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Psychosocial therapies have been found to be helpful for patients already taking medication who need support in dealing with aspects of schizophrenia that affect quality of life, including:

• Difficulty with communication
• Self-care
• Employment
• Motivation
• Maintaining relationships

In addition, patients who receive psychosocial therapy tend to comply with medication schedules and have fewer relapses of psychotic episodes and hospitalizations. Some therapies target specific aspects of impairment, such as attention or concentration, while others try to circumvent the deficit by teaching compensatory strategies. Another approach is a more global one where treatment is integrated and touches upon all the relevant deficits and issues that the patient is dealing with. The patient with schizophrenia may benefit from simultaneous treatment with more than one particular type of therapy depending on the immediate needs. Psychosocial therapy sessions are managed by a therapist, case manager, or social worker.

There are several types of treatments included in the category of psychosocial therapy, including:

• Cognitive-behavioral therapy
• Vocational rehabilitation
• Training in social skills
• Promoting patient independence
• Treating substance abuse
• Illness management skills
• Self help groups
• Family education and counseling
• Intensive community treatment

Cognitive-Behavioral Therapy

Cognitive behavioral therapy is a widely used therapy for schizophrenia which is effective for:

• Reducing the severity of positive and negative symptoms
• Reducing the rate of relapse
• Addressing impairments directly related to schizophrenia (such as cognitive or social impairment, dysfunction affecting employment)
• Addressing secondary issues such as stigma, loss of self esteem, and isolation

An essential component of cognitive-behavioral therapy, like with other treatments for schizophrenics, is a strong therapeutic alliance between the therapist and the patient. In addition, other elements of this therapy include:

• Developing alternative explanations for the patient's symptoms and beliefs. The goal is to help the patient understand symptoms and find satisfactory explanations for whatever the patient is experiencing
• Determining and examining areas of stress which may trigger psychotic symptoms
• Reducing the impact of positive symptoms rather than refuting them or proving them wrong. By questioning the patient and discussing details of the hallucinations, delusions, or voices, the patient can be taught to take a more cognitive (understanding) and behavioral (confronting what they are experiencing and modifying response) approach to dealing with their positive symptoms.
• Learning how to reduce apathy and increase motivation
• Fostering compliance in medical treatment - there is no conclusive data yet that cognitive-behavioral therapy increases adherence to treatment protocols but there may be evidence that cognitive-behavioral therapy may be successful in keeping patients involved in therapy groups that provide counseling about compliance, among other things, and a supportive environment. One of the strongest predictors of treatment noncompliance in schizophrenia is persistent denial of being ill. One of the advantages of cognitive-behavioral therapy is that rather than convincing the patient that they are ill, the clinician and patient can reach an agreement that medication compliance will reduce the intensity of the symptoms or reduce the impact of stressors in the patient's life that lead to positive or negative symptoms, drug abuse, etc.