Drugs are the mainstay of treatment for schizophrenia but they are usually combined with some form of talking therapy. Research into non-drug interventions shows promising results for cognitive behavioural therapy (CBT), as well as support and education for patients and families, but little or no benefit from other interventions.
Cognitive behavioural therapy
CBT is offered by clinical psychologists for many mental health problems, but is not widely available for schizophrenia. It works by encouraging the patient to challenge patterns of negative thinking, which lead to distress, and to develop ways of thinking more positively. A review analysing trials of CBT for schizophrenia found that 20% fewer people relapse within 18 months when CBT is added to standard care, it improves symptoms such as hallucinations, and is well liked by patients.
This fairly experimental therapy uses tests to help people improve memory, attention and other aspects of thinking. Only small studies have been carried out, showing no clinical benefit.
Most psychiatrists argue that psychoanalysis is unhelpful for schizophrenia. Some small, fairly old, studies of this approach show that psychoanalysis leads to people actually spending longer in hospital than medication and is even worse than doing nothing.
Using tokens as rewards to attempt to change people's behaviour is another fairly old approach, although still used on some psychiatric wards. Limited research shows it can improve symptoms such as poor concentration, which even drugs rarely help.
Education and support
Various forms of support are usually offered to people suffering from schizophrenia and their families. Large studies show that providing support, information and coping strategies for individual patients reduces their risk of relapse. Providing families with similar support also reduces relapse rates.
There has been no useful research so far on the benefits of teaching life skills, to promote independent living, to people suffering schizophrenia. Teaching social skills has no convincing benefit, small studies show.
What works? is based on reviews of the most up-to-date and reliable evidence available. It is written in collaboration with the NHS Centre for Reviews and Dissemination at York University (01904 433 634) and verified by experts.