Psychosocial Treatments for the Management of Schizophrenia

Transcript: Dawn Velligan, PhD: Psychosocial treatments for schizophrenia are important. There are a number of treatments we use all the time for schizophrenia. The first one we developed at San Antonio [at the University of Texas Health Science Center] called cognitive adaptation training. This helps bypass the cognitive impairments that are often present in schizophrenia. We go into the home, and we help people set up their medication, and reminders to take their medication, like a voice alarm that says, “I want to take my medication because I want to get a girlfriend, or I want to apply for jobs.”

When they're recovering, we tie their goals to taking medication. We set up reminders, signs, and checklists for many activities. When they're taking showers, dressing better, and becoming more social they will receive a better reaction from others. Then they start to have a secondary gain. This intervention is important. Another one is cognitive behavioral therapy [CBT] for psychosis.

We work with people to look at the evidence. What is the evidence that when people cough or sniffle that they're having some kind of communication that only they understand? What are all the reasons that people might cough, sneeze, or sniffle? They can respond that maybe they smoke cigarettes, or they have allergies. And suddenly, there are more reasons. They're broadening their frame of reference, and it's not just a secret communication that people are having. Cognitive behavior therapy can be effective, and you can do behavioral experiments where you go to the community with someone who's afraid to take the bus because people are going to hurt them on the bus. When they ride the bus they look down, and they don't see anybody because they're afraid. You would then encourage them to look up and look around. Some people on the bus are scary. But there are many people on the bus who are smiling, or children playing their video games, who have no clue that you're even there. Maybe those people don't want to kill you. Now, only half the people on the bus want to kill you. This helps to chip away at delusional thoughts. Also, CBT is good for helping people to deal with persistent hallucinations. They use techniques to help cope with hallucinations, either by distracting themselves or by focusing on the hallucinations to control them. Can I make them louder or softer? Whatever works to help them gain a sense of mastery.

I would never recommend psychosocial treatment in the absence of pharmacotherapy for psychosis. The medication forms the foundation for recovery, and you need to have that in place so that people are stable enough to build on that. It's difficult to do cognitive behavioral therapy for psychosis with someone who is so psychotic that you can't even get them to calm down and focus. It's very important to have the medication on board to give people space and room to be able to think about things in a different way.

Transcript Edited for Clarity