replace negative thoughts and behaviors with more accurate, functional ones. With the therapist’s help, you learn to:

  • check the credibility of your thoughts and perceptions
  • ignore or tolerate unreal voices you may hear
  • manage your response to other symptoms

CBT is not meant to be a cure for schizophrenia or lead to remission. There is no cure for this condition. Treatment is intended to reduce your symptoms and help you learn to manage them. In most cases, it’s not realistic to expect your symptoms to go away completely.

Medication is considered the primary treatment for schizophrenia. CBT is used to supplement medication, not replace it. CBT is usually a short-term course of therapy, taking from 6 to 9 months.

In the United States, CBT is recognized as the gold standard of psychotherapy for psychosis associated with schizophrenia. The American Psychiatric Association recommends that CBT be used for the treatment of psychosis in schizophrenia, combined with medication and psychosocial support.

Similarly, the English government recommends CBT be offered for all patients with schizophrenia or psychosis. Its direction appears in the National Institute for Clinical Excellence (NICE) guidelines.

Worldwide, however, the World Health Organization does not specifically include CBT in its recommendations for treatment of schizophrenia. It recommends a combination of medication and psychosocial support.

Research shows CBT to be especially helpful when medication does not significantly improve the symptoms of schizophrenia. About 30% of people diagnosed with schizophrenia don’t respond to medication.

What does the research say?

Research indicates that CBT, in combination with medication, can help lessen psychotic symptoms in schizophrenia. Evidence points to CBT’s particular effectiveness in reducing auditory hallucinations, one of the most distressing symptoms for people with schizophrenia.

However, some researchers over the past decade point to biases and small sample sizes that flaw some research favoring CBT. One study reported only a small benefit from CBT by the end of a trial, which did not hold a follow-up. Another study goes so far as to question whether the benefit of CBT for schizophrenia had been “oversold.”

How is CBT used to treat schizophrenia?

CBT may help reduce hallucinations, delusions, and paranoia in people with schizophrenia. These are what doctors call the “positive” symptoms of schizophrenia. The therapy works by helping people identify their delusions, cope with them, and learn acceptable responses.

The National Alliance on Mental Illness points out that CBT helps people with schizophrenia by identifying what triggers their psychotic episodes and developing ways to lessen the number and severity of episodes.

CBT can also be useful for what are called the “negative” symptoms of schizophrenia, such as:

  • low self-esteem
  • flat expression
  • trouble organizing thoughts and actions
  • loss of interest in people and activities that used to interest you

What can you expect in CBT?

You will begin your CBT course by building trust in your therapist. This is an essential part of CBT because you will be working very closely on issues that may be troubling or even frightening to you. You will be learning a whole new way of looking at your life and finding new ways to act.

Next, you will collaborate with your therapist to develop a “problem list” of issues in your life that you want to work on. These may include schizophrenia symptoms like auditory hallucinations, as well as issues in your life like poor communication with your family or failing grades at school.

You and the therapist will work together to design goals that you want to achieve during therapy. These will be very specific, such as learning one new communication skill for talking with your family or raising one of your school grades from a failing grade to a C.

As your therapy continues, you will begin to learn new coping skills for dealing with your schizophrenia symptoms. You will often have homework in between your CBT sessions in which you practice your new skills in real-life situations. For example, you might try the new communication skill you learned in therapy at home with your family.

Gradually, you will be able to change your response to your symptoms. By the conclusion of therapy, you will have a number of tools available to respond differently to your symptoms. For example, you may learn that you hear voices most when you are stressed or tired. Knowing this, you could make an effort to practice calming meditation and get sufficient sleep to reduce the episodes.

CBT doesn’t help everyone with schizophrenia. Part of the reason for this is that expectations may be set too high. You may want your symptoms to go away altogether. But the goal of CBT is to develop tools to deal with your symptoms, not to eliminate symptoms altogether.

If CBT does not seem to be helping you, the first step is to check with your treatment team to ensure your medication is appropriate and working as it should. CBT is most effective for schizophrenia when combined with an appropriate medication regimen.

If CBT isn’t working, you may try:

Some alternative therapies are very much like CBT, while others are very different. Your treatment team will be able to point you toward therapies that may work for you.

Some alternative therapies for schizophrenia treatment recommended by healthcare professionals and public service groups include:

Further treatment options include psychosocial treatment or assertive community therapy. These are programs that focus on helping you live independently and become active within a community. They involve assistance in a wide range of personal issues including:

  • financial management
  • employment
  • education
  • home structure
  • co-occurring medical conditions
  • social skills
  • family education and involvement
  • alcohol and other substance use
  • child custodianship
  • domestic violence

Also, some researchers report success with holistic treatment of schizophrenia. These complementary and alternative health approaches can be part of a comprehensive treatment plan, according to the National Alliance on Mental Illness (NAMI).

You may want to discuss with your doctor whether you could benefit from complementary treatment options, such as:

  • yoga therapy
  • nutritional and diet guidance
  • exercise and movement training
  • meditation and relaxation practice
  • acupuncture and acupressure

Schizophrenia is a serious mental illness that usually begins in early adulthood and can cause lifelong disability if left untreated. The good news is that it is treatable with a combination of medication, psychotherapy, and psychosocial support. With treatment, you can expect to live a long and satisfying life.

Medication is the primary treatment for schizophrenia, often supplemented with psychotherapy and psychosocial support. The most common psychotherapy prescribed is cognitive behavioral therapy. In CBT, you collaborate with a therapist to define goals in your life and learn new ways of thinking and acting to achieve them.

CBT doesn’t work for everyone with schizophrenia. Alternatives involve a change in your medication, a new therapist or a different therapy, and a variety of holistic treatment approaches and psychosocial support programs.

To find a CBT therapy provider, your best option is to check with a trusted healthcare professional for a recommendation. To look for available practitioners in your area, you can go to the Academy of Cognitive and Behavioral Therapies website where you can search for one of their certified therapists by zip code.

To learn about schizophrenia treatment options and available resources, consider visiting the Schizophrenia & Psychosis Action Alliance website. If you’d like to learn about early identification of mental illness, along with options for care, services, and support on the way to recovery, the Mental Health America website offers valuable resources.