We all know schizophrenia as a serious mental illness, which requires strong medication and has little chance of improvement. The truth is that we were wrong. Contrary to what is commonly thought, it has been found that psychological therapies are effective in this disorder and in fact, the patient evolves better if he is offered access to them and not just medication.

Therapy, When And Why?

Psychologists understand that the various mental disorders can go through different phases, so there is an acute phase, a maintenance phase, a remission phase, etc.

The phase that everyone associates with schizophrenia is an acute phase, this can occur the person, in which hallucinations, delusions, emotional disturbance, and acute symptoms. It is logical to think that in this phase the person will require medication, and indeed it is. But as we said in other articles, the medication solves the problem but does not offer strategies to the person to continue later or face the problem by himself/herself when it appears again.

In this era when the concept of rehabilitation, reintegration into society and the idea that the person does not always depend on a health system but recovers his autonomy, psychological therapies have been developed for schizophrenia was the something unthinkable years ago.

Thus, these therapies are intended for use in combination with medication (it is still considered necessary because there is an underlying physiological disorder, without now entering into the debate of whether it is the cause or consequence of its origin).

What some people don’t know is that behind the growing symptoms there are cognitive deficits that were not previously worked out, such as the predisposition to acute disorganization, perceptual distortions, attention problems, memory, differential reasoning, and social judgment.

Emotional disorders and affect regulation, as well as distortions of the sense of self and the perception of others, are also present. The treatment taking into account all these aspects so far is carried out thanks to the emergence of the vulnerability-stress model that explains how the disorders can hatch before the interaction of stressful situations with vulnerability factors presented in the person. (genetic, learned, etc…)

What Are The Therapies?

What Are The Therapies

Basically (counting those with studies that demonstrate their usefulness and effectiveness) we can describe four:

Family psychoeducational therapies: They seek to provide families with strategies to manage the patient, reduce family conflicts, communication problems or feelings of guilt that may appear in them. They are also educated about the disease. These interventions reduce the negative “expressed emotion”, which can be very negative for the patient, thus being very useful in combination with other therapies as a basic component.

These family interventions should be maintained in the long term, offering support to families for an average duration of about 2 years. By focusing on the family, it can be applied at any time, there is no need to expect stabilization of the patient and it is useful to work with the family from the beginning.

Training in social skills: it is very important for social integration and long-term patient adaptation. The material is highly structured with frequent repetitions and visual and auditory material. Again it is contemplated as a long-term program. Research shows that if the patient’s situation is taken into account, these techniques can be applied at any stage of the disease.

Cognitive-behavioral treatments aimed at both positive symptoms (hallucinations and delusions) and underlying cognitive problems: This therapy teaches them to manage the psychotic symptoms in an alternative (or mutual) way to the medication, making sense of them, re-labeling them and modifying the beliefs that derive from them.  What tasks can block or inhibit hallucinations? They use very varied techniques: operant techniques, stop thinking, distraction, verbal suppression, self-observation, aversive therapy, etc .

Anyway, all the techniques are grouped into three subjects:

  1. Those that promote the distraction of hallucinatory voices. Listen to music, tell, read, etc.
  2. Those that promote the focus on voices. Attribute the voices as their own. Identify the voices and their characteristics, identify what internal conflicts may be reflecting, etc … And modify their own beliefs about the voices.
  3. And the techniques that seek to reduce anxiety. For example relaxation or breathing techniques.

It is generally understood that distracting techniques only produce transient effects while focusing techniques would have longer-term effects. Anyway, we see that these types of techniques are more focused or have been more used in the case of auditory hallucinations.

This therapy requires a more stable state in the subject to participate so it is usually started when there is minimal stabilization of the symptoms, it will not be used if the person is completely unable to concentrate on the instructions or pay attention in the sessions. It usually starts when the medication has begun to improve symptoms since it requires a minimum capacity in the patient.

The integrated multimodal or ITP (Brenner, Hodel, Roder, and Corrigan) :

It is a group intervention program with a cognitive-behavioral orientation that is supported by the “penetration capacity” model that involves interactions between information processing and social behavior. The groups are 5 to 7 subjects in sessions and three times a week for about 30 to 60 minutes. The minimum duration is three months but it can be extended up to 12.

This therapy can be applied completely or only some modules depending on the needs of the person, in addition as we have said it is also flexible in its duration and number of sessions. Again it will be difficult to implement in acute phases, it requires a minimum stabilization in order to be able to train the subject in the techniques. It consists of five subprograms, the first two are more structured and the last two more flexible,

  1. Cognitive Differentiation: It works on the attention and training of concepts with techniques such as card classification and exercises of verbal concepts or search strategies. It works on the main and characteristic cognitive deficits of schizophrenia.
  2. Social Perception: It works on the analysis of social stimuli by means of slides. They must describe, interpret and discuss social stimulus. It differentiates between relevant and irrelevant stimuli and properly encodes the information.
  3. Verbal Communication: Communication skills are enhanced through verbal repetition exercises, repetition of analogs, questions, free conversation, etc.
  4. Social Skills: Role-playing and cognitive restructuring of cognitive skills acquisition. It aims to improve interpersonal execution.
  5. Solving Interpersonal Problems:  Application of problem-solving strategies, cognitive pre-structuring, transfer of strategies to real-life situations. It does not differ much from the original program developed by D ‘ Zurilla and Goldfried (1971) with seven stages.

As you can see the time of application depending on the stage in which the patient is still being studied, but it is usually quite obvious to those who see it, if the person is in an acute state, with many positive or negative symptoms that imply inability on their part to attend to and take advantage of the program properly. We should wait for the medication to produce some improvement or adapt the therapy exercises to the condition of the subject.

All these programs have proven their effectiveness.


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