Talking therapy and psychosocial support for schizophrenia

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Talking therapy and psychosocial support are very important for people with schizophrenia. They can help to relieve the symptoms and reduce the risk of relapses. Some types of support also involve family members.

Schizophrenia affects many different areas of life, so a lot of support is needed – for friends and family, too. Although medications can be important, they’re usually not enough. Helpful types of support include:

  • Psycho-education
  • Talking therapy
  • Social skills training
  • Cognitive training
  • Family therapy

People often don’t even know about the various available support services. You can seek information and advice from doctor’s practices, hospitals, social psychiatric services, and health insurers.

Most services are offered either in an outpatient setting or as part of a hospital or clinic stay.

Many people with schizophrenia have other problems too, like addictions or physical illnesses. So the support may not only focus on the immediate consequences of psychosis.

What is psycho-education?

The main goal of psycho-education is to inform you about the disease. The idea is that it's easier to be involved in planning your treatment if you know a lot about schizophrenia. Another goal is to reduce negative self-images and fears. You also learn about ways to cope better with the symptoms.

Psycho-education can be done one-on-one or in a group, sometimes together with family members. Group meetings give you an opportunity to exchange experiences with others who are in a similar situation.

In order to be able to cope better with schizophrenia, it's important to understand it. Research has shown that psycho-education can help to reduce the symptoms and related limitations in everyday life. It can also reduce the risk of relapses (further acute episodes of psychosis). This may be a result of getting help earlier because you recognize the signs sooner or learn to avoid certain stressful situations.

What does talking therapy do?

Talking therapy can help you to cope better with schizophrenia and its consequences. Here, too, the goal is to understand the disease and develop self-help strategies. This includes developing a more positive self-image and becoming more confident that you can cope with the disease. Many people find it important to talk openly about their situation during therapy. This can help them better understand their experiences, which are sometimes extreme. You can start talking therapy at any time, even during an acute psychotic episode.

Therapy can help you figure out what you find especially distressing and which situations cause problems. Last, but not least, it’s about finding ways to handle crises. For talking therapy to be successful, it’s important to have a good and trusting relationship with the therapist.

They will help you learn how to recognize early signs of acute psychosis, react sooner and take appropriate measures. Together, you can develop various strategies to respond to abnormal perceptions and delusions – for example, using distraction and relaxation techniques. Therapy can also help you better manage at work and in your private life.

Talking therapy can be done in one-on-one or group sessions, and family members may be involved too. Cognitive behavioral therapy (CBT) and systemic therapy are effective. Research has shown that CBT can reduce the symptoms of schizophrenia and improve quality of life. Systemic therapy can also reduce the symptoms.

Psychodynamic therapy is a further option. But there's a lack of good-quality research on the benefits of this type of therapy in people with schizophrenia.

How can social skills training help?

Social skills training programs focus on two areas: Some programs improve your ability to get by in everyday life as independently as possible – especially in your home, free time, work and family life. You learn things like specific strategies that help you find practical solutions to everyday problems.

Some programs focus on communication and interactions with other people. One aim is to help you better understand other people and interact with them appropriately. It is also about identifying realistic expectations of others' behavior and finding ways to stick to those expectations. This kind of goal can be "trained" in role play, for example.

Social skills training programs are usually offered in the form of group therapy. Research has shown that these programs can help you better cope with everyday challenges. The symptoms may improve too.

What does cognitive training do?

Many people with schizophrenia have trouble concentrating and paying attention. This can make it harder to do things like learn or solve complex problems. To some degree, you can make up for this with the help of cognitive training. Perception and memory training aims to improve cognitive skills that are especially important in everyday life – for example, at work.

Research suggests that one particular training approach is especially effective. Known as cognitive remediation therapy (CRT), it involves things like practicing memory and problem-solving tasks on a computer. This therapy can reduce symptoms like loss of drive and problems with memory and attention, and also improve your ability to cope with the demands of daily life.

What does family therapy do?

Family can provide valuable support. But sometimes the family situation can negatively affect the course of the disease instead. It can be a problem if it all gets too much for family members, resulting in conflicts or blaming. This can greatly affect the development of psychotic episodes: The risk of relapse is known to be higher in a critical, disrespectful, or overprotective family environment. Both sides – the person with schizophrenia and their loved ones – influence the atmosphere in the family.

Family therapy aims to prevent these problems by helping family members cope better with the disease. It involves learning about schizophrenia and the treatment options. The goal is to reduce fears and feelings of guilt and shame. Another aim of this therapy is to develop concrete solutions to family problems and find out how family members can better support each other.

Research has shown that the risk of having another acute psychotic episode is lower in the first few years after family therapy. The symptoms of schizophrenia may improve too.

What do community mental health services offer?

Community mental health services allow people with mental illnesses to live at home and get support in their immediate environment. One aim of these services for people with schizophrenia is to avoid the need for hospital stays. The services include:

  • Outpatient community mental health teams that come to your home
  • Part-time inpatient facilities that offer daytime counseling and treatment
  • Supported housing
  • Daytime care programs
  • Information centers
  • Supported employment

Community mental health care is provided by a team of professionals from different fields, including psychiatry, psychotherapy, social work, sociotherapy and occupational therapy. Some cities also have outpatient crisis intervention teams that help in acute emergencies at home.

Professional support at home has been shown to increase independence and improve social integration. But this is only possible if good-quality services are actually available locally. Research has shown that extensive support programs help people with schizophrenia live more independently and avoid unemployment.

Does early detection of psychosis help?

Warning signs of a psychotic episode can often be detected months or years in advance. In many cases, though, the typical signs aren't recognized. If you notice signs of psychosis, you can seek advice from a specialized center for early detection and treatment. After a thorough assessment, they will determine what kind of help is needed. In Germany, there are currently only few centers for early detection in some larger cities. If there is no center near you, you can contact any hospital department of psychiatry and psychotherapy.

Early support services aim to reduce the consequences of psychosis and positively influence the course of the disease. They also arrange for further help (like psychiatric treatment) and give advice on how to cope with the disease and related problems in everyday life. Their approach often includes elements of cognitive behavioral therapy and psycho-education.

The first episode of acute psychosis often happens at the start of a new phase of life – for example, after moving out of your childhood home, starting your first job, going to university, breaking up with a partner or starting a new relationship. Major changes like that are often a great challenge and call for intensive support. The first episode of acute psychosis typically leaves the biggest mark; it is usually very dramatic and frightening for the person experiencing it. If they are hospitalized against their will, it can be quite traumatic.

Research has shown that early support programs can improve quality of life and help you cope better with the symptoms. Last, but not least, they can reduce the risk of relapses.

Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). S3-Leitlinie Schizophrenie. AWMF-Registernr.: 038-009. 2019.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Systemic therapy in adults as a psychotherapeutic approach: Final report; Commission N14-02. 2017.

Jones C, Hacker D, Xia J et al. Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia. Cochrane Database Syst Rev 2018; (12): CD007964.

Jürgensen M, Patzelt C, Meyer T. "Dass man also frei bleibt, aber immer das Gefühl hat: Da ist diese Haltestange, die ich brauch." ["That you stay free, but always know there is this support rod that I need."]. Psychiatr Prax 2014; 41(1): 29-36.

Leucht S, Vauth R, Olbrich HM et al. Schizophrenien und andere psychotische Störungen. In: Psychische Erkrankungen - Klinik und Therapie. München: Urban und Fischer; 2015.

McDonagh MS, Dana T, Selph S et al. Treatments for Schizophrenia in Adults: A Systematic Review (AHQR Comparative Effectiveness Reviews; No. 198). 2017.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

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Created on June 13, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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