Psychosocial Treatments for Schizophrenia

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Antipsychotic drugs have proven to be crucial in relieving the psychotic symptoms of schizophrenia – hallucinations, delusions, and incoherence – but are not consistent in relieving the behavioral symptoms of the disorder. Even when patients with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (e.g., ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.

It is with these psychological, social, and occupational problems that psychosocial treatments may help most. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they may be useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient's social functioning – whether in the hospital or community, at home, or on the job. Some of these approaches are described here. Unfortunately, the availability of different forms of treatment varies greatly from place to place.

Rehabilitation

Broadly defined, rehabilitation includes a wide array of non-medical interventions for those with schizophrenia. Rehabilitation programs emphasize social and vocational training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.

Partial Hospital or Day Treatment Programs provide a broad array of rehabilitation activities. These programs are typically attended for four to six hours per day, several days per week. The program activities fall into several possible categories:

• Activities of Daily Living - Participants are taught how to live independently. This includes how to cook, comparison shop, plan a menu and budget money. Frequently, the learning is both didactic and experiential, as participants are taken shopping to show them how to shop, given personal assistance in planning their own budget, and practice planning and cooking meals.
• Vocational Training - Vocational activities may include sheltered work experiences, placement into volunteer jobs, or transitional employment placement to learn work skills. Participants may be taught how to complete a job application form, what they do and do not have to tell employers about their illness, and how to develop a resume. Job interviewing skills are often taught, as individuals with schizophrenia frequently are deficient in the social skills needed to make a good impression in an interview.
• Social Skill Training - Basic training in communication skills and interpersonal social skills is often needed because the perceptual impairments and disordered thinking of schizophrenia often interferes with the "natural" learning of these skills through interpersonal interactions and feedback.

continue: Individual and Cognitive Therapy for Schizophrenia

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Reviewed: 03/2006