Talking therapy and psychosocial support for schizophrenia

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 learning to avoid certain stressful situations or getting help earlier because you recognize the signs sooner.

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.

Social skills training programs focus on two areas: They 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 social interactions with other people. Here the 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.

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.

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.

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.

Occupational therapy is sometimes a good idea. Here, the therapists help people to live their lives as independently as possible and to look after themselves. The therapy may include creative activities such as making things or painting, as well as exercises to improve concentration and learning strategies to help you structure your day.

Mindfulness-based approaches are now offered for the treatment of many mental health conditions, including schizophrenia. They include things like certain types of movement, meditation techniques, and exercises to help you become more aware of your own body and your surroundings. Research has shown that mindfulness-based approaches can help to reduce the symptoms of schizophrenia.

Movement and exercise-based approaches such as physical therapy, endurance sports, strength training or swimming can also be helpful. The most suitable options for you will depend on your personal preferences and physical abilities.

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.