• Cognitive behavioral therapy is a limited-term talk therapy technique.
  • This type of therapy is often used along with medications for schizophrenia as part of a treatment plan.
  • Cognitive behavioral therapy may help those with schizophrenia manage their symptoms.

Cognitive behavioral therapy (CBT) is a type of talk therapy used to treat a variety of mental health conditions, including schizophrenia.

Schizophrenia is complex and lasts a lifetime. You may experience symptoms that include an inability to think clearly, have emotional regularity, interact with others, or make decisions.

Often medication is the first line of treatment for this condition. CBT may be useful as an additional therapy, though.

So, if you’re living with schizophrenia, CBT may help you manage your symptoms.

According to a 2014 review, studies have found that CBT for psychosis is most effective for reducing positive (presenting) symptoms like:

  • hallucinations
  • delusions
  • confused thoughts
  • altered speech
  • difficulty focusing
  • altered movement

Research from 2018 suggests that CBT may help moderate these symptoms in addition to medication. It may also help if the medication alone doesn’t improve symptoms.

CBT may also help with negative (absent) symptoms like blank facial expressions, withdrawn speech, and disinterest, according to some clinical practice guidelines. It could help you adhere to other treatments and understand your condition better too.

Newer research from 2020 is even examining using CBT through group therapy paired with an app to address negative symptoms with positive results. More research is needed in this area.

Cognitive behavioral therapy and medication

Many studies suggest that CBT is a useful additional treatment for schizophrenia. In general, the first line of treatment is medication. These can be medications you take daily or less regularly, depending on the type.

Medication and CBT can help someone with this condition adhere to treatment, improve functioning, and avoid relapse. Support from family and peers can also help with this condition.

There is a lack of research on the effectiveness of CBT for schizophrenia without medication.

This is because most people with the condition require medication for treatment. Withholding medication to treat the condition to study the effectiveness of CBT alone may be considered unethical.

CBT occurs when a trained professional like a therapist, counselor, or social worker uses specific talk therapy to work through mental health concerns with you.

These concerns may involve:

  • your inner thoughts
  • your emotional responses
  • your actions surrounding them

The cognitive part of the therapy relates to your thoughts and emotions. The behavioral part relates to your actions.

A facilitator listens as you speak and asks questions that push you past limiting and self-destructive thoughts so you can achieve personal goals. The process may even involve activities outside of one-on-one sessions that you try and then report back to your facilitator.

CBT can work for people with many types of mental health conditions. Researchers continue to develop studies examining the effectiveness of CBT and schizophrenia.

CBT may involve several objectives. You and your facilitator should identify these together.

Objectives may include:

  • reducing symptoms
  • working through the stigma of the condition
  • avoiding relapse
  • managing other conditions that may occur, like depression and anxiety
  • accepting the condition
  • acknowledging that symptoms like hallucinations and delusions are from the condition

It’s important that you and the facilitator create a trusting relationship, with boundaries and general rules established, before you begin treatment.

CBT may last between 6 and 9 months for about 20 sessions in total. These often last for an hour and are generally one-on-one sessions between you and the facilitator.

CBT can occur in person as in-patient or out-patient care. You can even try it via telemedicine through a computer or smartphone.

You may also benefit from CBT with another person. For example, you may want to include a family member.

Your first sessions will explore your condition and your general outlook. The facilitator will suggest ways to reframe your thinking with new behaviors.

Over time, you’ll evaluate the issues you’ve been working on and determine whether you’re now responding to them differently.

The facilitator will also work with you at the end of your CBT timeline to make sure you keep applying new ways of thinking to future situations.

A typical CBT session might look like:

  • check-in about current mental outlook
  • discussion of current medication status
  • follow-up on topics discussed in previous sessions
  • discussion as set by an agenda for the session
  • reflections from you
  • feedback and active listening from the facilitator
  • instructions for how to introduce changes in behavior
  • homework assignments to test these behavioral modifications
  • overview of how to journal outside of the session to record negative thoughts or symptoms

The facilitator may also engage you in several exercises during the feedback stage of the session. These may include:

  • identifying your thoughts and beliefs
  • challenging your thoughts
  • conducting behavioral experiments
  • suggesting imagery
  • making pro and con lists
  • scheduling your activities
  • engaging in role plays

These are just some of the facilitator’s options for helping you work through your thoughts.

Here are some ways you can find a facilitator for CBT:

  • Talk with your doctor, who can give you a referral.
  • Conduct internet searches.
  • Ask for a referral from someone you know.
  • Post a question on a social media community site for recommendations.
  • Contact your insurance provider for therapists covered by your plan.

CBT is one way to help treat the symptoms of schizophrenia. It’s often combined with medications.

In CBT, you’ll work with a facilitator to discuss negative thoughts and change your behaviors and mindset.

This can help you cope with symptoms, accept your diagnosis, and adhere to your broader treatment plan.